Placental pathology findings amongst extremely preterm perinatal deaths in Aotearoa New Zealand

Graaff, Esti de; Bartlett, Kate; Sadler, Lynn; Lakhdhir, Heena; Simon‐Kumar, Rachel; Peiris‐John, Roshini; Burgess, Wendy; Cronin, Robin; McCowan, Lesley; Anderson, Ngaire

doi:10.1016/j.placenta.2023.04.013

Cited by 4 publications

(1 citation statement)

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“…While induction of labour at term may prevent some perinatal deaths [ 24 , 25 ], it does not come without risk, as studies indicate increased neonatal morbidity [ 26 , 27 ]. Women of South Asian ethnicity have a different pregnancy risk-profile [ 28 ], and differing gestation-specific placental pathology compared with women of other ethnicities [ 29 , 30 ]. It is therefore important to understand the underlying pathology associated with the higher rates of perinatal death in South Asian women.…”

Section: Introductionmentioning

confidence: 99%

An in-depth analysis of perinatal related mortality among women of South Asian ethnicity in Aotearoa New Zealand

Graaff

Sadler

Lakhdhir

et al. 2023

BMC Pregnancy Childbirth

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Background International and national New Zealand (NZ) research has identified women of South Asian ethnicity at increased risk of perinatal mortality, in particular stillbirth, with calls for increased perinatal research among this ethnic group. We aimed to analyse differences in pregnancy outcomes and associated risk factors between South Asian, Māori, Pacific and NZ European women in Aotearoa NZ, with a focus on women of South Asian ethnicity, to ultimately understand the distinctive pathways leading to adverse events. Methods Clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, while national maternity and neonatal data, and singleton birth records from the same decade, were linked using the Statistics NZ Integrated Data Infrastructure for all births. Pregnancy outcomes and risk factors for stillbirth and neonatal death were compared between ethnicities with adjustment for pre-specified risk factors. Results Women of South Asian ethnicity were at increased risk of stillbirth (aOR 1.51, 95%CI 1.29–1.77), and neonatal death (aOR 1.51, 95%CI 1.17–1.92), compared with NZ European. The highest perinatal related mortality rates among South Asian women were between 20–23 weeks gestation (between 0.8 and 1.3/1,000 ongoing pregnancies; p < 0.01 compared with NZ European) and at term, although differences by ethnicity at term were not apparent until ≥ 41 weeks (p < 0.01). No major differences in commonly described risk factors for stillbirth and neonatal death were observed between ethnicities. Among perinatal deaths, South Asian women were overrepresented in a range of metabolic-related disorders, such as gestational diabetes, pre-existing thyroid disease, or maternal red blood cell disorders (all p < 0.05 compared with NZ European). Conclusions Consistent with previous reports, women of South Asian ethnicity in Aotearoa NZ were at increased risk of stillbirth and neonatal death compared with NZ European women, although only at extremely preterm (< 24 weeks) and post-term (≥ 41 weeks) gestations. While there were no major differences in established risk factors for stillbirth and neonatal death by ethnicity, metabolic-related factors were more common among South Asian women, which may contribute to adverse pregnancy outcomes in this ethnic group.

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