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01.12.2013 | Research article | Ausgabe 1/2013 Open Access

BMC Pregnancy and Childbirth 1/2013

Risk factors for antepartum stillbirth and the influence of maternal age in New South Wales Australia: A population based study

Zeitschrift:
BMC Pregnancy and Childbirth > Ausgabe 1/2013
Autoren:
Adrienne Gordon, Camille Raynes-Greenow, Kevin McGeechan, Jonathan Morris, Heather Jeffery
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2393-13-12) contains supplementary material, which is available to authorized users.

Competing interests

The authors have no conflict of interest to declare.

Authors' contributions

AG designed the study, linked the datasets, extracted data and drafted the final paper. CRG contributed to data linkage, data analysis and interpretation and drafting the paper. KMG performed statistical analysis and commented on the paper. HJ provided overall supervision and advice. JM provided general advice and comments on the paper. All authors reviewed the study findings and read and approved the final manuscript.

Abstract

Background

Maternal age is a known risk factor for stillbirth and delayed childbearing is a societal norm in developed country settings. The timing and reasons for age being a risk factor are less clear. This study aimed to document the gestational specific risk of maternal age throughout pregnancy and whether the underlying causes of stillbirth differ for older women.

Methods

Using linkage of state maternity and perinatal death data collections the authors assessed risk factors for antepartum stillbirth in New South Wales Australia for births between 2002 – 2006 (n = 327,690) using a Cox proportional hazards model. Gestational age specific risk was calculated for different maternal age groups. Deaths were classified according to the Perinatal Mortality Classifications of the Perinatal Society of Australia and New Zealand.

Results

Maternal age was a significant independent risk factor for antepartum stillbirth (35 – 39 years HR 1.4 95% CI 1.12 – 1.75; ≥ 40 years HR 2.41 95% CI 1.8 – 3.23). Other significant risk factors were smoking HR 1.82 (95% CI 1.56 –2.12) nulliparity HR 1.23 (95% CI 1.08 – 1.40), pre-existing hypertension HR 2.77 (95% CI 1.94 – 3.97) and pre-existing diabetes HR 2.65 (95% CI 1.63 – 4.32). For women aged 40 or over the risk of antepartum stillbirth beyond 40 weeks was 1 in 455 ongoing pregnancies compared with 1 in 1177 ongoing pregnancies for those under 40. This risk was increased in nulliparous women to 1 in 247 ongoing pregnancies. Unexplained stillbirths were the most common classification for all women, stillbirths classified as perinatal infection were more common in the women aged 40 or above.

Conclusions

Women aged 35 or older in a first pregnancy should be counselled regarding stillbirth risk at the end of pregnancy to assist with informed decision making regarding delivery. For women aged 40 or older in their first pregnancy it would be reasonable to offer induction of labour by 40 weeks gestation.
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