Findings in Stillbirths Associated with Placental Disease

• Authors: Karen J. Gibbins, Oregon Health and Science University; Halit Pinar, Brown University; Uma M. Reddy, Yale University; George R. Saade, University of Texas Medical Branch; Robert L. Goldenberg, Columbia University; Donald J. Dudley, University of Virginia; Carolyn Drews-Botsch, Emory University; Alexa Ann Freedman, Emory University; Lauren M. Daniels, Emory University; Corette B. Parker, RTI International; Vanessa Thorsten, RTI International; Radek Bukowski, University of Texas Austin; Robert M. Silver, Univ Utah Hlth
• Journal Title: American Journal of Perinatology
• Volume: Volume 37, Number 7
• Publisher: Thieme Medical Publications Inc. | 2020-06-01, Pages 708-715
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1055/s-0039-1688472
• Subjects: Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health; Health Sciences, Pathology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Obstetrics & Gynecology; Pediatrics; placental disease; stillbirth; placental insufficiency; placental pathology; Perivillous fibrin deposition; Maternal floor infarction; Fetal growth restriction; Tobacco smoke; United States; Risk factors; Gestational age; Pregnancy; Women; Disparities

Abstract

Objective: Placental disease is a leading cause of stillbirth. Our purpose was to characterize stillbirths associated with placental disease. Study Design: The Stillbirth Collaborative Research Network conducted a prospective, case-control study of stillbirths and live births from 2006–2008. This analysis includes 512 stillbirths with cause of death assignment and a comparison group of live births. We compared exposures between women with stillbirth due to placental disease and those due to other causes as well as between women with term (≥ 37 weeks) stillbirth due to placental disease and term live births. Results: 121 (23.6%) of 512 stillbirths had a probable or possible cause of death due to placental disease by INCODE. Characteristics were similar between stillbirths due to placental disease and other stillbirths. When comparing term live births to stillbirths due to placental disease, women with non-Hispanic black race, Hispanic ethnicity, lack of insurance, or who were born outside of the United States had higher odds of stillbirth due to placental disease. Nulliparity and antenatal bleeding also increased risk of stillbirth due to placental disease. Conclusion: Multiple discrete exposures were associated with stillbirth caused by placental disease. The relationship between these factors and utility of surveillance warrants further study.