Davies-Tuck Miranda L, Davey Mary-Ann, Wallace Euan M
The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia.
Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia.
PLoS One. 2017 Jun 6;12(6):e0178727. doi: 10.1371/journal.pone.0178727. eCollection 2017.
There is growing evidence from high-income countries that maternal country of birth is a risk factor for stillbirth. We aimed to examine the association between maternal region of birth and stillbirth between 2000 and 2011 inclusive in Victoria, Australia.
Retrospective population based cohort study of all singleton births at 24 or more weeks gestational age from 2000-2011 in Victoria, Australia. Stillbirths due to termination of pregnancy, babies with congenital anomalies and Indigenous mothers were excluded. Main Outcome Measure: Stillbirth.
Over the 12-year period there were 685,869 singleton births and 2299 stillbirths, giving an overall stillbirth rate of 3·4 per 1000 births. After adjustment for risk factors, compared to women born in Australia/New Zealand, women born in South Asia (aOR 1.27, 95% CI 1.01-1.53, p = 0.01), were more likely to have a stillbirth whereas women born in South East and East Asia were (aOR 0.60, (95% CI 0.49-0.72, p<0.001) less likely to have a stillbirth. Additionally, the increasing rate of stillbirth as gestation length progressed began to rise earlier and more steeply in the South Asian compared to Australian/New Zealand born women. The following risk factors were also significantly associated with an increased odds of stillbirth in multivariate analyses: maternal age <20 and 35 years and more, nulliparity, low socio-economic status, previous stillbirth, no ultrasound reported in 1st trimester, pre-existing hypertension, antepartum haemorrhage and failure to detect growth restriction antenatally.
Maternal region of birth is an independent risk factor for stillbirth. Improvements in the rate of stillbirth, particularly late pregnancy stillbirth, are likely to be gained in high-income settings where clinical care is informed by maternal region of birth.
来自高收入国家的证据越来越多，表明产妇的出生国是死产的一个风险因素。我们旨在研究2000年至2011年（含）期间澳大利亚维多利亚州产妇的出生地区与死产之间的关联。
对澳大利亚维多利亚州2000年至2011年所有孕龄24周及以上的单胎分娩进行基于人群的回顾性队列研究。因终止妊娠导致的死产、患有先天性异常的婴儿和土著母亲被排除在外。主要观察指标：死产。
在这12年期间，有685,869例单胎分娩和2299例死产，总体死产率为每1000例分娩中有3.4例。在对风险因素进行调整后，与在澳大利亚/新西兰出生的女性相比，在南亚出生的女性（调整后比值比1.27，95%置信区间1.01-1.53，p = 0.01）死产的可能性更高，而在东南亚和东亚出生的女性（调整后比值比0.60，95%置信区间0.49-0.72，p<0.001）死产的可能性较低。此外，与在澳大利亚/新西兰出生的女性相比，随着妊娠周数增加，南亚出生的女性死产率上升开始得更早且更陡峭。在多变量分析中，以下风险因素也与死产几率增加显著相关：产妇年龄<20岁和35岁及以上、未生育、社会经济地位低、既往死产史、孕早期未报告超声检查、孕前高血压、产前出血以及产前未检测到生长受限。
产妇的出生地区是死产的一个独立风险因素。在高收入环境中，如果临床护理考虑到产妇的出生地区，死产率，尤其是晚期妊娠死产率可能会得到改善。
