Prevalence and risk of stillbirth according to biologic vulnerability phenotypes in the municipality of São Paulo, Brazil: A population‐based cohort study

Abstract

ObjectiveTo estimate the prevalence and risk of stillbirths by biologic vulnerability phenotypes in a cohort of pregnant women in the municipality of São Paulo, Brazil, 2017–2019.MethodsRetrospective population‐based cohort study. Fetuses were assessed as small for gestational age (SGA), large for gestational age (LGA), adequate for gestational age (AGA), preterm (PT) as less than 37 weeks of gestation, non‐PT (NPT) as 37 weeks of gestation or more, low birth weight (LBW) as less than 2500 g, and non‐LBW (NLBW) as 2500 g or more. Relative risks (RR) with robust variance were estimated using Poisson regression.ResultsIn all 442 782 pregnancies, including 2321 (0.5%) stillbirths, were included. About 85% (n = 1983) of stillbirths had at least one characteristic of vulnerability, compared with 21% (n = 92524) of live births. Fetuses with all three markers of vulnerability had the highest adjusted RR of stillbirth—SGA + LBW + PT (RR 155.00; 95% confidence interval [CI] 136.29–176.30) and LGA + LBW + PT (RR 262.04; 95% CI 206.10–333.16) when compared with AGA + NLBW + NPT.ConclusionOur findings show that the simultaneous presence of prematurity, low birth weight, and abnormal intrauterine growth presented a higher risk of stillbirths. To accelerate progress towards reducing preventable stillbirths, one must identify the circumstances of greatest biologic vulnerability.

Editorial: Selected papers from the XXIV FIGO World Congress

“…In this issue, we are delighted to publish 12 papers that were invited following selection as outstanding abstracts from that Congress by FIGO's Scientific Programme Committee. All submitted full papers were independently peer reviewed by IJGO's Editorial Board, and the final selection covers a fascinating range of topics and geographical regions, including four papers from Europe, 1–4 two from Latin America, 5,6 three from Asia‐Oceania, 7–9 two from Africa–East Mediterranean, 10,11 and one from North America 12 . All papers in this special section will be free to read for a limited period following publication of the issue, and we hope that this will encourage a similarly wide breadth of readership.…”