Temporal trends in maternal medical conditions and stillbirth

Patel, Emily; Goodnight, William; James, Andra H.; Grotegut, Chad A.

doi:10.1016/j.ajog.2014.12.021

Cited by 16 publications

(20 citation statements)

References 10 publications

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“…As stillbirths account for approximately 60% of perinatal mortality [ 27 ], we observed significantly increased risk of stillbirth and perinatal mortality on the PGD women compared with the non-diabetic. Accumulative evidences have suggested that chronic fetal hypoxia was the leading causes of stillbirth [ 28 , 29 ], while maternal and fetal hyperglycemia was suggested as an etiology for antenatal asphyxia [ 30 ].…”

Section: Discussionmentioning

confidence: 72%

Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes

et al. 2017

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Pregnancies complicated by pre-gestational diabetes (PGD) are associated with a higher rate of adverse outcomes, including an increased rage of preterm delivery, pregnancy-induced hypertension, pre-eclampsia, caesarean section, perinatal mortality, stillbirth, shoulder dystocia, macrosomia, small for gestational age, large for gestational age, low birth weight, neonatal hypoglycemia, neonatal death, low Apgar score, NICU admission, jaundice and respiratory distress. In the past two decades, numerous reports have been published regarding associations between PGD and risk of adverse outcomes. However, study results are inconsistent. To provide a synopsis of the current understanding of PGD for risk of adverse pregnancy outcomes, a random-effects meta-analysis over 40 million subjects from 100 studies was performed to calculate the pooled ORs. Potential sources of heterogeneity were systematically explored by multiple strata analyses and meta-regression. Overall, PGD were significantly associated with increased risk of preterm delivery (OR=3.48), LGA (OR=3.90), perinatal mortality (OR=3.39), stillbirth (OR=3.52), pre-eclampsia (OR=3.48), caesarean section (OR=3.52), NICU admission (OR=3.92), and neonatal hypoglycemia (OR=26.62). Significant results were also observed for 7 adverse outcomes with OR range from 1.54 to 2.82, while no association was found for SGA and respiratory distress after Bonferroni correction. We found that women with T1DM had higher risks for most of adverse pregnancy outcomes compared with women with T2DM. When stratified by study design, sample size, type of diabetes, geographic region, and study quality, significant associations remains. Our findings demonstrated that PGD is a strong risk-conferring factor for adverse maternal, perinatal and neonatal outcomes.

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Section: Discussionmentioning

confidence: 72%

Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes

et al. 2017

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“…Nevertheless, it appears that unrecognized fetal distress, caused by cord complications or placental malfunction, is a major cause of stillbirth (24,27). Other conditions leading to fetal asphyxia include preeclampsia/eclampsia, placental abruption and placenta previa, FGR, and pregnancy complicated by multiples or abnormal presentation (28). Various infections including syphilis, malaria, human immunodeficiency virus, and other bacterial and viral infections are also responsible for a substantial number of stillbirths.…”

Section: Proximal and Distal Determinants Of Stillbirthmentioning

confidence: 98%

“…Medical conditions associated with or causal for stillbirth have also been studied ( Table 2) (24)(25)(26)(27)(28). In HIC, FGR is associated with 25% or more of stillbirths (23).…”

Section: Proximal and Distal Determinants Of Stillbirthmentioning

confidence: 98%

Reducing stillbirths in low‐income countries

Goldenberg

Saleem

Pasha

et al. 2015

Acta Obstet Gynecol Scand

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Worldwide, 98% of stillbirths occur in low-income countries (LIC), where stillbirth rates are ten-fold higher than in high-income countries (HIC). Although most HIC stillbirths occur prenatally, in LIC most stillbirths occur at term and during labor/delivery. Conditions causing stillbirths include those of maternal origin (obstructed labor, trauma, antepartum hemorrhage, preeclampsia/ eclampsia, infection, diabetes, other maternal diseases), and fetal origin (fetal growth restriction, fetal distress, cord prolapse, multiples, malpresentations, congenital anomalies). In LIC, aside from infectious origins, most stillbirths are caused by fetal asphyxia. Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal monitoring and expeditious delivery are possible, usually by cesarean section (CS). Of major causes, only syphilis and malaria can be managed prenatally. Targeting single conditions or interventions is unlikely to substantially reduce stillbirth. To reduce stillbirth rates, LIC must implement effective modern antepartum and intrapartum care, including fetal monitoring and CS.

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“…Outros estudos associam o óbito fetal ao uso de drogas, álcool e tabaco, mas esses hábitos não constavam em nenhuma das fichas das gestantes avaliadas. Quanto à idade, as faixas extremas são consideradas como fatores de risco para o óbito fetal 15 . Na população estudada, 35% das gestantes encontravam-se nas idades de risco.…”

Section: Métodosunclassified

Vigilância do óbito fetal: estudo das principais causas

et al. 2016

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O óbito fetal é uma das principais causas de mortalidade perinatal, e o entendimento das suas causas é essencial para melhorar a assistência pré-natal oferecida às gestantes. Nesse sentido, o estudo caracterizou os casos de óbito fetal intra-útero anteparto registrados em uma maternidade no Norte de Minas entre janeiro de 2010 e dezembro de 2012. Foram avaliadas fichas médicas obtidas junto ao Comitê de Mortalidade Infantil da Maternidade. Foram incluídas na amostragem 26 fichas de gestantes com diagnóstico de óbito fetal ocorrido antes do início do trabalho de parto, com idade gestacional igual ou superior a 20 semanas e ou peso fetal maior que 500g. Os dados foram coletados por meio de questionário estruturado e avaliados por estatística descritiva. A maioria das gestantes tinha entre 18 e 29 anos e apresentavam gestação a termo. Observou-se que 69% dos casos de óbito não apresentaram nenhum fator de risco associado, o que é um índice superior aos apresentados na literatura médica. Nos casos com causas identificáveis, atribuiu-se 7,7% das ocorrências a doenças hipertensivas específicas da gestação, 3,8% a diabetes mellitus, 3,8% a infecção do trato urinário, 3,8% a polidrâmnio e 11,5% a múltiplas intercorrências. A alta frequência de óbitos sem fatores de risco associados indica que é baixa qualidade da informação sobre o óbito perinatal, especialmente o óbito fetal. Palavras-chave:Óbito fetal. Gestação. Anteparto.The stillbirth is a major cause of perinatal mortality, and understanding its causes is essential to improve prenatal care provided to pregnant women. In this sense, the study characterized the cases of antepartum intrauterine fetal death recorded in a maternity ward in the North of Minas Gerais between January 2010 and December 2012. Medical records obtained were evaluated by the Child Mortality Committee of Motherhood. They were included in the sample 26 records of pregnant women with fetal death diagnosis occurred before the onset of labor, gestational age less than 20 weeks and birth weight or greater than 500g. Data were collected using a structured questionnaire and evaluated by descriptive statistics. Most of the women were between 18 and 29 years and had a pregnancy to term. It was observed that 69% of cases of death had no associated risk factor, which is a higher rate to those presented in the medical literature. In cases with identifiable causes, attributed to 7.7% of cases the specific hypertensive disorders of pregnancy, 3.8% diabetes mellitus, 3.8% to urinary tract infection, 3.8% to 11.5 and polyhydramnios 11,5% multiple complications. The high frequency of deaths without risk factors indicates that poor quality of information on perinatal death, especially fetal death.

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Temporal trends in maternal medical conditions and stillbirth

Cited by 16 publications

References 10 publications

Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes

Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes

Reducing stillbirths in low‐income countries

Vigilância do óbito fetal: estudo das principais causas

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