1
|
Heazell AE, Wilkinson J, Morris RK, Simpson N, Smith LK, Stacey T, Storey C, Higgins L. Mothers working to prevent early stillbirth study (MiNESS 20-28): a case-control study protocol. BMJ Open 2024; 14:e082835. [PMID: 38238057 PMCID: PMC11148669 DOI: 10.1136/bmjopen-2023-082835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION In the UK, 1600 babies die every year before, during or immediately after birth at 20-28 weeks' gestation. This bereavement has a similar impact on parental physical and psychological well-being to late stillbirth (>28 weeks' gestation). Improved understanding of potentially modifiable risk factors for late stillbirth (including supine going-to-sleep position) has influenced international clinical practice. Information is now urgently required to similarly inform clinical practice and aid decision-making by expectant mothers/parents, addressing inequalities in pregnancy loss between 20 and 28 weeks. METHODS AND ANALYSIS This study focuses on what portion of risk of pregnancy loss 20-28 weeks' gestation is associated with exposures amenable to public health campaigns/antenatal care adaptation. A case-control study of non-anomalous singleton baby loss (via miscarriage, stillbirth or early neonatal death) 20+0 to 27+6 (n=316) and randomly selected control pregnancies (2:1 ratio; n=632) at group-matched gestations will be conducted. Data is collected via participant recall (researcher-administered questionnaire) and extraction from contemporaneous medical records. Unadjusted/confounder-adjusted ORs will be calculated. Exposures associated with early stillbirth at OR≥1.5 will be detectable (p<0.05, β>0.80) assuming exposure prevalence of 30%-60%. ETHICS AND DISSEMINATION NHS research ethical approval has been obtained from the London-Seasonal research ethics committee (23/LO/0622). The results will be presented at international conferences and published in peer-reviewed open-access journals. Information from this study will enable development of antenatal care and education for healthcare professionals and pregnant people to reduce risk of early stillbirth. TRIAL REGISTRATION NUMBER NCT06005272.
Collapse
Affiliation(s)
- Alexander Edward Heazell
- Maternal and Fetal Health Research Centre, The University of Manchester, Manchester, UK
- St. Mary's Hospital, Manchester Academic Health Science Centre, Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - R Katie Morris
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Nigel Simpson
- Obstetrics and Gynaecology, University of Leeds, Leeds, UK
| | - Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Tomasina Stacey
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Lucy Higgins
- Maternal and Fetal Health Research Centre, The University of Manchester, Manchester, UK
- St. Mary's Hospital, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
2
|
Escañuela Sánchez T, O Donoghue K, Byrne M, Meaney S, Matvienko-Sikar K. A systematic review of behaviour change techniques used in the context of stillbirth prevention. Women Birth 2023; 36:e495-e508. [PMID: 37179243 DOI: 10.1016/j.wombi.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Stillbirth is one of the most devastating pregnancy outcomes that families can experience. Previous research has associated a wide range of risk factors with stillbirth, including maternal behaviours such as substance use, sleep position and attendance and engagement with antenatal care. Hence, some preventive efforts have been focused on tackling the behavioural risk factors for stillbirth. This study aimed to identify the Behaviour Change Techniques (BCTs) used in behaviour change interventions tacking behavioural risk factors for stillbirth such as substance use, sleep position, unattendance to antenatal care and weight management. STUDY DESIGN A systematic review of the literature was conducted in June 2021 and updated in November 2022 in five databases: CINHAL, Psyhinfo, SociIndex, PubMed and Web of Science. Studies published in high-income countries describing interventions designed in the context of stillbirth prevention, reporting stillbirth rates and changes in behaviour were eligible for inclusion. BCTs were identified using the Behaviour Change Technique Taxonomy v1. RESULTS Nine interventions were included in this review identified in 16 different publications. Of these, 4 interventions focused on more than one behaviour (smoking, monitoring fetal movements, sleep position, care-seeking behaviours), one focused on smoking, three on monitoring fetal movements and one on sleep position. Twenty-seven BCTs were identified across all interventions. The most commonly used was "Information about health consequences" (n = 7/9) followed by "Adding objects to the environment" (n = 6/9). One of the interventions included in this review has not been assessed for efficacy yet, of the remaining eight, three showed results in the reduction of stillbirth rates. and four interventions produced behaviour change (smoking reductions, increased knowledge, reduced supine sleeping time). CONCLUSIONS Our findings suggest that interventions designed to date have limited effects on the rates of stillbirth and utilise a limited number of BCTs which are mostly focused on information provision. Further research is necessary to design evidence base behaviour change interventions with a greater focus to tackle all the other factors influencing behaviour change during pregnancy (e.g.: social influence, environmental barriers).
