Improving, but could do better: Trends in gestation‐specific stillbirth in Australia, 1994‐2015

Hilder, Lisa; Flenady, Vicki; Ellwood, David; Donnolley, Natasha; Chambers, Georgina M.

doi:10.1111/ppe.12508

Cited by 19 publications

(20 citation statements)

References 18 publications

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“…Gestational age at birth is strongly linked with the perinatal mortality rate, and a recent Australian analysis showed a shift in gestational age‐specific risk of stillbirth despite a relatively static overall stillbirth rate. These changes reflect a shift in the distribution of reproductive health indicators over time—including rates of smoking in pregnancy, obesity and maternal age, among others—and highlight the importance of examining stillbirth risks by pregnancy stage . Further, perinatal mortality rate disparities in Australian data are likely to reflect differential access to quality care, and the social, economic and environmental processes that pose risks to Aboriginal health outcomes from preconception through early life .…”

Section: Introductionmentioning

confidence: 99%

Disparities between Aboriginal and non‐Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015

Adane

Bailey

Marriott

et al. 2019

Paediatric Perinatal Epid

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Background: Perinatal mortality rates are typically higher in Aboriginal than non-Aboriginal populations of Australia.Objectives: This study aimed to examine the pattern of stillbirth and neonatal mortality rate disparities over time in Western Australia, including an evaluation of these disparities across gestational age groupings. Methods: All singleton births (≥20 weeks gestation) in Western Australia between 1980 and 2015 were included. Linked data were obtained from core population health datasets of Western Australia. Stillbirth and neonatal mortality rates and percentage changes in the rates over time were calculated by Aboriginal status and gestational age categories. Results: From 1980 to 2015, data were available for 930 926 births (925 715 livebirths, 5211 stillbirths and 2476 neonatal deaths). Over the study period, there was a substantial reduction in both the Aboriginal (19.6%) and non-Aboriginal (32.3%) stillbirth rates. These reductions were evident in most gestational age categories among non-Aboriginal births and in Aboriginal term births. Concomitantly, neonatal mortality rates decreased in all gestational age windows for both populations, ranging from 32.1% to 77.5%. The overall stillbirth and neonatal mortality rate differences between Aboriginal and non-Aboriginal birth decreased by 0.6 per 1000 births and 3.9 per 1000 livebirths, respectively, although the rate ratios (RR 2.51, 95% CI 2.14, 2.94) and (RR 2.94, 95% CI 2.24, 3.85), respectively reflect a persistent excess of Aboriginal perinatal mortality across the study period. Conclusions: Despite steady improvements in perinatal mortality rates in Western Australia over 3½ decades, the gap between Aboriginal and non-Aboriginal rates remains unchanged in relative terms. There is a continuing, pressing need to address modifiable risk factors for preventable early mortality in Aboriginal populations. K E Y W O R D S aboriginal, neonatal mortality, perinatal mortality, stillbirth, trend, Western Australia | 413 ADANE Et Al.

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Section: Introductionmentioning

confidence: 99%

Disparities between Aboriginal and non‐Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015

Adane

Bailey

Marriott

et al. 2019

Paediatric Perinatal Epid

View full text Add to dashboard Cite

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“…The 2016 Lancet Ending Preventable Stillbirths series highlighted differences in rates of late stillbirth (≥ 28 weeks) between high-income countries ranging from 1.7 per 1,000 to 8.8 per 1,000 births (4). In Australia, over 2,000 families each year -six families each day -have a stillbirth, and there has been no improvement in stillbirth rates among late pregnancy stillbirths for over 20 years (5). Among women who were born elsewhere (6,7), women with lower socioeconomic status (8), and women who identify as Aboriginal and Torres Strait Islander (9), the risk of stillbirth is higher (4,10).…”

Section: Introductionmentioning

confidence: 99%

“…Around 38 weeks gestation, the risk of stillbirth increases overall and varies by maternal and clinical characteristics while the decision on whether or not to intervene becomes more challenging (5,9,15,16). The balance between benefit and harm is complicated by potentially avoiding a stillbirth at the risk of neonatal morbidity (17).…”

