Stillbirths: Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020

Yemisrach B Okwaraji; Lorena Suárez-Idueta; Eric O Ohuma; Ellen Bradley; Judith Yargawa; Veronica Pingray; Gabriela Cormick; Adrienne Gordon; Vicki Flenady; Erzsébet Horváth-Puhó; Henrik Toft Sørensen; Luule Sakkeus; Liili Abuladze; Mohammed Heidarzadeh; Narjes Khalili; Khalid A Yunis; Ayah Al Bizri; Shamala D Karalasingam; Ravichandran Jeganathan; Arturo Barranco; Aimée E van Dijk; Lisa Broeders; Fawzya Alyafei; Mai AlQubaisi; Neda Razaz; Jonas Söderling; Lucy K Smith; Ruth J Matthews; Rachael Wood; Kirsten Monteath; Isabel Pereyra; Gabriella Pravia; Sarka Lisonkova; Qi Wen; Joy E Lawn; Hannah Blencowe; National Vulnerable Newborn Collaborative Group for Stillbirths

doi:10.1111/1471-0528.17653

Stillbirths: Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020

BJOG. 2023 Nov 29. doi: 10.1111/1471-0528.17653. Online ahead of print.

Authors

Yemisrach B Okwaraji¹, Lorena Suárez-Idueta², Eric O Ohuma¹, Ellen Bradley¹, Judith Yargawa¹, Veronica Pingray³, Gabriela Cormick^{3

4}, Adrienne Gordon⁵, Vicki Flenady⁵, Erzsébet Horváth-Puhó⁶, Henrik Toft Sørensen⁶, Luule Sakkeus⁷, Liili Abuladze^{7

8}, Mohammed Heidarzadeh⁹, Narjes Khalili¹⁰, Khalid A Yunis¹¹, Ayah Al Bizri¹¹, Shamala D Karalasingam¹², Ravichandran Jeganathan¹³, Arturo Barranco¹⁴, Aimée E van Dijk¹⁵, Lisa Broeders¹⁵, Fawzya Alyafei¹⁶, Mai AlQubaisi¹⁷, Neda Razaz¹⁸, Jonas Söderling¹⁸, Lucy K Smith¹⁹, Ruth J Matthews¹⁹, Rachael Wood^{20

21}, Kirsten Monteath²², Isabel Pereyra²³, Gabriella Pravia²⁴, Sarka Lisonkova^{25

26}, Qi Wen²⁵, Joy E Lawn¹, Hannah Blencowe¹; National Vulnerable Newborn Collaborative Group for Stillbirths

Collaborators

National Vulnerable Newborn Collaborative Group for Stillbirths:
Veronica Pingray, Gabriela Gabriela, José Belizan, Luz Gibbons, Carlos Guevel, Vicki Flenady, Adrienne Gordon, Kara Warrilow, Harriet Lawford, Erzsébet Horváth-Puhó, Henrik T Sørensen, Luule Sakkeus, Liili Abuladze, Khalid A Yunis, Ayah Al Bizri, Pascale Nakad, Shamala Karalasingam, J Ravichandran, R Jeganathan, Nurakman Binti Baharum, Lorena Suárez-Idueta, Arturo Barranco Flores, Jesus Felipe Gonzalez Roldan, Sonia Lopez Alvarez, Lisa Broeders, Aimée E van Dijk, Fawzia Alyafei, Mai AlQubaisi, Tawa O Olukade, Hamdy A Ali, Mohamad Rami Alturk, Neda Razaz, Jonas Söderling, Lucy K Smith, Bradley N Manktelow, Ruth J Matthews, Elizabeth Draper, Alan Fenton, Jennifer J Kurinczuk, Rachael Wood, Celina Davis, Kirsten Monteath, Samantha Clarke, Isabel Pereyra, Gabriella Pravia, Sarka Lisonkova, Qi Wen, Joy E Lawn, Hannah Blencowe, Eric Ohuma, Yemi Okwaraji, Judith Yargawa, Ellen Bradley, Robert Black, Joanne Katz, Dan Erchick, Elizabeth Hazel, Mike Diaz, Anne C C Lee

Affiliations

¹ Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
² Mexican Society of Public Health, Mexico City, Mexico.
³ Institute for Clinical Effectiveness and Health Policy, Ciudad Autónoma de Buenos Aires, Argentina.
⁴ Centro de Investigaciones en Epidemiología y Salud Pública, National Scientific and Technical Research Council (CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
⁵ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁶ Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.
⁷ School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia.
⁸ Population Research Unit, Väestöliitto, Finland.
⁹ Paediatrics Department, Alzahra Hospital Iran, Tabriz, Iran.
¹⁰ Department of Community and Family Medicine, Preventive Medicine and Public Health Research Centre, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
¹¹ Division of Neonatology, Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
¹² Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cyberjaya, Cyberjaya, Malaysia.
¹³ Department of Obstetrics & Gynaecology, Malaysia Monash Medical School, Johor Bahru, Malaysia.
¹⁴ Directorate of Health Information, Ministry of Health, Mexico City, Mexico.
¹⁵ Perined, Utrecht, The Netherlands.
¹⁶ Department of Paediatrics, Hamad General Hospital, Doha, Qatar.
¹⁷ NICU, Women Wellness and Research Centre, Doha, Qatar.
¹⁸ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
¹⁹ Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK.
²⁰ Public Health Scotland, Edinburgh, UK.
²¹ Usher Institute, University of Edinburgh, Edinburgh, UK.
²² Pregnancy, Birth and Child Health Team, Public Health Scotland, Edinburgh, UK.
²³ Faculty of Health Sciences, Catholic University of Maule, Curicó, Chile.
²⁴ Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay.
²⁵ Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
²⁶ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 38018284
DOI: 10.1111/1471-0528.17653

Abstract

Objective: To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six 'newborn types'.

Design: Population-based multi-country analyses.

Setting: Births collected through routine data systems in 13 countries.

Sample: 125 419 255 total births from 22⁺⁰ to 44⁺⁶ weeks' gestation identified from 2000 to 2020.

Methods: We included 635 107 stillbirths from 22⁺⁰ weeks' gestation from 13 countries. We classified all births, including stillbirths, into six 'newborn types' based on gestational age information (preterm, PT, <37⁺⁰ weeks versus term, T, ≥37⁺⁰ weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards.

Main outcome measures: Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types.

Results: 635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22⁺⁰ weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8-118.8) followed by PT + AGA (RR 25.0, IQR, 20.0-34.3), PT + LGA (RR 25.9, IQR, 13.8-28.7) and T + SGA (RR 5.6, IQR, 5.1-6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7-1.1). At the population level, 25% of stillbirths were attributable to small-for-gestational-age.

Conclusions: In these high-quality data from high/middle income countries, almost three-quarters of stillbirths were born preterm and a fifth small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, as well as patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA.

Keywords: gestational age; newborn; pregnancy; premature birth; preterm; stillbirths.

Grants and funding

1803-02535/Children's Investment Fund Foundation