Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014–15
Abstract In the United States the rate of stillbirth after 28 weeks’ gestation (late stillbirth) is 2.7/1000 births. Fetuses that are small for gestational age (SGA) or large for gestational age (LGA) are at increased risk of stillbirth. SGA and LGA are often categorized as growth or birthweight ≤ 1...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2024-03-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-024-56572-7 |
| _version_ | 1797259287875026944 |
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| author | Darren Tanner Juan M. Lavista Ferres Edwin A. Mitchell |
| author_facet | Darren Tanner Juan M. Lavista Ferres Edwin A. Mitchell |
| author_sort | Darren Tanner |
| collection | DOAJ |
| description | Abstract In the United States the rate of stillbirth after 28 weeks’ gestation (late stillbirth) is 2.7/1000 births. Fetuses that are small for gestational age (SGA) or large for gestational age (LGA) are at increased risk of stillbirth. SGA and LGA are often categorized as growth or birthweight ≤ 10th and ≥ 90th centile, respectively; however, these cut-offs are arbitrary. We sought to characterize the relationship between birthweight and stillbirth risk in greater detail. Data on singleton births between 28- and 44-weeks’ gestation from 2014 to 2015 were extracted from the US Centers for Disease Control and Prevention live birth and fetal death files. Growth was assessed using customized birthweight centiles (Gestation Related Optimal Weight; GROW). The analyses included logistic regression using SGA/LGA categories and a generalized additive model (GAM) using birthweight centile as a continuous exposure. Although the SGA and LGA categories identified infants at risk of stillbirth, categorical models provided poor fits to the data within the high-risk bins, and in particular markedly underestimated the risk for the extreme centiles. For example, for fetuses in the lowest GROW centile, the observed rate was 39.8/1000 births compared with a predicted rate of 11.7/1000 from the category-based analysis. In contrast, the model-predicted risk from the GAM tracked closely with the observed risk, with the GAM providing an accurate characterization of stillbirth risk across the entire birthweight continuum. This study provides stillbirth risk estimates for each GROW centile, which clinicians can use in conjunction with other clinical details to guide obstetric management. |
| first_indexed | 2024-04-24T23:07:02Z |
| format | Article |
| id | doaj.art-7845ad8a6e3c4fccad9065a7d70411e9 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-24T23:07:02Z |
| publishDate | 2024-03-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-7845ad8a6e3c4fccad9065a7d70411e92024-03-17T12:25:10ZengNature PortfolioScientific Reports2045-23222024-03-0114111110.1038/s41598-024-56572-7Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014–15Darren Tanner0Juan M. Lavista Ferres1Edwin A. Mitchell2AI for Health, AI for Good Research Lab, Microsoft CorporationAI for Health, AI for Good Research Lab, Microsoft CorporationDepartment of Paediatrics: Child and Youth Health, The University of AucklandAbstract In the United States the rate of stillbirth after 28 weeks’ gestation (late stillbirth) is 2.7/1000 births. Fetuses that are small for gestational age (SGA) or large for gestational age (LGA) are at increased risk of stillbirth. SGA and LGA are often categorized as growth or birthweight ≤ 10th and ≥ 90th centile, respectively; however, these cut-offs are arbitrary. We sought to characterize the relationship between birthweight and stillbirth risk in greater detail. Data on singleton births between 28- and 44-weeks’ gestation from 2014 to 2015 were extracted from the US Centers for Disease Control and Prevention live birth and fetal death files. Growth was assessed using customized birthweight centiles (Gestation Related Optimal Weight; GROW). The analyses included logistic regression using SGA/LGA categories and a generalized additive model (GAM) using birthweight centile as a continuous exposure. Although the SGA and LGA categories identified infants at risk of stillbirth, categorical models provided poor fits to the data within the high-risk bins, and in particular markedly underestimated the risk for the extreme centiles. For example, for fetuses in the lowest GROW centile, the observed rate was 39.8/1000 births compared with a predicted rate of 11.7/1000 from the category-based analysis. In contrast, the model-predicted risk from the GAM tracked closely with the observed risk, with the GAM providing an accurate characterization of stillbirth risk across the entire birthweight continuum. This study provides stillbirth risk estimates for each GROW centile, which clinicians can use in conjunction with other clinical details to guide obstetric management.https://doi.org/10.1038/s41598-024-56572-7 |
| spellingShingle | Darren Tanner Juan M. Lavista Ferres Edwin A. Mitchell Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014–15 Scientific Reports |
| title | Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014–15 |
| title_full | Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014–15 |
| title_fullStr | Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014–15 |
| title_full_unstemmed | Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014–15 |
| title_short | Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014–15 |
| title_sort | improved estimation of the relationship between fetal growth and late stillbirth in the united states 2014 15 |
| url | https://doi.org/10.1038/s41598-024-56572-7 |
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