Objective
We sought to determine factors associated with racial disparities in stillbirth risk.
Study Design
Stillbirth hazard was analyzed using 5,138,122 singleton gestations from the National
Center of Health Statistics perinatal mortality and birth files, 2001–2002.
Results
Black women have a 2.2-fold increased risk of stillbirth compared with white women.
The black/white disparity in stillbirth hazard at 20–23 weeks is 2.75, decreasing
to 1.57 at 39–40 weeks. Higher education reduced the hazard for whites more than for
blacks and Hispanics. Medical, pregnancy, and labor complications accounted for 30%
of the hazard in blacks and 20% in whites and Hispanics. Congenital anomalies and
small for gestational age contributed more to preterm stillbirth risk among whites
than blacks. Pregnancy and labor conditions contributed more to preterm stillbirth
risk among blacks than whites.
Conclusion
The excess stillbirth risk for blacks was greatest at preterm gestations, and factors
contributing to stillbirth risk vary by race and gestational age.
Key words
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References
- Fetal and perinatal mortality, United States, 2003.Natl Vital Stat Rep. 2007; 55: 1-18
- Racial/ethnic trends in fetal mortality–United States, 1990-2000.MMWR Morb Mortal Wkly Rep. 2004; 53: 529-532
- Racial disparity in stillbirth among singleton, twin, and triplet gestations in the United States.Obstet Gynecol. 2004; 104: 734-740
- Risk factors for antepartum and intrapartum stillbirth: a population-based study.Am J Obstet Gynecol. 2007; 196: 499-507
- Racial and ethnic differences in perinatal mortality: the role of fetal death.Ann Epidemiol. 2006; 16: 485-491
- for the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.Am J Epidemiol. 2002; 156: 493-497
- Fetal deaths in the United States, 1997 vs 1991.Am J Obstet Gynecol. 2005; 193: 489-495
- Stillbirth and infant mortality among Hispanic singletons, twins and triplets in the United States.Am J Obstet Gynecol. 2005; 105: 789-796
- Risk factors for fetal death in white, black and Hispanic women.Obstet Gynecol. 1994; 84: 490-495
- Stillbirths in the United States, 1981-2000: an age, period, and cohort analysis.Am J Public Health. 2005; 95: 2213-2217
- Maternal age and the risk of stillbirth throughout pregnancy in the United States.Am J Obstet Gynecol. 2006; 195: 764-770
- Ethnic differences in neonatal and postneonatal mortality.Pediatrics. 2005; 115: e44-e51
- Adverse pregnancy outcomes: differences between US- and foreign-born women in major US racial and ethnic groups.Am J Public Health. 1996; 86: 837-843
- Rates of fetal death by maternal race, ethnicity, and nativity: New Jersey, 1991-1998.JAMA. 2001; 285: 2978-2979
- State-specific trends in US live births to women born outside the 50 states and the District of Columbia–United States, 1990 and 2000.MMWR Morb Mortal Wkly Rep. 2002; 51: 1091-1095
- Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy.Psychol Bull. 2005; 131: 662-683
- Infant mortality difference between whites and African Americans: the effect of maternal education.Am J Public Health. 1998; 88: 651-656
- Births: final data for 2002.Natl Vital Stat Rep. 2003; 52: 1-114
- Racial disparities in term induction rates in Illinois.Med Care. 2008; 46: 900-904
- Differences in late fetal death rates in association with determinants of small for gestational age fetuses: population-based cohort study.BMJ. 1998; 316: 1483-1487
- Analysis of birthweight and gestational age in antepartum stillbirths.BJOG. 1998; 105: 524-530
- Perinatal outcome in SGA births defined by customized versus population-based birthweight standards.BJOG. 2001; 108: 830-834
- Growth retardation in preterm infants.BJOG. 1987; 94: 115-120
- Newborn weight charts underestimate the incidence of low birthweight in preterm infants.Am J Obstet Gynecol. 2008; 199: 139.e1-139.e6
- The use of United States vital statistics in perinatal and obstetric research.Am J Obstet Gynecol. 2006; 194: 911-915
- The national fetal death file.Semin Perinatol. 2002; 26: 3-11
- Fetal and perinatal mortality United States, 2004.Natl Vital Stat Rep. 2007; 56: 1-20
- The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data.Am J Obstet Gynecol. 2005; 193: 125-134
- Validity of maternal and perinatal risk factors reported on fetal death certificates.Am J Public Health. 2005; 95: 1948-1951
- The changing risk of infant mortality by gestation, plurality, race: 1989-1991 versus 1999-2001.Pediatrics. 2006; 118: 2488-2497
Article info
Publication history
Published online: September 18, 2009
Accepted:
June 23,
2009
Received in revised form:
April 15,
2009
Received:
December 17,
2008
Footnotes
Cite this article as: Willinger M, Ko C-W, Reddy UM. Racial disparities in stillbirth risk across gestation in the United States. Am J Obstet Gynecol 2009;201:469.e1-8.
Identification
Copyright
Published by Elsevier Inc.
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- The study of stillbirthAmerican Journal of Obstetrics & GynecologyVol. 201Issue 5