Maternal and fetal risk factors for stillbirth: population based study
Open accessAbstract
OBJECTIVE: To assess the main risk factors associated with stillbirth in a multiethnic English maternity population. DESIGN: Cohort study. SETTING: National Health Service region in England. POPULATION: 92,218 normally formed singletons including 389 stillbirths from 24 weeks of gestation, delivered during 2009-11. MAIN OUTCOME MEASURE: Risk of stillbirth. RESULTS: Multivariable analysis identified a significant risk of stillbirth for parity (para 0 and para ≥ 3), ethnicity (African, African-Caribbean, Indian, and Pakistani), maternal obesity (body mass index ≥ 30), smoking, pre-existing diabetes, and history of mental health problems, antepartum haemorrhage, and fetal growth restriction (birth weight below 10th customised birthweight centile). As potentially modifiable risk factors, maternal obesity, smoking in pregnancy, and fetal growth restriction together accounted for 56.1% of the stillbirths. Presence of fetal growth restriction constituted the highest risk, and this applied to pregnancies where mothers did not smoke (adjusted relative risk 7.8, 95% confidence interval 6.6 to 10.9), did smoke (5.7, 3.6 to 10.9), and were exposed to passive smoke only (10.0, 6.6 to 15.8). Fetal growth restriction also had the largest population attributable risk for stillbirth and was fivefold greater if it was not detected antenatally than when it was (32.0% v 6.2%). In total, 195 of the 389 stillbirths in this cohort had fetal growth restriction, but in 160 (82%) it had not been detected antenatally. Antenatal recognition of fetal growth restriction resulted in delivery 10 days earlier than when it was not detected: median 270 (interquartile range 261-279) days v 280 (interquartile range 273-287) days. The overall stillbirth rate (per 1000 births) was 4.2, but only 2.4 in pregnancies without fetal growth restriction, increasing to 9.7 with antenatally detected fetal growth restriction and 19.8 when it was not detected. CONCLUSION: Most normally formed singleton stillbirths are potentially avoidable. The single largest risk factor is unrecognised fetal growth restriction, and preventive strategies need to focus on improving antenatal detection.
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One study found an elevated risk for stillbirth in women with a history of mental health problems compared to controls with no previous mental illness.
“For example, one study [58] found an elevated risk for SB in women with a history of mental health problems compared to controls with no previous mental illness.”
From Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review (2021) · cites this paper as [58]
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Yaşlı Kadınlarda Üreme Sağlığı
Kokanalı, D., & Engin Üstün, Y. (n.d.) · DergiPark (Istanbul University) · Cited by 170,090 · see citing works
Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis
Flenady, V., Koopmans, L., Middleton, P., Frøen, J. F., Smith, G. C., Gibbons, K., Coory, M., Gordon, A., Ellwood, D., McIntyre, H. D., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62233-7 · Cited by 1,247 · see citing works
Customised antenatal growth charts
Gardosi, J. O., Chang, A., Kalyan, B., Sahota, D. S., & Symonds, M. E. (1992) · The Lancet · doi:10.1016/0140-6736(92)91342-6 · Cited by 846 · see citing works
Self-citationAn adjustable fetal weight standard
Gardosi, J. O., Mongelli, M., Wilcox, M., & Chang, A. (1995) · Ultrasound in Obstetrics and Gynecology · doi:10.1046/j.1469-0705.1995.06030168.x · Cited by 568 · see citing works
Self-citationClassification of stillbirth by relevant condition at death (ReCoDe): population based cohort study
Gardosi, J. O., Kady, S. M., McGeown, P., Francis, A. I., & Tonks, A. M. (2005) · BMJ · doi:10.1136/bmj.38629.587639.7c · Cited by 544 · see citing works
Self-citationLindqvist, P. G., & Molin, J. (2005) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.1806 · Cited by 539 · see citing works
Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management
Figueras, F., & Gardosi, J. (2011) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.08.055 · Cited by 485 · see citing works
Self-citationStillbirths: the way forward in high-income countries.
