Stillbirth as left truncation for early neonatal death in California, 1989–2015: a time-series study

Abstract

Background Some scholars posit that attempts to avert stillbirth among extremely preterm gestations may result in a live birth but an early neonatal death. The literature, however, reports no empirical test of this potential form of left truncation. We examine whether annual cohorts delivered at extremely preterm gestational ages show an inverse correlation between their incidence of stillbirth and early neonatal death. Methods We retrieved live birth and infant death information from the California Linked Birth and Infant Death Cohort Files for years 1989 to 2015. We defined the extremely preterm period as delivery from 22 to < 28 weeks of gestation and early neonatal death as infant death at less than 7 days of life. We calculated proportions of stillbirth and early neonatal death separately by cohort year, race/ethnicity, and sex. Our correlational analysis controlled for well-documented declines in neonatal mortality over time. Results California reported 89,276 extremely preterm deliveries (live births and stillbirths) to Hispanic, non-Hispanic (NH) Black, and NH white mothers from 1989 to 2015. Findings indicate an inverse correlation between stillbirth and early neonatal death in the same cohort year (coefficient: -0.27, 95% CI of − 0.11; − 0.42). Results remain robust to alternative specifications and falsification tests. Conclusions Findings support the notion that cohorts with an elevated risk of stillbirth also show a reduced risk of early neonatal death among extremely preterm deliveries. Results add to the evidence base that selection in utero may influence the survival characteristics of live-born cohorts.

Missing Black males among preterm births in the US, 1995 to 2019

“…Demographers and epidemiologists continue to debate the extent to which cohort left-truncation of gestations affects the survival characteristics of live births [ 8 , 37 ]. As this argument relates to our sex ratio findings, an unusually low level of NH Black male PTB may reflect a high level of losses in utero among this group that, if born live, would have resulted in a live-born PTB but which would show an elevated risk of neonatal death.…”

“…A recent study in California, for instance, estimated a large "missingness" of males among non-Hispanic Black PTB (relative to expected levels derived by comparisons to other race/ethnicities such as non-Hispanic white infants) [4]. The Authors, and previous researchers [8], suggest that high levels of "left-truncation" in utero, especially among gestations to NH Black birthing persons, may account for relatively fewer NH Black male PTB.…”

National trends in suicides and male twin live births in the US, 2003 to 2019: an updated test of collective optimism and selectionin utero

“…Darwinian expectations from selection in utero would suggest that males born among cohorts with lower-than-expected male twin live births exhibit stronger survival characteristics 24 . To explore potential changes in cohort fitness, re-tests of collective optimism and selection in utero may include examination of preterm births and early neonatal deaths among males 54 , male-specific infant mortality 55 , birth defects among live-born males 56 , and incidence of other genetic conditions such as childhood cancers 57 among conception cohorts exposed in utero to greater-than-expected suicides 22 . We expect these analyses to provide evidence of whether changes in collective optimism affect the survival characteristics of live-born cohorts, or if their relation to selection in utero against male twins diminishes beyond parturition.…”

Magnitude and associated factors of stillbirth among women who gave birth at Hiwot Fana Specialized University Hospital, Harar, eastern Ethiopia

“…The cut-off points for defining stillbirth varies, with the World Health Organization (WHO) defining it as a baby who dies after 28 weeks of pregnancy, but before or during birth. In United Kingdom, it is defined as a death at 24 weeks or later, whereas in the US, it is loss of a baby at or after 20 weeks of pregnancy 1 , 2 . Stillbirth is further classified as either early, late, or term 3 .…”