Collapse
Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
| | - Keelin O Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | | |
Collapse
|
3
|
Escañuela Sánchez T, Byrne M, Meaney S, O'Donoghue K, Matvienko-Sikar K. A protocol for a systematic review of behaviour change techniques used in the context of stillbirth prevention. HRB Open Res 2022; 4:92. [PMID: 36743684 PMCID: PMC9874168 DOI: 10.12688/hrbopenres.13375.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Stillbirth is a devastating pregnancy outcome that affects approximately 3.5 per 1000 births in high-income countries. Previous research has highlighted the importance of focusing prevention efforts on targeting risk factors and vulnerable groups. A wide range of risk factors has been associated with stillbirth before, including maternal behaviours such as back sleep position, smoking, alcohol intake, illicit drug use, and inadequate attendance at antenatal care. Given the modifiable nature of these risk factors, there has been an increase in the design of behaviour change interventions targeting such behaviours to reduce the risk of stillbirth. Objectives: The aim of this study is to identify all behavioural interventions with a behavioural component designed and trialled for the prevention of stillbirth in high-income countries, and to identify the behaviour change techniques (BCTs) used in such interventions using the Behaviour Change Techniques Taxonomy V1 (BCTTv1). Inclusion criteria: Interventions will be included in this review if they (1) have the objective of reducing stillbirth rates with a focus on behavioural risk factors; (2) are implemented in high-income countries; (3) target pregnant women or women of childbearing age; and (4) are published in research articles. Methods: A systematic search of the literature will be conducted. The results of the search will be screened against our inclusion criteria by two authors. The following data items will be extracted from the selected papers: general information, study characteristics, participant and intervention/approach details. The Cochrane Effective Practice and Organization of Care (EPOC) risk of bias criteria will be used to assess the methodological quality of included studies. Intervention content will be coded for BCTs as present (+) or absent (-) by two authors using the BCTTv1, discrepancies will be discussed with a third author. A narrative synthesis approach will be used to present the results of this systematic review.
Collapse
Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Deparment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland,INFANT Centre, University College Cork, Cork, Ireland,
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Deparment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland,INFANT Centre, University College Cork, Cork, Ireland
| | | |
Collapse
|
4
|
Escañuela Sánchez T, Byrne M, Meaney S, O'Donoghue K, Matvienko-Sikar K. A protocol for a systematic review of behaviour change techniques used in the context of stillbirth prevention. HRB Open Res 2022; 4:92. [PMID: 36743684 PMCID: PMC9874168 DOI: 10.12688/hrbopenres.13375.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Stillbirth is a devastating pregnancy outcome that affects approximately 3.5 per 1000 births in high-income countries. Previous research has highlighted the importance of focusing prevention efforts on targeting risk factors and vulnerable groups. A wide range of risk factors has been associated with stillbirth before, including maternal behaviours such as back sleep position, smoking, alcohol intake, illicit drug use, and inadequate attendance at antenatal care. Given the modifiable nature of these risk factors, there has been an increase in the design of behaviour change interventions targeting such behaviours to reduce the risk of stillbirth. Objectives: The aim of this study is to identify all behavioural interventions with a behavioural component designed and trialled for the prevention of stillbirth in high-income countries, and to identify the behaviour change techniques (BCTs) used in such interventions using the Behaviour Change Techniques Taxonomy V1 (BCTTv1). Inclusion criteria: Interventions will be included in this review if they (1) have the objective of reducing stillbirth rates with a focus on behavioural risk factors; (2) are implemented in high-income countries; (3) target pregnant women or women of childbearing age; and (4) are published in research articles. Methods: A systematic search of the literature will be conducted. The results of the search will be screened against our inclusion criteria by two authors. The following data items will be extracted from the selected papers: general information, study characteristics, participant and intervention/approach details. The Cochrane Effective Practice and Organization of Care (EPOC) risk of bias criteria will be used to assess the methodological quality of included studies. Intervention content will be coded for BCTs as present (+) or absent (-) by two authors using the BCTTv1, discrepancies will be discussed with a third author. A narrative synthesis approach will be used to present the results of this systematic review.
