Maternal Race and Stillbirth: Cohort Study and Systematic Review with Meta-Analysis

Abstract

Accurate identification of independent predictors of stillbirth is needed to define preventive strategies. We aim to examine the independent contribution of maternal race in the risk of stillbirth after adjusting for maternal characteristics and medical history. There are two components to the study: first, prospective screening in 168,966 women with singleton pregnancies coordinated by the Fetal Medicine Foundation (FMF) and second, a systematic review and meta-analysis of studies reporting on race and stillbirth. In the FMF study, logistic regression analysis found that in black women, the risk of stillbirth, after adjustment for confounders, was higher than in white women (odds ratio 1.78, 95% confidence interval 1.50 to 2.11). The risk for other racial groups was not significantly different. The literature search identified 20 studies that provided data on over 6,500,000 pregnancies, but only 10 studies provided risks adjusted for some maternal characteristics; consequently, the majority of these studies did not provide accurate contribution of different racial groups to the prediction of stillbirth. It is concluded that in women of black origin, the risk of stillbirth, after adjustment for confounders, is about twofold higher than in white women. Consequently, closer surveillance should be granted for these women.

Keywords: pregnancy complications; race; screening; singleton pregnancies; stillbirth.

Figure 1

Flow chart for the systematic review.

Figure 2

Forest plots of risk ratio for stillbirth in Black women compared with White women with 95% confidence intervals (CI) and weighted pooled summary statistics using a bivariate random-effects model.

Figure 3

Forest plots of odds ratio for stillbirth in Black women compared with White women with 95% confidence intervals (CI) and pooled summary statistics using a bivariate random-effects model.