Section: Introductionmentioning

confidence: 99%

Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

Sexton

Coory

Kumar

et al. 2020

Preprint

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Background Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform decision-making around timing of birth to reduce the risk of stillbirth from 35 weeks gestation. Methods This is a protocol for a retrospective cohort study of all late-pregnancy births in Australia (1998-2015) from 35 weeks gestation including 7,200 stillbirths among 4.9 million births at an estimated rate of 1.47 stillbirths per 1000 live births. A multivariable logistic regression model will be developed in line with current T ransparent R eporting of a multivariable prediction model for I ndividual P rognosis or D iagnosis (TRIPOD) guidelines to estimate the gestation-specific probability of stillbirth with prediction intervals. Candidate predictors were identified from systematic reviews and clinical consultation and will be assessed through univariate regression analysis. To generate a final model, elimination by backward stepwise logistic regression will be performed. The model will be internally validated using K-fold cross-validation and externally validated using a geographically unique dataset. Overall model performance will be assessed with R 2 in addition calibration and discrimination. Calibration will be visualized using a calibration plot. Discrimination will be measured by the C- statistic and visualized using area underneath the receiver-operator curves (AUROC). Clinical usefulness will be reported as positive and negative predictive values and a decision curve analysis will be considered. Discussion A robust method to predict a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform timely, appropriate care to reduce stillbirth. Among existing prediction models designed for obstetric use, few have been subject to internal and external validation and many fail to meet recommended reporting standards. In developing a risk prediction model for late-gestation stillbirth with both providers and pregnant women in mind, we endeavor to develop a validated model for clinical use in Australia that meets current reporting standards.

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“…The 2016 Lancet Ending Preventable Stillbirths series highlighted differences in rates of late stillbirth (≥28 weeks) between high-income countries ranging from 1.7 per 1,000 to 8.8 per 1,000 births (4). Australia is a high-income country where over 2,000 families each year -six families each day -experience stillbirth, with no improvement in stillbirth rates among late pregnancy stillbirths for over 20 years (5,6). Among women who were born elsewhere (7,8), women with lower socioeconomic status (9), and women who identify as Aboriginal and Torres Strait Islander (10), the risk of stillbirth is higher (4,11).…”

Section: Introductionmentioning

confidence: 99%

“…Around 38 weeks gestation, the risk of stillbirth increases overall and varies by maternal and clinical characteristics while the decision on whether to intervene becomes more challenging (5,10,16,17). The balance between bene t and harm is complicated by potentially avoiding a stillbirth at the risk of neonatal morbidity (18).…”

Section: Introductionmentioning

confidence: 99%

Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

Sexton

Coory

Kumar

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth may inform decision-making around timing of birth to reduce the risk of stillbirth from 35 weeks gestation in Australia, a high-resource setting.Methods: This is a protocol for a cross-sectional study of all late-pregnancy births in Australia (2005-2015) from 35 weeks gestation including 5,188 stillbirths among 3.1 million births at an estimated rate of 1.7 stillbirths per 1000 births. A multivariable logistic regression model will be developed in line with current Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) guidelines to estimate the gestation-specific probability of stillbirth with prediction intervals. Candidate predictors were identified from systematic reviews and clinical consultation and will be assessed through univariable regression analysis. To generate a final model, elimination by backward stepwise multivariable logistic regression will be performed. The model will be internally validated using bootstrapping with 1000 repetitions and externally validated using a temporally unique dataset. Overall model performance will be assessed with R2, calibration, and discrimination. Calibration will be reported using a calibration plot with 95% confidence intervals (α=0.05). Discrimination will be measured by the C-statistic and area underneath the receiver-operator curves. Clinical usefulness will be reported as positive and negative predictive values and a decision curve analysis will be considered. Discussion: A robust method to predict a pregnant woman’s individualized risk of late-pregnancy stillbirth may inform timely, appropriate care to reduce stillbirth. Among existing prediction models designed for maternity use, few have been subject to internal and external validation and many fail to meet recommended reporting standards. In developing a risk prediction model for late-gestation stillbirth with both providers and pregnant women in mind, we endeavor to develop a validated model for clinical use in Australia that meets current reporting standards.

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Improving, but could do better: Trends in gestation‐specific stillbirth in Australia, 1994‐2015

Cited by 19 publications

References 18 publications

Disparities between Aboriginal and non‐Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015

Disparities between Aboriginal and non‐Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015

Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

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