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The risk factors for unexplained antepartum stillbirths in Scotland, 1994 to 2003.

Sutan R, Campbell D, Prescott GJ, Smith WC - J Perinatol (2009)

Bottom Line: In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant.Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity.The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia. rosnah@medic.ukm.my

ABSTRACT

Objective: To determine the factors contributing to unexplained antepartum stillbirth in Scotland.

Study design: A 10-year birth database in Scotland was used to compare the unexplained antepartum stillbirth with other birth outcomes. The sample unit was a pregnant mother with a gestational age of 20 weeks and above and with a fetal birth weight of 200 g and above.

Result: Maternal age of 35 years and above, lower deprivation category, inaccessible area of residence, maternal smoking, maternal height of <160 cm and gestational age of above 39 weeks were significantly associated with unexplained antepartum stillbirth. In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant. Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity. The prevalence of stillbirth for this population was 0.2%. A positive predictive value of only 1.2% implies that only 1 in 83 women with these three risk factors will have antepartum stillbirth. The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.

Conclusion: Advanced maternal age, maternal smoking, and shorter maternal height were associated risk for unexplained antepartum stillbirth but screening based on these factors would be of limited value.

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Related in: MedlinePlus

Odds ratios for unexplained antepartum stillbirths by Carstairs deprivation category. Note: Category 1 as reference.
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fig2: Odds ratios for unexplained antepartum stillbirths by Carstairs deprivation category. Note: Category 1 as reference.

Mentions: Further analysis using multiple logistic regressions was conducted based on the significant findings of the univariate analyses. A multivariable model with automatic selection of risk variables showed that smoking during pregnancy, maternal age, and maternal height remained independently significant (Table 2). The model's goodness of fit was good with a small value of −2 log-likelihood (5984.954) and a Cox and Snell R2 of 0.100. The Hosmer and Lemeshow test also showed a high P-value indicating the goodness-of-fit between the observed and predicted number of cases (P=0.994). Table 2 shows multiple logistic regression analyses, which include all singleton pregnancies and also analyses among the singleton iparous pregnancies only. The result showed that the adjusted OR for unexplained antepartum stillbirth increased with increased maternal age after 35 years compared with the reference age of 20 to 24 years for both analyzed groups (Table 2). The adjusted odds of unexplained antepartum stillbirth varied from category 1 (most affluent) to category 7 (most deprived). The less affluent showed increasing of risk of unexplained antepartum stillbirth (Figure 2). Smoking during pregnancy was associated with two times (OR: 1.639, 95% CI: 1.351, 1.909, P<0.01) higher odds of unexplained antepartum stillbirth. Nulliparous pregnancies had a higher risk of unexplained antepartum stillbirth compared with multiparous pregnancies. The risk reduces with an increasing number of pregnancies. Those of a height of <160 cm showed a higher risk of having an unexplained antepartum stillbirth as compared with height above 160 cm. There was an increasing risk of unexplained antepartum stillbirth if they had previous history of stillbirth (OR: 3.467, 95% CI: 2.101, 5.643, P<0.01).


The risk factors for unexplained antepartum stillbirths in Scotland, 1994 to 2003.

Sutan R, Campbell D, Prescott GJ, Smith WC - J Perinatol (2009)

Odds ratios for unexplained antepartum stillbirths by Carstairs deprivation category. Note: Category 1 as reference.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864419&req=5

fig2: Odds ratios for unexplained antepartum stillbirths by Carstairs deprivation category. Note: Category 1 as reference.
Mentions: Further analysis using multiple logistic regressions was conducted based on the significant findings of the univariate analyses. A multivariable model with automatic selection of risk variables showed that smoking during pregnancy, maternal age, and maternal height remained independently significant (Table 2). The model's goodness of fit was good with a small value of −2 log-likelihood (5984.954) and a Cox and Snell R2 of 0.100. The Hosmer and Lemeshow test also showed a high P-value indicating the goodness-of-fit between the observed and predicted number of cases (P=0.994). Table 2 shows multiple logistic regression analyses, which include all singleton pregnancies and also analyses among the singleton iparous pregnancies only. The result showed that the adjusted OR for unexplained antepartum stillbirth increased with increased maternal age after 35 years compared with the reference age of 20 to 24 years for both analyzed groups (Table 2). The adjusted odds of unexplained antepartum stillbirth varied from category 1 (most affluent) to category 7 (most deprived). The less affluent showed increasing of risk of unexplained antepartum stillbirth (Figure 2). Smoking during pregnancy was associated with two times (OR: 1.639, 95% CI: 1.351, 1.909, P<0.01) higher odds of unexplained antepartum stillbirth. Nulliparous pregnancies had a higher risk of unexplained antepartum stillbirth compared with multiparous pregnancies. The risk reduces with an increasing number of pregnancies. Those of a height of <160 cm showed a higher risk of having an unexplained antepartum stillbirth as compared with height above 160 cm. There was an increasing risk of unexplained antepartum stillbirth if they had previous history of stillbirth (OR: 3.467, 95% CI: 2.101, 5.643, P<0.01).

Bottom Line: In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant.Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity.The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia. rosnah@medic.ukm.my

ABSTRACT

Objective: To determine the factors contributing to unexplained antepartum stillbirth in Scotland.

Study design: A 10-year birth database in Scotland was used to compare the unexplained antepartum stillbirth with other birth outcomes. The sample unit was a pregnant mother with a gestational age of 20 weeks and above and with a fetal birth weight of 200 g and above.

Result: Maternal age of 35 years and above, lower deprivation category, inaccessible area of residence, maternal smoking, maternal height of <160 cm and gestational age of above 39 weeks were significantly associated with unexplained antepartum stillbirth. In multivariable analysis only maternal age (adjusted odds ratio (OR): 1.8, confidence interval (CI): 1.1 to 3.0, P=0.02), smoking during pregnancy (adjusted OR: 2.0, CI: 1.1 to 3.5, P=0.02), and maternal height (adjusted OR: 1.4, CI: 1.1 to 1.8, P=0.01), remain significant. Screening of pregnancies based on these three risk factors had 4.2% sensitivity and 99.4% specificity. The prevalence of stillbirth for this population was 0.2%. A positive predictive value of only 1.2% implies that only 1 in 83 women with these three risk factors will have antepartum stillbirth. The remaining 82 will suffer needless anxiety and potentially diagnostic procedures.

Conclusion: Advanced maternal age, maternal smoking, and shorter maternal height were associated risk for unexplained antepartum stillbirth but screening based on these factors would be of limited value.

Show MeSH
Related in: MedlinePlus