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Case Reports
. 2016 Jul;6(3):e287-98.
doi: 10.1055/s-0036-1587322.

Influence of Birthweight on the Prospective Stillbirth Risk in the Third Trimester: A Cross-Sectional Cohort Study

Stephen Contag  1 , Clayton Brown  2 , Sarah Crimmins  1 , Katherine Goetzinger  1
Affiliations
Case Reports

Influence of Birthweight on the Prospective Stillbirth Risk in the Third Trimester: A Cross-Sectional Cohort Study

Stephen Contag et al. AJP Rep. 2016 Jul.

Abstract

Objective: The objective of this study was to determine the effect of birthweight on prospective stillbirth risk.

Methods: Cross-sectional study of singleton births in the United States from 2010 to 2012 from 32 through 42 weeks was conducted. Stillbirth risk was stratified by birthweight and gestational age adjusted for time from death to delivery. The primary outcome was the prospective stillbirth risk for each birthweight category. Student t-test was used for continuous data, chi-square to compare categorical data. Binomial proportions were used to derive prospective and cumulative risks. Cox proportional hazards regression with log-rank test comparison for heterogeneity was used to compare birthweight categories and derive hazard ratios.

Results: There was an increase in the risk for stillbirth as birthweight diverged from the reference group. At 40 weeks adjusted gestational age, stillbirth rate per 10,000 births for the bottom (6.17, 95% CI: 7.47-4.87) and top (2.37, 95%CI: 3.1-1.65) 5th centiles of birthweight conveyed the highest risk. Hazard ratios (HR) after adjusting for covariates were: 1.55 (1.73-1.4) <5th centile and 2.2 (2.43-1.99) > 95th centile (p < 0.001).

Conclusion: Stillbirth risk increases as birthweight departs from the mean. Birthweight below the 5th and above the 95th centile conveyed a significantly increased risk for stillbirth which was most noticeable after 37 weeks.

Keywords: birthweight; growth restriction; prospective risk; stillbirth; third trimester.

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Conflict of interest statement

Conflict of Interest The authors have no competing interests to disclose. Authors' Contribution All three authors contributed in the conception, planning, carrying out analysis of the data, and writing up of the article. Disclosure on Ethics Approval The study was performed with publicly available administrative databases and did not require approval from our institutional review committee.

Figures

Fig. 1
Fig. 1
Flowchart demonstrating all women included in the study cohort according to outcome and exclusion category.
Fig. 2
Fig. 2
Stillbirth risk according to gestational age and adjusted gestational age. Prospective stillbirth risk numerator are stillbirths occurring in a specific week of pregnancy, and the denominator is all ongoing pregnancies. Cumulative stillbirth risk is 1- the product of the cumulative risks of survival up to a week of gestation.
Fig. 3
Fig. 3
(A) Cumulative stillbirth risk by birthweight category according to unadjusted gestational age. Stillbirths are per 10,000 births. Unadjusted gestational age is according to best clinical estimate registered in the birth or fetal death certificate. (B) Cumulative stillbirth risk by birthweight category according to adjusted gestational age. Stillbirths are per 10,000 births. Stillbirth gestational age is adjusted for interval between gestational age at time of diagnosis of fetal death and gestational age at time of delivery.
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