Randomized Controlled Trial

. 2025 Jan;132(1):89-98.

doi: 10.1111/1471-0528.17951. Epub 2024 Sep 18.

Differences in Factors Associated With Preterm and Term Stillbirth: A Secondary Cohort Analysis of the DESiGN Trial

Chivon Winsloe^{1

2}, James Elhindi³, Matias C Vieira^{1

4}, Sophie Relph⁵, Charles G Arcus³, Alessandro Alagna⁶, Annette Briley^{1

7}, Mark Johnson⁸, Louise M Page⁹, Andrew Shennan¹, Baskaran Thilaganathan^{10

11}, Neil Marlow¹², Christoph Lees¹³, Deborah A Lawlor^{14

15}, Asma Khalil^{10

11}, Jane Sandall¹, Andrew Copas², Dharmintra Pasupathy^{1

3}; DESiGN Trial team

Affiliations

¹ Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
² Centre for Pragmatic Global Health Trials, Institute for Global Health, University College London, London, UK.
³ Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
⁵ Women's Health Division, Royal London Hospital, Barts Health NHS Trust, London, UK.
⁶ London Perinatal Morbidity and Mortality Working Group (NHS), London, UK.
⁷ Caring Futures Institute Flinders University and North Adelaide Local Health Network, Adelaide, South Australia, Australia.
⁸ Department of Surgery and Cancer, Imperial College London, London, UK.
⁹ West Middlesex University Hospital, Chelsea & Westminster Hospital NHS Foundation Trust, Isleworth, UK.
¹⁰ Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
¹¹ Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK.
¹² UCL Institute for Women's Health, University College London, London, UK.
¹³ Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
¹⁴ Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
¹⁵ Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.

PMID: 39291344
PMCID: PMC11612614
DOI: 10.1111/1471-0528.17951

Randomized Controlled Trial

Differences in Factors Associated With Preterm and Term Stillbirth: A Secondary Cohort Analysis of the DESiGN Trial

Chivon Winsloe et al. BJOG. 2025 Jan.

. 2025 Jan;132(1):89-98.

doi: 10.1111/1471-0528.17951. Epub 2024 Sep 18.

Authors

Affiliations

¹ Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
² Centre for Pragmatic Global Health Trials, Institute for Global Health, University College London, London, UK.
³ Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
⁵ Women's Health Division, Royal London Hospital, Barts Health NHS Trust, London, UK.
⁶ London Perinatal Morbidity and Mortality Working Group (NHS), London, UK.
⁷ Caring Futures Institute Flinders University and North Adelaide Local Health Network, Adelaide, South Australia, Australia.
⁸ Department of Surgery and Cancer, Imperial College London, London, UK.
⁹ West Middlesex University Hospital, Chelsea & Westminster Hospital NHS Foundation Trust, Isleworth, UK.
¹⁰ Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
¹¹ Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK.
¹² UCL Institute for Women's Health, University College London, London, UK.
¹³ Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
¹⁴ Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
¹⁵ Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.

PMID: 39291344
PMCID: PMC11612614
DOI: 10.1111/1471-0528.17951

Abstract

Objective: To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth.

Design: Secondary cohort analysis of the DESiGN RCT.

Setting: Thirteen UK maternity units.

Population: Singleton pregnant women and their babies.

Methods: Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods.

Main outcome measure: Stillbirth stratified by preterm (<37⁺⁰ weeks') and term (37⁺⁰-42⁺⁶ weeks') births.

Results: A total of 195 344 pregnancies were included. Six hundred and sixty-seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP-A, gestational hypertension, pre-eclampsia and gestational diabetes but not for chronic hypertension and pre-existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5-24.9 kg/m² (BMI 30.0-34.9 kg/m² term adjusted OR 2.1 [95% CI 1.4-3.0] vs. preterm aOR 1.1 [0.8-1.7]; BMI ≥ 35.0 kg/m² term aOR 2.2 [1.4-3.4] vs. preterm aOR 1.5 [1.2-1.8]; p-interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1-2.7] vs. preterm aOR 1.2 [0.9-1.6]; p-interaction < 0.01) and Asian ethnicity compared with White (p-interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre-eclampsia.

Conclusion: Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to further mitigate the risk of stillbirth.

Keywords: SGA; fetal growth restriction; perinatal death; premature birth; stillbirth; term birth.

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Conflict of interest statement

M.C.V. was supported by CAPES (BEX 9571/13‐2). S.R., K.C., A.H. and J.S. were supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust. D.A.L.'s contributions were supported by the Bristol NIHR Biomedical Research Centre and her NIHR Senior Investigator Award (NF‐0616‐10102). D.A.L. has received support from Medtronic Ltd. and Roche Diagnostics for research unrelated to that presented here and that ended 5 years or more ago. D.A.L.'s contribution is supported by the UK Medical Research Council (MC_UU_00032/05) and the British Heart Foundation (CH/F/20/90003). J.S. is supported by an NIHR Senior Investigator Award. N.M. reports personal fees from Takeda, personal fees from RSM Consulting, personal fees from Novartis, outside the submitted work. N.M. receives a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme at UCLH/UCL. B.T. is the Clinical Director and J.S. is a programme lead of the Tommy's National Centre for Maternity Improvement based at the Royal College of Obstetrics and Gynaecology; the Centre's objective is to translate the latest evidence into clinical practice in the United Kingdom. J.S. is Head of Maternity and Midwifery Research at NHS England. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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References

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Differences in Factors Associated With Preterm and Term Stillbirth: A Secondary Cohort Analysis of the DESiGN Trial

Affiliations

Differences in Factors Associated With Preterm and Term Stillbirth: A Secondary Cohort Analysis of the DESiGN Trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous