Risk of recurrent stillbirth and neonatal mortality: mother-specific random effects analysis using longitudinal panel data from Indonesia (2000 – 2014)

Abstract

Background Despite significant government investments to improve birth outcomes in low and middle-income countries over the past several decades, stillbirth and neonatal mortality continue to be persistent public health problems. While they are different outcomes, there is little evidence regarding their shared and unique population-level risk factors over a mother’s reproductive lifespan. Data gaps and measurement challenges have left several areas in this field unexplored, especially assessing the risk of stillbirth or neonatal mortality over successive pregnancies to the same woman. This study aimed to assess the risk of stillbirth and neonatal mortality in Indonesia during 2000–2014, using maternal birth histories from the Indonesia Family Life Survey panel data. Methods Data from three panels were combined to create right-censored birth histories. There were 5,002 unique multiparous mothers with at least two singleton births in the sample. They reported 12,761 total births and 12,507 live births. Random effects (RE) models, which address the dependency of variance in births to the same mother, were fitted assuming births to the same mother shared unobserved risk factors unique to the mother. Results The main finding was that there having had a stillbirth increased the odds of another stillbirth nearly seven-fold and that of subsequent neonatal mortality by over two-fold. Having had a neonatal death was not associated with a future neonatal death. Mothers who were not educated and nullipara were much more likely to experience a neonatal death while mothers who had a prior neonatal death had no risk of another neonatal death due to unmeasured factors unique to the mother. Conclusions The results suggest that for stillbirths, maternal heterogeneity, as explained by a prior stillbirth, could capture underlying pathology while the relationship between observed risk factors and neonatal mortality could be much more dependent on context. Establishing previous adverse outcomes such as neonatal deaths and stillbirth could help identify high-risk pregnancies during prenatal care, inform interventions, and improve health policy.

Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries

“…Sixty-eight studies were cross sectional studies [22-33, 36, 37, 39-56, 58-65, 67-72, 75, 76, 78-83, 85-94, 96-98], four studies were retrospective studies [66,73,74,84], four studies were cohort studies [20,21,35,95], one study was a case control study [57], one study was a desk review [34], and one study was a panel study [77]. We noted gaps in standardized categorization and reference points for the various risk factors that not only made it difficult to compare findings across different studies, but also influenced the direction of the observed relationship.…”

Racial and ethnic differences in the risk of recurrent preterm or small for gestational age births in the United States: a systematic review and stratified analysis

“…Our findings were limited in the range of outcomes from similar studies using national registries and hospital data from Europe (Sweden, Finland, Malta, Scotland, Norway) [ 28 – 31 ], Australia [ 32 ], India [ 33 ], Indonesia [ 34 ], Brazil [ 35 ], Tanzania [ 36 ], and several other developing countries [ 37 ], which have shown that having a stillbirth, PTB, LBW, or neonatal mortality increases the risk of having another similar outcome. Further, we excluded recurrent cross-matched outcomes due to poor reporting of race and ethnicity measures.…”

“…Research also suggests a genetic link between repeat adverse outcomes, especially across more than two pregnancies, given the likelihood of the same mother delivering a preterm baby at the same gestation over consecutive pregnancies [ 34 ]. The authors argue that the likelihood of similar social and environmental exposures occurring at the same time in consecutive pregnancies is slim, suggesting an underlying genetic pathology.…”