Flenady, V., Middleton, P., Smith, G. C. S., Duke, W., Erwich, J., Khong, T., Neilson, J., Ezzati, M., Koopmans, L., Ellwood, D., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60064-0 · Cited by 470 · see citing works
Causes of death among stillbirths
(2011) · JAMA · doi:10.1001/jama.2011.1823 · Cited by 444 · see citing works
Obstetric and Perinatal Outcomes in Type 1 Diabetic Pregnancies
Persson, M., Norman, M., & Hanson, U. (2009) · Diabetes Care · doi:10.2337/dc09-0656 · Cited by 437 · see citing works
Doppler ultrasonography in high-risk pregnancies: Systematic review with meta-analysis
Alfirevic, Z., & Neilson, J. P. (1995) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(95)90466-2 · Cited by 414 · see citing works
Bai, J. Y., Wong, F., Bauman, A. E., & Mohsin, M. (2002) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2002.119639 · Cited by 353 · see citing works
Restricted fetal growth in sudden intrauterine unexplained death
Frøen, J. F., Gardosi, J. O., Thurmann, A., Francis, A. I., & Stray‐Pedersen, B. (2004) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/j.0001-6349.2004.00602.x · Cited by 345 · see citing works
Self-citationMcCowan, L. M. E., Dekker, G. A., Chan, E., Stewart, A., Chappell, L. C., Hunter, M., Moss-Morris, R., North, R. A., & On behalf of the SCOPE consortium (2009) · BMJ · doi:10.1136/bmj.b1081 · Cited by 284 · see citing works
Schick, S. F., & Glantz, S. A. (2005) · Tobacco Control · doi:10.1136/tc.2005.011288 · Cited by 275 · see citing works
Secondhand Smoke and Adverse Fetal Outcomes in Nonsmoking Pregnant Women: A Meta-analysis
Leonardi‐Bee, J., Britton, J. R., & Venn, A. J. (2011) · PEDIATRICS · doi:10.1542/peds.2010-3041 · Cited by 262 · see citing works
Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation
(2011) · JAMA · doi:10.1001/jama.2011.1798 · Cited by 256 · see citing works
Maternal age and malformations in singleton births
Hollier, L. H. (2000) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(00)01019-x · Cited by 242 · see citing works
Analysis of birthweight and gestational age in antepartum stillbirths
Gardosi, J. O., Mul, T., Mongelli, M., & Fagan, D. G. (1998) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1998.tb10153.x · Cited by 217 · see citing works
Self-citationControlled trial of fundal height measurement plotted on customised antenatal growth charts
Gardosi, J. O., & Francis, A. I. (1999) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1999.tb08267.x · Cited by 173 · see citing works
Self-citationMajor Risk Factors for Stillbirth in High-Income Countries: A Systematic Review and Meta-Analysis
Flenady, V., Koopmans, L., Middleton, P., Frøen, J. F., Smith, G. C. S., GIBBONS, K. S., Coory, M. D., Gordon, A., Ellwood, D. A., McIntyre, D. H., et al. (2011) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0b013e318235215c · Cited by 162 · see citing works
Genest, D. R., Williams, M., & Greene, M. F. (1992) · PubMed · Cited by 131 · see citing works
Self-citationKorteweg, F. J., Gordijn, S. J., Timmer, A., Holm, J. P., Ravisé, J. M., & Erwich, J. J. (2007) · Placenta · doi:10.1016/j.placenta.2007.07.003 · Cited by 103 · see citing works
Identifying the causes of stillbirth: a comparison of four classification systems
Vergani, P., Cozzolino, S., Pozzi, E., Cuttin, M. S., Greco, M., Ornaghi, S., & Lucchini, V. (2008) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2008.06.098 · Cited by 97 · see citing works
Customized fetal weight limits for antenatal detection of fetal growth restriction
de Jong, C. L. D., Francis, A., van Geijn, H. P., & Gardosi, J. O. (2000) · Ultrasound in Obstetrics and Gynecology · doi:10.1046/j.1469-0705.2000.00001.x · Cited by 85 · see citing works
Self-citationRisk of stillbirth and neonatal death linked with maternal mental illness: a national cohort study
King-Hele, S. A., Webb, R. T., Mortensen, P. B., Appleby, L., Pickles, A. R., & Abel, K. M. (2008) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2007.135459 · Cited by 74 · see citing works
Reeske, A., Kutschmann, M., Razum, O., & Spallek, J. (2011) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-11-63 · Cited by 70 · see citing works
Stacey, T., Thompson, J., Mitchell, E. A., ZUCCOLLO, J. M., Ekeroma, A. J., & McCowan, L. M. E. (2012) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.2011.01406.x · Cited by 69 · see citing works
