Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Perinatol. 2024 May;41(S 01):e601-e611. doi: 10.1055/a-1925-2131. Epub 2022 Aug 16.
This study documents 2000 to 2017 trends in stillbirth rates and changes in associations between known maternal and fetal risk factors and stillbirths for 2000 to 2002 versus 2015 to 2017 in the United States.
We conducted a retrospective, population-based analysis of stillbirths and live-births using national vital statistics data. We calculated annual stillbirth rates overall and by gestational age; and examined stillbirth rates by maternal age, race-ethnicity, and state for 2000 to 2002 versus 2015 to 2017. We used Chi-squared tests to examine associations between maternal and fetal risk factors separately for early (20-27 weeks) and late (28+ weeks) stillbirths compared with live-births for 2000 to 2002 versus 2015 to 2017.
Stillbirth rates declined by 7.5% ( < 0.001) during 2000 to 2006 but remained flat at approximately 6 stillbirths per 1,000 births thereafter. Throughout 2000 to 2017, there were significant improvements in stillbirth rates at 39+ weeks nationally ( < 0.001), but rates varied greatly between and within states. Sociodemographic (advanced maternal age, Black race, low education, unmarried status, and rural residence), obstetric, and other medical factors (>3 births, use of infertility treatment, maternal obesity, diabetes, chronic hypertension, eclampsia, no prenatal care, and tobacco use) were significantly more prevalent in women with late than early stillbirths or live births. Notably, late and total stillbirth rates were approximately 30% higher for women >35 years than for women <35 years and twice as high for non-Hispanic Black than non-Hispanic White women; American Indian/Alaska Native women represented the only racial-ethnic group with significantly higher late stillbirth rates in 2015 to 2017 than in 2000 to 2002. Pregnancy and fetal factors (multiple pregnancy, male fetus, and breech presentation) were more prevalent in women with early than late stillbirths or live births.
U.S. stillbirth rates have plateaued since 2006. There are persistent differential risk profiles for early versus late stillbirths which can inform stillbirth prevention strategies (e.g., close observation of women with risk factors for stillbirth) and new research into the causes of stillbirths by gestational age.
· U.S. stillbirth rates have plateaued since 2006.. · Stillbirth rates vary between and within U.S. states and by maternal and fetal factors.. · Early versus late stillbirths have different risk profiles which can guide stillbirth prevention strategies..
本研究记录了 2000 年至 2017 年美国死产率的趋势，并比较了 2000 年至 2002 年与 2015 年至 2017 年之间，已知产妇和胎儿危险因素与死产之间的关联变化。
我们使用国家生命统计数据，对死产和活产进行了回顾性、基于人群的分析。我们计算了整体和按胎龄的年度死产率；并检查了 2000 年至 2002 年与 2015 年至 2017 年之间，产妇年龄、种族和州别与死产的关系。我们使用卡方检验分别检查了 2000 年至 2002 年与 2015 年至 2017 年之间，早期（20-27 周）和晚期（28+ 周）死产与活产相比，产妇和胎儿危险因素之间的关联。
2000 年至 2006 年期间，死产率下降了 7.5%（<0.001），此后基本保持在每 1000 例活产 6 例左右的水平。在 2000 年至 2017 年期间，全国 39+ 周的死产率显著改善（<0.001），但各州之间和各州内的差异很大。社会人口统计学（高龄产妇、黑人、教育程度低、未婚、农村居民）、产科和其他医学因素（>3 次分娩、使用不孕治疗、产妇肥胖、糖尿病、慢性高血压、子痫、无产前检查和吸烟）在晚期死产或活产妇女中更为常见。值得注意的是，35 岁以上的妇女晚期和总死产率比 35 岁以下的妇女高约 30%，非西班牙裔黑人比非西班牙裔白人高两倍；美国印第安人/阿拉斯加原住民妇女是唯一一个在 2015 年至 2017 年期间晚期死产率高于 2000 年至 2002 年的种族群体。妊娠和胎儿因素（多胎妊娠、男性胎儿和臀位分娩）在早期死产或活产妇女中更为常见。
自 2006 年以来，美国的死产率已经趋于平稳。早期和晚期死产的风险特征仍然存在差异，这可以为死产预防策略提供信息（例如，密切观察有死产风险的妇女），并为按胎龄的死产原因的新研究提供信息。
· 自 2006 年以来，美国的死产率一直保持平稳。..· 死产率在美国各州之间以及产妇和胎儿因素之间存在差异，并按胎龄有所不同。..· 早期和晚期死产的风险特征不同，这可以指导死产预防策略。..
