RISK-FACTORS FOR FETAL DEATH IN WHITE, BLACK, AND HISPANIC WOMEN

Objective: To document the relation between stillbirth and various dem ographic, obstetric, and medical risk factors. Methods: We analyzed th e risk factors and medical origins of 403 stillbirths. The population studied included 34,350 births occurring during the March of Dimes Pre term Birth Prevention Trial. All births occurring in five perinatal ce nters from 1982-1986 were included in the analysis. Stillbirth was def ined as those infants born at 20 weeks' gestation or later whose Apgar score was 0 at 1 and 5 minutes. Results: Stillbirth occurred in 1.2% of all births. Fifty-one percent occurred before 28 weeks and only 18% were at term. Blacks had a greater risk of stillbirth when compared t o other women. Prior preterm delivery yielded nearly a twofold increas e in the risk of stillbirth. Preeclampsia, chronic hypertension, and c lass A or class B-R diabetes were not associated with an increased ris k of stillbirth. Other medical factors (hemoglobinopathies, Rh sensiti zation) resulted in a greater than sixfold increase in the rate of sti llbirth, and congenital anomalies resulted in a fivefold increase. Abr uption was associated with a 12-fold increase in the risk of stillbirt h; nearly 14% of all stillbirths were associated with abruption. Concl usion: Eighty-two percent of all stillbirths occurred before term, and more than 50% occurred before 28 weeks. The majority of stillbirths w ere not explained by medical complications, but instead were often ass ociated with other risk factors related to preterm birth. Further inve stigations are needed to understand the complex etiology of stillbirth .