Incidence of stillbirth: effect of deprivation

Abstract

Objectives To examine the relationship between the English index of multiple deprivation (IMD) and the incidence of stillbirth and assess whether IMD contributes to the prediction of stillbirth provided by the combination of maternal demographic characteristics and elements of medical history. Methods This was a prospective, observational study of 159 125 women with a singleton pregnancy who attended their first routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation in two maternity hospitals in the UK. The inclusion criterion was delivery at ≥ 24 weeks' gestation of a fetus without major abnormality. Participants completed a questionnaire on demographic characteristics and obstetric and medical history. IMD was used as a measure of socioeconomic status, which takes into account income, employment, education, skills and training, health and disability, crime, barriers to housing and services, and living environment. Each neighborhood is ranked according to its level of deprivation relative to that of other areas into one of five equal groups, with Quintile 1 containing the 20% most deprived areas and Quintile 5 containing the 20% least deprived areas. Logistic regression analysis was used to determine whether IMD provided a significant independent contribution to stillbirth after adjustment for known maternal risk factors. Results The overall incidence of stillbirth was 0.35% (551/159 125), and this was significantly higher in the most deprived compared with the least deprived group (Quintile 1 vs Quintile 5). The odds ratio (OR) in Quintile 1 was 1.57 (95% CI, 1.16–2.14) for any stillbirth, 1.64 (95% CI, 1.20–2.28) for antenatal stillbirth and 1.89 (95% CI, 1.23–2.98) for placental dysfunction‐related stillbirth. In Quintile 1 (vs Quintile 5), there was a higher incidence of factors that contribute to stillbirth, including black race, increased body mass index, smoking, chronic hypertension and previous stillbirth. The OR of black (vs white) race was 2.58 (95% CI, 2.14–3.10) for any stillbirth, 2.62 (95% CI, 2.16–3.17) for antenatal stillbirth and 3.34 (95% CI, 2.59–4.28) for placental dysfunction‐related stillbirth. Multivariate analysis showed that IMD did not have a significant contribution to the prediction of stillbirth provided by maternal race and other maternal risk factors. In contrast, in black (vs white) women, the risk of any and antenatal stillbirth was 2.4‐fold higher and the risk of placental dysfunction‐related stillbirth was 2.9‐fold higher after adjustment for other maternal risk factors. Conclusions The incidence of stillbirth, particularly placental dysfunction‐related stillbirth, is higher in women living in the most deprived areas in South East England. However, in screening for stillbirth, inclusion of IMD does not improve the prediction provided by race, other maternal characteristics and elements of medical history. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Maternal ethnicity and socioeconomic deprivation: influence on adverse pregnancy outcomes

“…However, the authors demonstrated that incorporating IMD quintiles into screening algorithms did not improve the prediction of pre-eclampsia or stillbirth. It is of note that in the latter study, only 15% of women were of black origin, whereas 47% were from the most socioeconomically deprived areas (IMD quintiles 1 and 2) 3 .…”

“…The most deprived areas were allocated to the lowest group (Group 1), while the least deprived were in the highest group (Group 10). IMD indices have been used extensively in the literature as a proxy for socioeconomic deprivation 3,9,13 , and are periodically updated 8 .…”

“…A more recent publication, by Arechvo et al, showed that in a cohort of 159 125 singleton pregnancies, the risks of pre-eclampsia and stillbirth were 2-to 3-fold higher in women of black ethnicity when compared with white women 3 . They also reported that women living in underprivileged conditions had an increased risk of pre-eclampsia and stillbirth.…”

“…The FMF first-trimester combined screening algorithm has demonstrated superior detection rates for pre-eclampsia and small-for-gestational-age birth compared with the use of a checklist-based approach 22 . This can be attributed to the algorithm's incorporation of various demographic characteristics, risk factors and biomarkers, including ethnicity but not IMD indices 3,7,10,23,24 .…”

“…Black and ethnic minority groups represent a subset of the population at greatest risk of an adverse health outcome. In pregnancy, complications such as pre-eclampsia and perinatal mortality are more prevalent in women of black and South Asian ethnicity when compared with white women [1][2][3] . Similarly, socioeconomic deprivation also constitutes a key driver for both general and pregnancy-specific adverse outcomes [3][4][5][6] .…”