Cited by 1,247Global Maternal and Child HealthMaternal and Neonatal HealthcareMaternal and fetal healthcare

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Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis

Flenady, Vicki, Koopmans, Laura, Middleton, Philippa, Frøen, J Frederik, Smith, Gordon C, Gibbons, Kristen, Coory, Michael, Gordon, Adrienne, Ellwood, David, McIntyre, Harold David, Fretts, Ruth, Ezzati, Majid·2011·The Lancet

DOI 10.1016/s0140-6736(10)62233-7

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Abstract

Background Stillbirth rates in high-income countries have shown little or no improvement over the past two decades. Prevention strategies that target risk factors could be important in rate reduction. This systematic review and meta-analysis was done to identify priority areas for stillbirth prevention relevant to those countries.Methods Population-based studies addressing risk factors for stillbirth were identified through database searches. The factors most frequently reported were identified and selected according to whether they could potentially be reduced through lifestyle or medical intervention. The numbers attributable to modifiable risk factors were calculated from data relating to the five high-income countries with the highest numbers of stillbirths and where all the data required for analysis were available. Odds ratios were calculated for selected risk factors, from which population-attributable risk (PAR) values were calculated.Findings Of 6963 studies initially identified, 96 population-based studies were included. Maternal overweight and obesity (body-mass index >25 kg/m(2)) was the highest ranking modifiable risk factor, with PARs of 8-18% across the five countries and contributing to around 8000 stillbirths (≥22 weeks' gestation) annually across all high-income countries. Advanced maternal age (>35 years) and maternal smoking yielded PARs of 7-11% and 4-7%, respectively, and each year contribute to more than 4200 and 2800 stillbirths, respectively, across all high-income countries. In disadvantaged populations maternal smoking could contribute to 20% of stillbirths. Primiparity contributes to around 15% of stillbirths. Of the pregnancy disorders, small size for gestational age and abruption are the highest PARs (23% and 15%, respectively), which highlights the notable role of placental pathology in stillbirth. Pre-existing diabetes and hypertension remain important contributors to stillbirth in such countries.Interpretation The raising of awareness and implementation of effective interventions for modifiable risk factors, such as overweight, obesity, maternal age, and smoking, are priorities for stillbirth prevention in high-income countries.Funding The Stillbirth Foundation Australia, the Department of Health and Ageing, Canberra, Australia, and the Mater Foundation, Brisbane, Australia.

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Authors: Flenady, V., Koopmans, L., Middleton, P., Frøen, J. F., Smith, G. C., Gibbons, K., Coory, M., Gordon, A., Ellwood, D., McIntyre, H. D., Fretts, R., & Ezzati, M.
Affiliations: The University of Queensland (AU)
The University of Adelaide (AU)
Norwegian Institute of Public Health (NO)
University of Cambridge (GB)
Queensland Health (AU)
Royal Prince Alfred Hospital (AU)
Australian National University (AU)
Harvard Vanguard Medical Associates (US)
Imperial College London (GB)
Corresponding author: Flenady, Vicki
ORCID: Flenady, Vicki
Middleton, Philippa
Frøen, J Frederik
Smith, Gordon C
Gibbons, Kristen
Coory, Michael
Gordon, Adrienne
Ellwood, David
Ezzati, Majid
Venue: The Lancet
Publisher: Elsevier BV
Published: 2011-04
Volume: 377
Issue: 9774
Pages: 1331-1340
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(10)62233-7
OpenAlex: W2110678046
Cited by: 1,247
References: 121
Citations by year: 2026: 35 · 2025: 68 · 2024: 81 · 2023: 89 · 2022: 95 · 2021: 92 · 2020: 116 · 2019: 91 · 2018: 81 · 2017: 96 · 2016: 84 · 2015: 80 · 2014: 85 · 2013: 77 · 2012: 52
FWCI: 11.44
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
ANU Open Research (Australian National University) (submittedVersion)
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Keywords: stillbirth, stillbirth prevention, modifiable risk factors, population attributable risk, maternal obesity, maternal overweight, advanced maternal age, maternal smoking, primiparity, small for gestational age, placental abruption, pregestational diabetes, pre-existing hypertension, high-income countries
MeSH terms: Female, Humans, Pregnancy, Risk Factors, Socioeconomic Factors, Developed Countries, Stillbirth

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Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis

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