Incidence of stillbirth: effect of deprivation

Journal article


Arechvo, A, Nikolaidi, D A, Gil, M., Rolle, V, Syngelaki, A, Akolekar, R. and Nicolaides, K H 2022. Incidence of stillbirth: effect of deprivation. Ultrasound in Obstetrics & Gynecology. 61 (2), pp. 198-206. https://doi.org/10.1002/uog.26096
AuthorsArechvo, A, Nikolaidi, D A, Gil, M., Rolle, V, Syngelaki, A, Akolekar, R. and Nicolaides, K H
AbstractWe aimed to examine the relationship between the English Index of Multiple Deprivation (IMD) and the incidence of stillbirth and to assess whether IMD contributes to the prediction of stillbirth over and above what is provided by the combination of maternal demographic characteristics and elements of medical history. This was a prospective, observational study of 159125 women with singleton pregnancies who attended their first routine hospital visit at 11+0 to 13+6 weeks' gestation, in two maternity hospitals in the UK. The inclusion criteria were delivery at ≥24 weeks' gestation of babies without major abnormalities. Participants completed a questionnaire on demographic characteristics and obstetric and medical history. We used IMD as a measure of socioeconomic status; this creates a score by taking into account income, employment, education skills and training, health and disability, crime, barriers to housing and services, and living environment. Each neighborhood is then ranked according to their level of deprivation relative to that of other areas into one of five equal groups; quintile 1 contains those areas that are in the 20% most deprived and quintile 5 contains those areas that are in the 20% least deprived. Logistic regression analysis was used to determine whether IMD provided significant independent contribution to stillbirth after adjustment for known maternal risk factors. The overall incidence of stillbirth was 0.35% (551/159125) and this was significantly higher in the most than the least deprived group (quintile 1 vs. quintile 5); the odds ratio (OR) in quintile 1 was 1.57 (95% CI 1.16 - 2.14) for all stillbirths, 1.64 (1.20 - 2.28) for antenatal stillbirths and 1.89 (1.23 - 2.98) for placental dysfunction-related stillbirths. In quintile 1 (vs. quintile 5) there was a higher incidence of factors that contribute to stillbirth, including Black race, increased body mass index, smoking, chronic hypertension and previous stillbirth. The OR of Black (vs. White) race was 2.58 (95% CI 2.14 - 3.10) for all stillbirths, 2.62 (2.16 - 3.17) for antenatal stillbirth and 3.34 (2.59 - 4.28) for placental dysfunction-related stillbirth. Multivariate analysis found that IMD did not provide a significant contribution to the prediction of stillbirth provided by maternal race and other maternal risk factors. In contrast, in Black (vs. White) women, the risk of all and antenatal stillbirth, after adjustment for other maternal risk factors, was 2.4-fold higher and the risk of placental dysfunction-related stillbirth was 2.9-fold higher. The incidence of stillbirth, particularly placental dysfunction-related stillbirth, is higher in women living in the most deprived areas in England. However, in screening for stillbirth, inclusion of IMD does not improve the prediction provided by race and other maternal characteristics and elements of medical history. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.]
KeywordsPregnancy complications; Stillbirth; Screening; Singleton pregnancies; Deprivation; Socioeconomic status; Race
Year2022
JournalUltrasound in Obstetrics & Gynecology
Journal citation61 (2), pp. 198-206
PublisherWiley
ISSN1469-0705
Digital Object Identifier (DOI)https://doi.org/10.1002/uog.26096
Official URLhttps://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.26096
Publication dates
Online23 Oct 2022
Publication process dates
Accepted05 Oct 2022
Deposited27 Sep 2024
Output statusPublished
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https://repository.canterbury.ac.uk/item/960y6/incidence-of-stillbirth-effect-of-deprivation

