Winsloe Chivon, Elhindi James, Vieira Matias C, Relph Sophie, Arcus Charles G, Alagna Alessandro, Briley Annette, Johnson Mark, Page Louise M, Shennan Andrew, Thilaganathan Baskaran, Marlow Neil, Lees Christoph, Lawlor Deborah A, Khalil Asma, Sandall Jane, Copas Andrew, Pasupathy Dharmintra
Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Centre for Pragmatic Global Health Trials, Institute for Global Health, University College London, London, UK.
BJOG. 2025 Jan;132(1):89-98. doi: 10.1111/1471-0528.17951. Epub 2024 Sep 18.
To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth.
Secondary cohort analysis of the DESiGN RCT.
Thirteen UK maternity units.
Singleton pregnant women and their babies.
Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods.
Stillbirth stratified by preterm (<37 weeks') and term (37-42 weeks') births.
A total of 195 344 pregnancies were included. Six hundred and sixty-seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP-A, gestational hypertension, pre-eclampsia and gestational diabetes but not for chronic hypertension and pre-existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5-24.9 kg/m (BMI 30.0-34.9 kg/m term adjusted OR 2.1 [95% CI 1.4-3.0] vs. preterm aOR 1.1 [0.8-1.7]; BMI ≥ 35.0 kg/m term aOR 2.2 [1.4-3.4] vs. preterm aOR 1.5 [1.2-1.8]; p-interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1-2.7] vs. preterm aOR 1.2 [0.9-1.6]; p-interaction < 0.01) and Asian ethnicity compared with White (p-interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre-eclampsia.
Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to further mitigate the risk of stillbirth.
确定早产死产和足月死产中与死产相关的孕产妇及妊娠特征是否存在差异。
对DESiGN随机对照试验进行二次队列分析。
英国13个产科单位。
单胎孕妇及其婴儿。
采用多因素逻辑回归分析来评估所探讨的12个因素是否与死产相关。交互作用检验评估早产和足月期间这些关联的差异。
按早产（<37周）和足月（37 - 42周）分娩分层的死产情况。
共纳入195344例妊娠。667例为死产（每1000例分娩中有3.4例），其中431例（65%）为早产。在孕产妇年龄、种族、多重剥夺指数、体重指数、产次、吸烟、妊娠相关血浆蛋白A、妊娠期高血压、子痫前期和妊娠期糖尿病方面观察到显著的交互作用，但慢性高血压和孕前糖尿病未观察到交互作用。与体重指数为18.5 - 24.9kg/m²的女性相比，肥胖女性与足月死产的关联更强（体重指数为30.0 - 34.9kg/m²时，足月校正比值比为2.1[95%可信区间1.4 - 3.0]，早产调整比值比为1.1[0.8 - 1.7]；体重指数≥35.0kg/m²时，足月校正比值比为2.2[1.4 - 3.4]，早产调整比值比为1.5[1.2 - 1.8]；交互作用P<0.01），与产次为1次相比，初产妇与足月死产的关联更强（足月比值比为1.7[1.1 - 2.7]，早产比值比为1.2[0.9 - 1.6]；交互作用P<0.01），与白人相比，亚洲种族与足月死产的关联更强（交互作用P<0.01）。与早产相比，年龄较大的孕产妇、吸烟和子痫前期与足月死产的关联较弱或不存在关联。
早产死产和足月死产的母亲之间存在关联差异。这些差异有助于设计及时的监测和干预措施，以进一步降低死产风险。
