Ethnic variation in causes of stillbirth in high‐income countries: A systematic review and meta‐analysis

Abstract

Stillbirth is a devastating pregnancy outcome that not only has emotional, psychological, and financial consequences for affected women and families, 1 but also impacts individual healthcare workers, health care networks and the wider society. 2 The global stillbirth rate is estimated to be 18.4 per 1000 births, equating to approximately 2.6 million stillbirths every year. 3 The World Health Organization's (WHO) Every Newborn: An Action Plan to End Preventable Deaths aims to reduce the stillbirth rate to ≤12 per 1000 births by 2030 worldwide. 4 For countries already meeting this target, mostly high-income nations, the Every Newborn initiative aims to reduce equity gaps within the population. 4,5 Despite similar access to healthcare services, 6 inequities in stillbirth rates continue to persist in high income nations, especially in certain minority ethnic groups. For example, women of ethnic minorities who birth in Australia or Europe have stillbirth rates 2-3 times higher than Caucasian women. 7-9 A similar trend is observed

Causes of stillbirth in ethnically diverse women in a Perth metropolitan hospital: A retrospective study

“…also found that South Asian women in New Zealand were more likely to have placentas showing histologic chorioamnionitis or chorionic vasculitis than other ethnicities 26 . This is consistent with a recent systematic review by Bhat et al ., which reported women of Asian and South Asian ethnicities were most likely to suffer stillbirth caused by complications of the ‘placenta, cord and membranes’ compared to other ethnicities 11 …”

“…Second, use of well‐recognised classification systems such as the PSANZ‐PDC allows standardised and ready comparisons to be made between cohorts and studies. Third, we did not use surrogate markers of ethnic identity such as language or mother tongue, an identified limitation in other studies; 11 instead, ethnicity was self‐identified by women. Using self‐identified ethnic categories also omitted any possible bias that may be introduced by a possible third party assigning ethnicity, where assumptions based on surname or language may have been introduced.…”

“…11 Furthermore, data on the topic remain too heterogeneous in terms of collected stillbirth parameters, definitions, classification systems used, and outcomes measured to draw reliable conclusions, with only a minority of studies utilising the gold standard of perinatal autopsy and placental histopathology to reliably determine cause of stillbirth. 11 The objective of this study was to investigate whether causes of stillbirth differ between Caucasian and non-Caucasian ethnic groups in an Australian context using perinatal autopsy and placental histopathology data. The broader aim was to identify focal areas for improvement in reducing stillbirth rates by implementing preventative strategies that are targeted toward different societal groups to reduce equity gaps in stillbirth.…”

“…Compared to research investigating stillbirth risk factors, studies exploring actual causes of stillbirth among women of different ethnicities are relatively scarce 11 . Furthermore, data on the topic remain too heterogeneous in terms of collected stillbirth parameters, definitions, classification systems used, and outcomes measured to draw reliable conclusions, with only a minority of studies utilising the gold standard of perinatal autopsy and placental histopathology to reliably determine cause of stillbirth 11 . The objective of this study was to investigate whether causes of stillbirth differ between Caucasian and non‐Caucasian ethnic groups in an Australian context using perinatal autopsy and placental histopathology data.…”