TY - JOUR
T1 - Differences in Factors Associated With Preterm and Term Stillbirth
T2 - A Secondary Cohort Analysis of the DESiGN Trial
AU - Winsloe, Chivon
AU - Elhindi, James
AU - Vieira, Matias C.
AU - Relph, Sophie
AU - Arcus, Charles G.
AU - Alagna, Alessandro
AU - Briley, Annette
AU - Johnson, Mark
AU - Page, Louise M.
AU - Shennan, Andrew
AU - Thilaganathan, Baskaran
AU - Marlow, Neil
AU - Lees, Christoph
AU - Lawlor, Deborah A.
AU - Khalil, Asma
AU - Sandall, Jane
AU - Copas, Andrew
AU - Pasupathy, Dharmintra
AU - the DESiGN trial team
AU - Healey, Andrew
AU - McCowan, Lesley
AU - Coxon, Kirstie
AU - Peebles, Donald
AU - Muruet-Gutierrez, Walter
AU - Elstad, Maria
AU - Coker, Bolaji
PY - 2025/1
Y1 - 2025/1
N2 - Objective: To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth. Design: Secondary cohort analysis of the DESiGN RCT. Setting: Thirteen UK maternity units. Population: Singleton pregnant women and their babies. Methods: Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods. Main Outcome Measure: Stillbirth stratified by preterm (<37+0 weeks') and term (37+0–42+6 weeks') births. Results: A total of 195 344 pregnancies were included. Six hundred and sixty-seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP-A, gestational hypertension, pre-eclampsia and gestational diabetes but not for chronic hypertension and pre-existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5–24.9 kg/m2 (BMI 30.0–34.9 kg/m2 term adjusted OR 2.1 [95% CI 1.4–3.0] vs. preterm aOR 1.1 [0.8–1.7]; BMI ≥ 35.0 kg/m2 term aOR 2.2 [1.4–3.4] vs. preterm aOR 1.5 [1.2–1.8]; p-interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1–2.7] vs. preterm aOR 1.2 [0.9–1.6]; p-interaction < 0.01) and Asian ethnicity compared with White (p-interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre-eclampsia. Conclusion: Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to further mitigate the risk of stillbirth.
AB - Objective: To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth. Design: Secondary cohort analysis of the DESiGN RCT. Setting: Thirteen UK maternity units. Population: Singleton pregnant women and their babies. Methods: Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods. Main Outcome Measure: Stillbirth stratified by preterm (<37+0 weeks') and term (37+0–42+6 weeks') births. Results: A total of 195 344 pregnancies were included. Six hundred and sixty-seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP-A, gestational hypertension, pre-eclampsia and gestational diabetes but not for chronic hypertension and pre-existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5–24.9 kg/m2 (BMI 30.0–34.9 kg/m2 term adjusted OR 2.1 [95% CI 1.4–3.0] vs. preterm aOR 1.1 [0.8–1.7]; BMI ≥ 35.0 kg/m2 term aOR 2.2 [1.4–3.4] vs. preterm aOR 1.5 [1.2–1.8]; p-interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1–2.7] vs. preterm aOR 1.2 [0.9–1.6]; p-interaction < 0.01) and Asian ethnicity compared with White (p-interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre-eclampsia. Conclusion: Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to further mitigate the risk of stillbirth.
KW - fetal growth restriction
KW - perinatal death
KW - premature birth
KW - SGA
KW - stillbirth
KW - term birth
UR - http://www.scopus.com/inward/record.url?scp=85204191950&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.17951
DO - 10.1111/1471-0528.17951
M3 - Article
AN - SCOPUS:85204191950
SN - 1470-0328
VL - 132
SP - 89
EP - 98
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 1
ER -