The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
BMC Pregnancy Childbirth. 2022 Jun 28;22(1):524. doi: 10.1186/s12884-022-04819-4.
Despite significant government investments to improve birth outcomes in low and middle-income countries over the past several decades, stillbirth and neonatal mortality continue to be persistent public health problems. While they are different outcomes, there is little evidence regarding their shared and unique population-level risk factors over a mother's reproductive lifespan. Data gaps and measurement challenges have left several areas in this field unexplored, especially assessing the risk of stillbirth or neonatal mortality over successive pregnancies to the same woman. This study aimed to assess the risk of stillbirth and neonatal mortality in Indonesia during 2000-2014, using maternal birth histories from the Indonesia Family Life Survey panel data.
Data from three panels were combined to create right-censored birth histories. There were 5,002 unique multiparous mothers with at least two singleton births in the sample. They reported 12,761 total births and 12,507 live births. Random effects (RE) models, which address the dependency of variance in births to the same mother, were fitted assuming births to the same mother shared unobserved risk factors unique to the mother.
The main finding was that there having had a stillbirth increased the odds of another stillbirth nearly seven-fold and that of subsequent neonatal mortality by over two-fold. Having had a neonatal death was not associated with a future neonatal death. Mothers who were not educated and nullipara were much more likely to experience a neonatal death while mothers who had a prior neonatal death had no risk of another neonatal death due to unmeasured factors unique to the mother.
The results suggest that for stillbirths, maternal heterogeneity, as explained by a prior stillbirth, could capture underlying pathology while the relationship between observed risk factors and neonatal mortality could be much more dependent on context. Establishing previous adverse outcomes such as neonatal deaths and stillbirth could help identify high-risk pregnancies during prenatal care, inform interventions, and improve health policy.
尽管过去几十年，中低收入国家的政府投入了大量资金来改善生育结果，但死产和新生儿死亡仍然是持续存在的公共卫生问题。尽管它们是不同的结果，但关于产妇生殖寿命内它们的共同和独特的人群水平风险因素的证据很少。数据差距和衡量挑战使得该领域的几个方面未得到探索，特别是评估同一妇女连续妊娠的死产或新生儿死亡风险。本研究旨在评估 2000-2014 年印度尼西亚的死产和新生儿死亡风险，使用印度尼西亚家庭生活调查小组数据中的产妇生育史。
将三个小组的数据合并以创建右删失的生育史。在样本中，有 5002 名独特的多产妇，至少有两次单胎分娩。他们报告了 12761 次总分娩和 12507 次活产。假设同一母亲的分娩具有母亲特有的未观察到的风险因素，随机效应 (RE) 模型被拟合以解决同一母亲的分娩之间的方差依赖性。
主要发现是，死产增加了再次死产的几率近七倍，而随后的新生儿死亡几率增加了两倍多。新生儿死亡与未来的新生儿死亡无关。未受过教育和初产妇的母亲更有可能经历新生儿死亡，而由于母亲特有的未测量因素，先前有新生儿死亡的母亲没有再次发生新生儿死亡的风险。
结果表明，对于死产，由先前的死产解释的产妇异质性可以捕捉潜在的病理，而观察到的风险因素与新生儿死亡之间的关系可能更多地取决于背景。确定先前的不良结果（如新生儿死亡和死产）可以帮助在产前护理期间识别高危妊娠，为干预措施提供信息，并改善卫生政策。
