死产：2000 - 2020年13个国家全国记录中1.254亿例总出生数的早产和小于胎龄儿的贡献

Stillbirths: Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020.

作者信息

Okwaraji Yemisrach B, Suárez-Idueta Lorena, Ohuma Eric O, Bradley Ellen, Yargawa Judith, Pingray Veronica, Cormick Gabriela, Gordon Adrienne, Flenady Vicki, Horváth-Puhó Erzsébet, Sørensen Henrik Toft, Sakkeus Luule, Abuladze Liili, Heidarzadeh Mohammed, Khalili Narjes, Yunis Khalid A, Al Bizri Ayah, Karalasingam Shamala D, Jeganathan Ravichandran, Barranco Arturo, van Dijk Aimée E, Broeders Lisa, Alyafei Fawzya, AlQubaisi Mai, Razaz Neda, Söderling Jonas, Smith Lucy K, Matthews Ruth J, Wood Rachael, Monteath Kirsten, Pereyra Isabel, Pravia Gabriella, Lisonkova Sarka, Wen Qi, Lawn Joy E, Blencowe Hannah

机构信息

Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.

Mexican Society of Public Health, Mexico City, Mexico.

出版信息

BJOG. 2023 Nov 29. doi: 10.1111/1471-0528.17653.

DOI:10.1111/1471-0528.17653

PMID:38018284

Abstract

OBJECTIVE

To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six 'newborn types'.

DESIGN

Population-based multi-country analyses.

SETTING

Births collected through routine data systems in 13 countries.

SAMPLE

125 419 255 total births from 22 to 44 weeks' gestation identified from 2000 to 2020.

METHODS

We included 635 107 stillbirths from 22 weeks' gestation from 13 countries. We classified all births, including stillbirths, into six 'newborn types' based on gestational age information (preterm, PT, <37 weeks versus term, T, ≥37 weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards.

MAIN OUTCOME MEASURES

Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types.

RESULTS

635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22 weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8-118.8) followed by PT + AGA (RR 25.0, IQR, 20.0-34.3), PT + LGA (RR 25.9, IQR, 13.8-28.7) and T + SGA (RR 5.6, IQR, 5.1-6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7-1.1). At the population level, 25% of stillbirths were attributable to small-for-gestational-age.

CONCLUSIONS

In these high-quality data from high/middle income countries, almost three-quarters of stillbirths were born preterm and a fifth small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, as well as patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA.

摘要

目的

使用六种“新生儿类型”来研究早产和小于胎龄儿在死产中的作用。

设计

基于人群的多国分析。

背景

通过13个国家的常规数据系统收集的出生数据。

样本

2000年至2020年期间确定的妊娠22至44周的125419255例总出生数。

方法

我们纳入了13个国家妊娠22周及以上的635107例死产。根据胎龄信息（早产，PT，<37周与足月，T，≥37周）以及根据国际胎儿生长发育标准中胎儿出生体重与胎龄的关系，将所有出生（包括死产）分为六种“新生儿类型”，即小于胎龄儿（SGA，<第10百分位数）、适于胎龄儿（AGA，第10 - 90百分位数）或大于胎龄儿（LGA，>第90百分位数）。

主要观察指标

根据六种新生儿类型划分的死产分布、死产率和率比。

结果

在125419255例总出生数中，635107例（0.5%）在妊娠22周后导致死产。大多数死产（74.3%）为早产。约21.2%为小于胎龄儿类型（早产 + 小于胎龄儿[16.2%]，早产 + 适于胎龄儿[48.3%]，足月 + 小于胎龄儿[5.0%]），14.1%为大于胎龄儿类型（早产 + 大于胎龄儿[9.9%]，足月 + 大于胎龄儿[4.2%]）。与足月 + 适于胎龄儿相比，早产 + 小于胎龄儿的死产率比中位数（RR）最高（RR 81.1，四分位数间距[IQR]，68.8 - 118.8），其次是早产 + 适于胎龄儿（RR 25.0，IQR，20.0 - 34.3）、早产 + 大于胎龄儿（RR 25.9，IQR，13.8 - 28.7）和足月 + 小于胎龄儿（RR 5.6，IQR，5.1 - 6.0）。足月 + 大于胎龄儿与足月 + 适于胎龄儿的死产率比相似（RR 0.7，IQR，0.7 - 1.1）。在人群层面，25%的死产可归因于小于胎龄儿。