Customised assessment of fetal growth potential: implications for perinatal care
Gardosi, J. O. (2012) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/fetalneonatal-2012-301708 · Cited by 58 · see citing works
Self-citationKooperberg, C. L., & Petitti, D. B. (1991) · Epidemiology · doi:10.1097/00001648-199109000-00009 · Cited by 57 · see citing works
Maternal Age and Malformations in Singleton Births
Hollier, L. M., Leveno, K. J., Kelly, M. A., et al. (2000) · Obstetrics and Gynecology · doi:10.1097/00006250-200011000-00011 · Cited by 55 · see citing works
Roex, A., Nikpoor, P., van Eerd, E., et al. (2012) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.2011.01408.x · Cited by 39 · see citing works
Customised antenatal growth charts
Chard, T., Macintosh, M. C. M., Yoong, A. K. H., Chang, T. C., Robson, S. C., Spencer, J. A. D., Steer, P. J., Gardosi, J. O., Chang, A., & Symonds, M. E. (1992) · The Lancet · doi:10.1016/0140-6736(92)90327-y · Cited by 34 · see citing works
Self-citationHealth‐risk behaviours: examining social disparities in the occurrence of stillbirth
Goy, J., Dodds, L. A., Rosenberg, M. W., & King, W. D. (2008) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2008.00947.x · Cited by 31 · see citing works
Doppler ultrasonography in high-risk pregnancies: Systematic review with meta-analysis
(1996) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(96)88078-7 · Cited by 16 · see citing works
Secondhand Smoke and Adverse Fetal Outcomes in Nonsmoking Pregnant Women: A Meta-analysis
Stockman, J. A. (2012) · Yearbook of Pediatrics · doi:10.1016/j.yped.2011.06.039 · Cited by 12 · see citing works
Analysis of birthweight and gestational age in antepartum stillbirths
Ong, S. S., & Danielian, P. (1998) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1998.tb09986.x · Cited by 7 · see citing works
Causes of Death Among Stillbirths
Dungan, J. S. (2012) · Yearbook of Obstetrics Gynecology and Women s Health · doi:10.1016/j.yobg.2012.06.108 · Cited by 3 · see citing works
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Consensus definition of fetal growth restriction: a Delphi procedure: Consensus definition of FGR
Gordijn, S. J., Beune, I. M., Thilaganathan, B., Papageorghiou, A., Baschat, A. A., Baker, P. N., Silver, R. M., Wynia, K., & Ganzevoort, W. (2016) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.15884 · Cited by 1,638 · see citing works
Papageorghiou, A. T., Ohuma, E. O., Altman, D. G., Todros, T., Ismail, L. C., Lambert, A., Jaffer, Y. A., Bertino, E., Gravett, M. G., Purwar, M., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61490-2 · Cited by 870 · see citing works
Lees, C. C., Stampalija, T., Baschat, A. A., da Silva Costa, F., Ferrazzi, E., Figueras, F., Hecher, K., Kingdom, J., Poon, L. C., Salomon, L. J., et al. (2020) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.22134 · Cited by 886 · see citing works
Aune, D., Saugstad, O. D., Henriksen, T., & Tonstad, S. (2014) · JAMA · doi:10.1001/jama.2014.2269 · Cited by 631 · see citing works
Hug, L., You, D., Blencowe, H., Mishra, A., Wang, Z., Fix, M. J., Wakefield, J., Moran, A. C., Gaigbe-Togbe, V., Suzuki, E., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01112-0 · Cited by 527 · see citing works
McCowan, L. M., Figueras, F., & Anderson, N. H. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.12.004 · Cited by 451 · see citing works
Diagnosis and surveillance of late-onset fetal growth restriction
Figueras, F., Caradeux, J., Crispi, F., Eixarch, E., Peguero, A., & Gratacos, E. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.12.003 · Cited by 300 · see citing works
Management of Stillbirth: Obstetric Care Consensus No, 10
(2020) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000003719 · Cited by 174 · see citing works
Unterscheider, J., O’Donoghue, K., Daly, S., Geary, M. P., Kennelly, M. M., McAuliffe, F. M., Hunter, A., Morrison, J. J., Burke, G., Dicker, P., et al. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-14-63 · Cited by 172 · see citing works
Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review
Westby, C. L., Erlandsen, A. R., Nilsen, S. A., Visted, E., & Thimm, J. C. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-04254-x · Cited by 130 · see citing works
“For example, one study [58] found an elevated risk for SB in women with a history of mental health problems compared to controls with no previous mental illness.”
