Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation
Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation
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DOI：
10.1001/jama.2011.1798
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发表时间：
2011-12-14
影响因子：
120.7
通讯作者：
Willinger, Marian
中科院分区：
文献类型：
--
作者：
Bukowski, Radek;Carpenter, Marshall;Willinger, Marian
死产几乎占美国从妊娠20周到1岁的死亡人数的一半。大多数大型研究死产的危险因素使用有限的data.Objective的生命统计数据，以确定死产和危险因素，可以确定在怀孕的开始，特别是这些因素的贡献，以种族dispartial.Design，设置和参与者之间的关系多站点人口为基础的病例对照研究进行了2006年3月和2008年9月。59家美国三级护理和社区医院，在州和县界线定义的5个集水区内至少有90%的分娩，招募了1个或多个死胎分娩的居民和仅活产婴儿分娩的代表性样本，超过结果分析包括614例妊娠期小于32周的孕妇和非洲裔孕妇，1816次控制交付。在多变量分析中，以下因素与死产独立相关：非西班牙裔黑人种族/民族（23.1%死产，11.2%活产）（vs非西班牙裔白人;校正比值比[AOR]，2.12 [95% CI，1.41-3.20]）;既往死胎（死产6.7%，活产1.4%）;（10.5%死产，5.2%活产）和无（34.0%死产，29.7%活产）妊娠不到20周时流产（与无死产或既往流产的多产相比; AOR分别为5.91 [95% CI，3.18-11.00]; AOR为3.13 [95% CI，2.06-4.75]; AOR为1.98 [95% CI，1.51-2.60]）;糖尿病（5.6%死产，1.6%活产）（vs无糖尿病; AOR，2.50 [95% CI，1.39-4.48]）;母亲年龄≥ 40岁（死产4.5%，活产2.1%）（与年龄20-34岁; AOR，2.41 [95% CI，1.24-4.70]）;母亲AB血型（死产4.9%，活产3.0%）（vs O型; AOR，1.96 [95% CI，1.16-3.30]）;药物成瘾史（4.5%死产，2.1%活产）（vs从未使用; AOR，2.08 [95% CI，1.12-3.88]）;妊娠前3个月内吸烟（
Context Stillbirths account for almost half of US deaths from 20 weeks' gestation to 1 year of life. Most large studies of risk factors for stillbirth use vital statistics with limited data.Objective To determine the relation between stillbirths and risk factors that could be ascertained at the start of pregnancy, particularly the contribution of these factors to racial disparities.Design, Setting, and Participants Multisite population-based case-control study conducted between March 2006 and September 2008. Fifty-nine US tertiary care and community hospitals, with access to at least 90% of deliveries within 5 catchment areas defined by state and county lines, enrolled residents with deliveries of 1 or more stillborn fetuses and a representative sample of deliveries of only live-born infants, over-sampled for those at less than 32 weeks' gestation and those of African descent.Main Outcome Measure Stillbirth.Results Analysis included 614 case and 1816 control deliveries. In multivariate analyses, the following factors were independently associated with stillbirth: non-Hispanic black race/ethnicity (23.1% stillbirths, 11.2% live births) (vs non-Hispanic whites; adjusted odds ratio [AOR], 2.12 [95% CI, 1.41-3.20]); previous stillbirth (6.7% stillbirths, 1.4% live births); nulliparity with (10.5% stillbirths, 5.2% live births) and without (34.0% stillbirths, 29.7% live births) previous losses at fewer than 20 weeks' gestation (vs multiparity without stillbirth or previous losses; AOR, 5.91 [95% CI, 3.18-11.00]; AOR, 3.13 [95% CI, 2.06-4.75]; and AOR, 1.98 [95% CI, 1.51-2.60], respectively); diabetes (5.6% stillbirths, 1.6% live births) (vs no diabetes; AOR, 2.50 [95% CI, 1.39-4.48]); maternal age 40 years or older (4.5% stillbirths, 2.1% live births) (vs age 20-34 years; AOR, 2.41 [95% CI, 1.24-4.70]); maternal AB blood type (4.9% stillbirths, 3.0% live births) (vs type O; AOR, 1.96 [95% CI, 1.16-3.30]); history of drug addiction (4.5% stillbirths, 2.1% live births) (vs never use; AOR, 2.08 [95% CI, 1.12-3.88]); smoking during the 3 months prior to pregnancy (