Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2012;7(7):e39050. doi: 10.1371/journal.pone.0039050. Epub 2012 Jul 13.
No studies have examined the effect of socioeconomic deprivation on antepartum and intrapartum stillbirths in the poorest women in low income countries.
METHODOLOGY/ PRINCIPAL FINDINGS: This study used data from a prospective population based surveillance system involving all women of childbearing age and their babies in rural Ghana. The primary objective was to evaluate associations between household wealth and risk of antepartum and intrapartum stillbirth. The secondary objective was to assess whether any differences in risk were mediated by utilisation of health services during pregnancy. Data were analysed using multivariable logistic regression. Random effect models adjusted for clustering of women who delivered more than one infant. There were 80267 babies delivered from 1 July 2003 to 30 September 2008: 77666 live births and 2601 stillbirths. Of the stillbirths 1367 (52.6%) were antepartum, 989 (38.0%) were intrapartum and 245 (9.4%) had no data on the timing of death. 94.8% of the babies born in the study (76129/80267) had complete data on all covariates and outcomes. 36 878 (48.4%) of babies were born to women in the two poorest quintiles and 3697 (4.9%) had no pregnancy care. There was no association between wealth and antepartum stillbirths. There was a marked 'dose response' of increasing risk of intrapartum stillbirth with increasing levels of socioeconomic deprivation (adjOR 1.09 [1.03-1.16] p value 0.002). Women in the poorest two quintiles had greater risk of intrapartum stillbirth (adjOR 1.19 [1.02-1.38] p value 0.023) compared to the richest women. Adjusting for heath service utilisation and other variables did not alter results.
CONCLUSIONS/ SIGNIFICANCE: Poor women had a high risk of intrapartum stillbirth and this risk was not influenced by health service utilisation. Health system strengthening is required to meet the needs of poor women in our study population.
尚无研究调查在低收入国家最贫困的妇女中，社会经济剥夺对产前和产时死胎的影响。
方法/主要发现：本研究使用了一项基于人群的前瞻性监测系统的数据，该系统涵盖了加纳农村所有育龄妇女及其婴儿。主要目标是评估家庭财富与产前和产时死胎风险之间的关联。次要目标是评估在怀孕期间利用卫生服务是否会改变任何风险差异。数据采用多变量逻辑回归进行分析。随机效应模型调整了每位产妇分娩多个婴儿的聚类。2003 年 7 月 1 日至 2008 年 9 月 30 日期间，共有 80267 名婴儿出生：活产 77666 例，死产 2601 例。2601 例死产中，1367 例（52.6%）为产前死胎，989 例（38.0%）为产时死胎，245 例（9.4%）无死亡时间数据。研究中出生的 80267 名婴儿中有 94.8%（76129/80267）有所有协变量和结局的完整数据。2 个最贫困五分位数的婴儿中有 36878 名（48.4%），而 3697 名（4.9%）没有妊娠护理。财富与产前死胎之间无关联。随着社会经济剥夺程度的增加，产时死胎的风险呈明显的“剂量反应”增加趋势（调整后的比值比 1.09 [1.03-1.16]，p 值<0.002）。与最富裕的妇女相比，最贫困的前两个五分位数的妇女发生产时死胎的风险更高（调整后的比值比 1.19 [1.02-1.38]，p 值=0.023）。调整卫生服务利用和其他变量后，结果未发生改变。
结论/意义：贫困妇女产时死胎的风险很高，而这种风险不受卫生服务利用的影响。需要加强卫生系统，以满足我们研究人群中贫困妇女的需求。