BackgroundCaradeux, J., Martinez-Portilla, R. J., Peguero, A., Sotiriadis, A., & Figueras, F. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.09.043 · Cited by 122 · see citing works
Effects of maternal obstructive sleep apnoea on fetal growth: a prospective cohort study
Fung, A. M., Wilson, D. L., Lappas, M., Howard, M., Barnes, M., O'Donoghue, F., Tong, S., Esdale, H., Fleming, G., & Walker, S. P. (2013) · PLoS ONE · doi:10.1371/journal.pone.0068057 · Cited by 119 · see citing works
Caradeux, J., Martinez-Portilla, R. J., Basuki, T. R., Kiserud, T., & Figueras, F. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.11.566 · Cited by 115 · see citing works
Parents' experiences about support following stillbirth and neonatal death
Camacho Ávila, M., Fernández Medina, I. M., Jiménez-López, F. R., Granero-Molina, J., Hernández-Padilla, J. M., Hernández Sánchez, E., & Fernández-Sola, C. (2020) · Advances in Neonatal Care · doi:10.1097/anc.0000000000000703 · Cited by 63 · see citing works
Ananth, C. V., & Friedman, A. M. (2014) · Seminars in Perinatology · doi:10.1053/j.semperi.2014.03.007 · Cited by 58 · see citing works
Risk factors for stillbirths: how much can a responsive health system prevent?
Neogi, S. B., Sharma, J., Negandhi, P., Chauhan, M., Reddy, S., & Sethy, G. (2018) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-018-1660-1 · Cited by 53 · see citing works
Monier, I., Ancel, P.-Y., Ego, A., Jarreau, P.-H., Lebeaux, C., Kaminski, M., Goffinet, F., & Zeitlin, J. (2017) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.02.001 · Cited by 46 · see citing works
Meler, E., Mazarico, E., Eixarch, E., Gonzalez, A., Peguero, A., Martinez, J., Boada, D., Vellvé, K., Gomez‐Roig, M. D., Gratacós, E., et al. (2021) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.23537 · Cited by 36 · see citing works
Wernham, E., Gurney, J., Stanley, J., Ellison-Loschmann, L., & Sarfati, D. (2016) · PLOS Medicine · doi:10.1371/journal.pmed.1002134 · Cited by 37 · see citing works
Dhalwani, N. N., Szatkowski, L., Coleman, T., Fiaschi, L., & Tata, L. J. (2019) · Nicotine & Tobacco Research · doi:10.1093/ntr/nty019 · Cited by 15 · see citing works
Addressing Stillbirth in India Must Include Men
Roberts, L., Montgomery, S., Ganesh, G., Kaur, H. P., & Singh, R. (2017) · Issues in Mental Health Nursing · doi:10.1080/01612840.2017.1294220 · Cited by 14 · see citing works
- Authors
- Gardosi, J., Madurasinghe, V., Williams, M., Malik, A., & Francis, A.
- Affiliations
- University of Warwick (GB)
- Perinatal Institute (GB)
- Corresponding author
- Gardosi, J.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2013-01-24
- Volume
- 346
- Issue
- jan24 3
- Pages
- f108-f108
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3554866
- OpenAlex
- W2079192915
- Cited by
- 941
- References
- 39
- Citations by year
- 2026: 43 · 2025: 79 · 2024: 75 · 2023: 66 · 2022: 96 · 2021: 109 · 2020: 89 · 2019: 70 · 2018: 74 · 2017: 67 · 2016: 61 · 2015: 36 · 2014: 48 · 2013: 27
- FWCI
- 53.52
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- stillbirth, fetal growth restriction, maternal obesity, smoking during pregnancy, passive smoking, parity, ethnicity, antepartum hemorrhage, pregestational diabetes, maternal mental health, population attributable risk, gestational age at delivery, singleton pregnancy, England, National Health Service, stillbirth rate
- MeSH terms
- Adult, Mental Disorders, Diabetes Mellitus, England, Female, Fetal Growth Retardation, Humans, India, Obesity, Pakistan, Parity, Pregnancy, Pregnancy Complications, Risk Factors, Smoking, Uterine Hemorrhage, Multivariate Analysis, Black People, Stillbirth, Young Adult
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