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Akolekar, R., Panaitescu, A. M., Ciobanu, A., Syngelaki, A. and Nicolaides, K. H. 2019. Two-stage approach for prediction of small-for-gestational-age neonate and adverse perinatal outcome by routine ultrasound examination at 35-37 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 54, pp. 484-491. https://doi.org/10.1002/uog.20391
Prevention of stillbirths: impact of a two-stage screening for vasa previa
Zhang, W., Geris, S., Beta, J., Ramadan, G., Nicolaides, K. H. and Akolekar, R. 2019. Prevention of stillbirths: impact of a two-stage screening for vasa previa. Ultrasound in Obstetrics and Gynecology. 55 (5), pp. 605-612. https://doi.org/10.1002/uog.21953
Impact of prospective measurement of outflow tracts in the prediction of coarctation of the aorta
Vigneswaran, T. V., Zidere, V., Chivers, S., Charakida, M., Akolekar, R. and Simpson, J. M. 2019. Impact of prospective measurement of outflow tracts in the prediction of coarctation of the aorta. Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.21957
Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with high nuchal translucency, tricuspid regurgitation and abnormal flow in the ductus venosus
Minnella, G. P., Crupano, F. M., Syngelaki, A., Zidere, V., Akolekar, R. and Nicolaides, K. H. 2019. Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with high nuchal translucency, tricuspid regurgitation and abnormal flow in the ductus venosus. Ultrasound in Obstetrics and Gynecology. 55 (5), pp. 637-644. https://doi.org/10.1002/uog.21956
Screening for pre-eclampsia using sFlt-1/PlGF ratio cut-off of 38 at 30-37 weeks' gestation
Dragan, I., Georgiou, T., Prodan, N., Akolekar, R. and Nicolaides, K. H. 2017. Screening for pre-eclampsia using sFlt-1/PlGF ratio cut-off of 38 at 30-37 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 49 (1), pp. 73-77. https://doi.org/10.1002/uog.17301
Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2016. Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (3), pp. 308-315. https://doi.org/10.1002/uog.14898
Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2016. Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (2), pp. 194-202. https://doi.org/10.1002/uog.14928
Screening for trisomies by cell-free DNA testing of maternal blood: consequences of a failed result
Revello, R., Sarno, L., Ispas, A., Akolekar, R. and Nicolaides, K. H. 2016. Screening for trisomies by cell-free DNA testing of maternal blood: consequences of a failed result. Ultrasound in Obstetrics and Gynecology. 47 (6), pp. 698-704. https://doi.org/10.1002/uog.15851
Metformin versus placebo in obese pregnant women without diabetes mellitus
Syngelaki, A., Nicolaides, K. H., Balani, J., Hyer, S., Akolekar, R., Kotecha, R., Pastides, A. and Shehata, H. 2016. Metformin versus placebo in obese pregnant women without diabetes mellitus. New England Journal of Medicine. 374, pp. 434-43. https://doi.org/10.1056/NEJMoa1509819
Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy
Sarno, L., Revello, R., Hanson, E., Akolekar, R. and Nicolaides, K. H. 2016. Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy. Ultrasound in Obstetrics and Gynecology. 47 (6), pp. 705-11. https://doi.org/10.1002/uog.15913
Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks
Mastrodima, S., Akolekar, R., Yerlikaya, G., Tzelepis, T. and Nicolaides, K. H. 2016. Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 613-617. https://doi.org/10.1002/uog.17289
Prediction of stillbirth from maternal demographic and pregnancy characteristics
Yerlikaya, G., Akolekar, R., McPherson, K., Syngelaki, A. and Nicolaides, K. H. 2016. Prediction of stillbirth from maternal demographic and pregnancy characteristics. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 607-612. https://doi.org/10.1002/uog.17290
Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies
Peeva, G., Chaveeva, P., Gil Guevara, E., Akolekar, R. and Nicolaides, K. H. 2016. Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies. Fetal Diagnosis and Therapy. 40 (3), pp. 174-180. https://doi.org/10.1159/000443792
Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks
Akolekar, R., Tokunaka, M., Ortega, N., Syngelaki, A. and Nicolaides, K. H. 2016. Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 624-630. https://doi.org/10.1002/uog.17295
Prediction of stillbirth from placental growth factor at 11-13 weeks
Akolekar, R., Machuca, M., Mendes, M., Paschos, V. and Nicolaides, K. H. 2016. Prediction of stillbirth from placental growth factor at 11-13 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 618-623. https://doi.org/10.1002/uog.17288
Prediction of stillbirth from placental growth factor at 19-24 weeks
Aupont J. E., Akolekar, R., Illian, A., Neonakis, S. and Nicolaides, K. H. 2016. Prediction of stillbirth from placental growth factor at 19-24 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 631-635. https://doi.org/10.1002/uog.17229
Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2015. Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (2), pp. 203-209. https://doi.org/10.1002/uog.15663