The epidemiology of stillbirth: The INTERGROWTH-21st Newborn Cross-Sectional Study
<p>Background. INTERGROWTH-21st is a prospective, multi-ethnic, population-based project exploring growth from early pregnancy to two years of age. The Newborn Cross- Sectional Study (NCSS) component of INTERGROWTH-21st was designed to evaluate the population characteristics and pregnancy outc...
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| Format: | Thesis |
| Language: | English |
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2013
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| _version_ | 1826257563163820032 |
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| author | Finkton, D |
| author2 | Villar, J |
| author_facet | Villar, J Finkton, D |
| author_sort | Finkton, D |
| collection | OXFORD |
| description | <p>Background. INTERGROWTH-21st is a prospective, multi-ethnic, population-based project exploring growth from early pregnancy to two years of age. The Newborn Cross- Sectional Study (NCSS) component of INTERGROWTH-21st was designed to evaluate the population characteristics and pregnancy outcomes for the 8 study sites included in the project. The INTERGROWTH-21st geographic areas were in: Pelotas, Brazil; Beijing, China; Nagpur, India; Torino, Italy; Nairobi, Kenya; Muscat, Oman; Oxford, United Kingdom; Seattle, United States.</p> <p>Methods. Using the data gathered from the NCSS until the time that I completed my course work in Oxford, I attempted to identify potential risk factors for stillbirth in the INTERGROWTH-21st population. Stillbirth is defined as all foetal deaths occurring after at least 18 weeks gestation in order to capture stillbirths using the most inclusive definition. I also created the Foetal Death Supplementary Form to collect information on the causes of stillbirth that were not included in the original instrument according to Goldenberg et al.</p> <p>Results/ Conclusions. I had available data from 6 study sites at the time of preparing this thesis. The population includes 43,078 pregnancies resulting in 43,781 total births. Of these, 295 were stillbirths representing an overall foetal death rate of 6.7 per 1000 births. Maternal education of primary school or lower [Odds ratio (OR): 2.10, 95% Confidence interval (CI): 1.45-3.04], maternal age >40 (OR: 2.52, 95% CI: 1.55-4.08), single marital status at parturition (OR: 1.70, 95% CI: 1.06-2.71) and maternal use of alcohol (OR: 4.60, 95% CI: 1.88-11.29), tobacco (OR: 1.83, CI: 1.18-2.83), or recreational drugs (OR: 4.27, CI: 1.57-11.63) during pregnancy independently increased the risk of stillbirth. Maternal medical conditions during pregnancy such as malaria (OR: 9.17, 95% CI: 3.69-22.76), HIV/AIDS (OR: 5.84, 95% CI: 2.72-12.54), and syphilis (OR: 7.11, 95% CI: 1.71-29.53) led to significantly higher stillbirth rates. Foetuses in breech presentation were at the greatest risk for stillbirth (OR: 5.00, 95% CI: 3.59-6.98). Caesarean delivery significantly reduced stillbirth risk (OR: 0.35, 95% CI: 0.27-0.47). The cause of death was unknown for 47% of stillbirths. Placental/cord complications, foetal genetic, structural, and karyotypic abnormalities, and maternal medical conditions accounted for 19%, 11%, and 9% of all stillbirths, respectively.</p> <p>Conclusions. These analyses suggest a need for a more detailed stillbirth evaluation to understand the causes associated with half of all stillbirths. Expanding access to obstetric and antenatal care could reduce stillbirth, but this is a complex syndrome that requires multiple interventions for its prevention.</p> |
| first_indexed | 2024-03-06T18:20:12Z |
| format | Thesis |
| id | oxford-uuid:0601b558-5bc1-40a5-9982-2248eca5d271 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:20:12Z |
| publishDate | 2013 |
| record_format | dspace |