Collapse
Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Deparment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland,INFANT Centre, University College Cork, Cork, Ireland,
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Deparment of Obstetrics and Gynaecology, University College Cork, Cork, Ireland,INFANT Centre, University College Cork, Cork, Ireland
| | | |
Collapse
|
5
|
Heazell A, Budd J, Smith LK, Li M, Cronin R, Bradford B, McCowan L, Mitchell EA, Stacey T, Roberts D, Thompson J. Associations between social and behavioural factors and the risk of late stillbirth - findings from the Midland and North of England Stillbirth case-control study. BJOG 2020; 128:704-713. [PMID: 32992405 DOI: 10.1111/1471-0528.16543] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate behavioural and social characteristics of women who experienced a late stillbirth compared with women with ongoing live pregnancies at similar gestation. DESIGN Case-control study. SETTING 41 maternity units in the UK. POPULATION Women who had a stillbirth ≥28 weeks' gestation (n = 287) and women with an ongoing pregnancy at the time of interview (n = 714). METHODS Data were collected using an interviewer-administered questionnaire which included questions regarding women's behaviours (e.g. alcohol intake and household smoke exposure) and social characteristics (e.g. ethnicity, employment, housing). Stress was measured by the 10-item Perceived Stress Scale. MAIN OUTCOME MEASURE Late stillbirth. RESULTS Multivariable analysis adjusting for co-existing social and behavioural factors showed women living in the most deprived quintile had an increased risk of stillbirth compared with the least deprived quintile (adjusted odds ratio [aOR] 3.16; 95% CI 1.47-6.77). There was an increased risk of late stillbirth associated with unemployment (aOR 2.32; 95% CI 1.00-5.38) and women who declined to answer the question about domestic abuse (aOR 4.12; 95% CI 2.49-6.81). A greater number of antenatal visits than recommended was associated with a reduction in stillbirth (aOR 0.26; 95% CI 0.16-0.42). CONCLUSIONS This study demonstrates associations between late stillbirth and socio-economic deprivation, perceived stress and domestic abuse, highlighting the need for strategies to prevent stillbirth to extend beyond maternity care. Enhanced antenatal care may be able to mitigate some of the increased risk of stillbirth. TWEETABLE ABSTRACT Deprivation, unemployment, social stress & declining to answer about domestic abuse increase risk of #stillbirth after 28 weeks' gestation.
Collapse
Affiliation(s)
- Aep Heazell
- Faculty of Biology, Medicine and Health, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Budd
- St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - L K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - M Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - R Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - B Bradford
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lme McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - T Stacey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.,Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - D Roberts
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Jmd Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
Heazell AEP, Timms K, Scott RE, Rockliffe L, Budd J, Li M, Cronin R, McCowan LME, Mitchell EA, Stacey T, Roberts D, Thompson JMD. Associations between consumption of coffee and caffeinated soft drinks and late stillbirth-Findings from the Midland and North of England stillbirth case-control study. Eur J Obstet Gynecol Reprod Biol 2020; 256:471-477. [PMID: 33218821 DOI: 10.1016/j.ejogrb.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The consumption of caffeinated drinks and soft drinks is widespread in society, including by pregnant women. Data regarding the association of caffeine intake and stillbirth are varied. We aimed to investigate the degree of consumption of caffeinated drinks or soft drinks in the last four weeks of pregnancy in women who experienced a late stillbirth compared to women with ongoing live pregnancies at similar gestation. Influences on maternal caffeine intake and soft drink consumption during pregnancy were also investigated. STUDY DESIGN A case-control study undertaken in 41 maternity units in the United Kingdom. Cases were women who had a singleton non-anomalous stillbirth ≥28 weeks' gestation (n = 290) and controls were women with an ongoing pregnancy at the time of interview (n = 729). Data were collected using an interviewer-administered questionnaire which included questions regarding consumption of a variety of caffeinated drinks and soft drinks in the last four weeks of pregnancy as well as other behaviours (e.g. cigarette smoking). RESULTS Multivariable analysis adjusting for co-existing demographic and behavioural factors found the consumption of instant coffee, energy drinks and cola were associated with increased risk of stillbirth. There was an independent association between caffeine intake and late stillbirth (adjusted Odds Ratio 1.27, 95 % Confidence Interval (95 %CI) 1.14, 1.43 for each 100 mg increment/day). 15 % of cases and 8% of controls consumed more than the World Health Organisation (WHO) recommendation (>300 mg of caffeine/day; aOR 2.30, 95 % CI 1.40, 4.24). The population attributable risk for stillbirth associated with >300 mg of caffeine/day was 7.4 %. The majority of respondents reduced caffeine consumption in pregnancy. Midwives and internet resources were the most frequently used sources of information which influenced maternal behaviour with regard to soft drinks and caffeine, and this did not differ between cases and controls. CONCLUSIONS Women should be informed that consumption of caffeine during pregnancy is associated with increased risk of stillbirth, particularly at levels greater than recommended by the WHO (>300 mg/day). Recommendations from midwives and internet-based resources are likely to be the most effective means to influence maternal behaviour.
Collapse
Affiliation(s)
- Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom; St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Kate Timms
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom; Lydia Becker Institute of Inflammation and Immunology, Faculty of Biology, