Nunn Sophie Kc, Farrell Tanya, Chamberlain Catherine, Zakazakaarcher Tracey, Wallace Euan M, Davies-Tuck Miranda L, Davey Mary-Ann
Monash University, School of Clinical Sciences, Department of Obstetrics and Gynaecology, 246 Clayton Rd, Clayton 3168, Australia; Department of Health Victoria, 50 Lonsdale St, Melbourne 3000, Australia.
Joan Kirner Women's and Children's Hospital, 176 Furlong Rd, St Albans 3041, Australia.
Midwifery. 2025 Oct;149:104543. doi: 10.1016/j.midw.2025.104543. Epub 2025 Jul 26.
PROBLEM/BACKGROUND: The long-standing disproportionate risk of perinatal death for babies born to Aboriginal and/or Torres Strait Islander women reduced in Victoria, Australia from 2008-2016. Identifying the contributing factors to this improvement is crucial to ensuring implementation of effective strategies to continue closing this gap.
To explore whether changes in key characteristics among Victorian Aboriginal and/or Torres Strait Islander women contributed to reduced perinatal death rates.
Retrospective population-based cohort study of all births in Victoria from 2000-2019. We calculated relative risk ratios with 95% confidence intervals to determine relationships between maternal characteristics and perinatal death. We performed univariate and multivariate logistic regression to obtain unadjusted and adjusted odds ratios for perinatal death based on maternal Aboriginal and/or Torres Strait Islander status.
Between 2000-2019 the number of births to Aboriginal and/or Torres Strait Islander women increased and perinatal death rates decreased from 19.7/1000 births to 10.6 /1000 births. Some risk factors for perinatal death, including age younger than 20 years and rural residence, decreased in Aboriginal and/or Torres Strait Islander women between 2000 and 2019, from 19.4% to 8.1% and 67.5% to 55.3% respectively (both p-trend<0.001). Other risk factors for perinatal death stagnated or increased including Body Mass Index ≥35, maternal smoking and low socio-economic status.
Changes in key maternal characteristics may have contributed to improved perinatal death rates among babies of Victorian Aboriginal and/or Torres Strait Islander women. However, these are unlikely to fully explain observed improvements and several stagnant/increasing risk factors may have hindered further improvements.
问题/背景：2008年至2016年期间，澳大利亚维多利亚州原住民和/或托雷斯海峡岛民妇女所生婴儿的围产期死亡风险长期存在的不均衡现象有所降低。确定促成这一改善的因素对于确保实施有效策略以持续缩小这一差距至关重要。
探讨维多利亚州原住民和/或托雷斯海峡岛民妇女关键特征的变化是否有助于降低围产期死亡率。
对2000年至2019年维多利亚州所有出生情况进行基于人群的回顾性队列研究。我们计算了95%置信区间的相对风险比，以确定孕产妇特征与围产期死亡之间的关系。我们进行了单变量和多变量逻辑回归，以获得基于孕产妇原住民和/或托雷斯海峡岛民身份的围产期死亡的未调整和调整后的比值比。
2000年至2019年期间，原住民和/或托雷斯海峡岛民妇女的出生人数增加，围产期死亡率从每1000例出生19.7例降至每1000例出生10.6例。2000年至2019年期间，原住民和/或托雷斯海峡岛民妇女中一些围产期死亡的风险因素有所下降，包括年龄小于20岁和居住在农村地区，分别从19.4%降至8.1%，从67.5%降至55.3%（两者p趋势<0.001）。其他围产期死亡风险因素停滞或增加，包括体重指数≥35、孕产妇吸烟和社会经济地位低下。
孕产妇关键特征的变化可能有助于改善维多利亚州原住民和/或托雷斯海峡岛民妇女所生婴儿的围产期死亡率。然而，这些变化不太可能完全解释所观察到的改善情况，一些停滞/增加的风险因素可能阻碍了进一步的改善。