| spelling | oxford-uuid:0601b558-5bc1-40a5-9982-2248eca5d2712022-03-26T09:00:19ZThe epidemiology of stillbirth: The INTERGROWTH-21st Newborn Cross-Sectional StudyThesishttp://purl.org/coar/resource_type/c_bdccuuid:0601b558-5bc1-40a5-9982-2248eca5d271EpidemiologyEnglishOxford University Research Archive - Valet2013Finkton, DVillar, J<p>Background. INTERGROWTH-21st is a prospective, multi-ethnic, population-based project exploring growth from early pregnancy to two years of age. The Newborn Cross- Sectional Study (NCSS) component of INTERGROWTH-21st was designed to evaluate the population characteristics and pregnancy outcomes for the 8 study sites included in the project. The INTERGROWTH-21st geographic areas were in: Pelotas, Brazil; Beijing, China; Nagpur, India; Torino, Italy; Nairobi, Kenya; Muscat, Oman; Oxford, United Kingdom; Seattle, United States.</p> <p>Methods. Using the data gathered from the NCSS until the time that I completed my course work in Oxford, I attempted to identify potential risk factors for stillbirth in the INTERGROWTH-21st population. Stillbirth is defined as all foetal deaths occurring after at least 18 weeks gestation in order to capture stillbirths using the most inclusive definition. I also created the Foetal Death Supplementary Form to collect information on the causes of stillbirth that were not included in the original instrument according to Goldenberg et al.</p> <p>Results/ Conclusions. I had available data from 6 study sites at the time of preparing this thesis. The population includes 43,078 pregnancies resulting in 43,781 total births. Of these, 295 were stillbirths representing an overall foetal death rate of 6.7 per 1000 births. Maternal education of primary school or lower [Odds ratio (OR): 2.10, 95% Confidence interval (CI): 1.45-3.04], maternal age >40 (OR: 2.52, 95% CI: 1.55-4.08), single marital status at parturition (OR: 1.70, 95% CI: 1.06-2.71) and maternal use of alcohol (OR: 4.60, 95% CI: 1.88-11.29), tobacco (OR: 1.83, CI: 1.18-2.83), or recreational drugs (OR: 4.27, CI: 1.57-11.63) during pregnancy independently increased the risk of stillbirth. Maternal medical conditions during pregnancy such as malaria (OR: 9.17, 95% CI: 3.69-22.76), HIV/AIDS (OR: 5.84, 95% CI: 2.72-12.54), and syphilis (OR: 7.11, 95% CI: 1.71-29.53) led to significantly higher stillbirth rates. Foetuses in breech presentation were at the greatest risk for stillbirth (OR: 5.00, 95% CI: 3.59-6.98). Caesarean delivery significantly reduced stillbirth risk (OR: 0.35, 95% CI: 0.27-0.47). The cause of death was unknown for 47% of stillbirths. Placental/cord complications, foetal genetic, structural, and karyotypic abnormalities, and maternal medical conditions accounted for 19%, 11%, and 9% of all stillbirths, respectively.</p> <p>Conclusions. These analyses suggest a need for a more detailed stillbirth evaluation to understand the causes associated with half of all stillbirths. Expanding access to obstetric and antenatal care could reduce stillbirth, but this is a complex syndrome that requires multiple interventions for its prevention.</p> |
| spellingShingle | Epidemiology Finkton, D The epidemiology of stillbirth: The INTERGROWTH-21st Newborn Cross-Sectional Study |
| title | The epidemiology of stillbirth: The INTERGROWTH-21st Newborn Cross-Sectional Study |
| title_full | The epidemiology of stillbirth: The INTERGROWTH-21st Newborn Cross-Sectional Study |
| title_fullStr | The epidemiology of stillbirth: The INTERGROWTH-21st Newborn Cross-Sectional Study |
| title_full_unstemmed | The epidemiology of stillbirth: The INTERGROWTH-21st Newborn Cross-Sectional Study |
| title_short | The epidemiology of stillbirth: The INTERGROWTH-21st Newborn Cross-Sectional Study |
| title_sort | epidemiology of stillbirth the intergrowth 21st newborn cross sectional study |
| topic | Epidemiology |
| work_keys_str_mv | AT finktond theepidemiologyofstillbirththeintergrowth21stnewborncrosssectionalstudy AT finktond epidemiologyofstillbirththeintergrowth21stnewborncrosssectionalstudy |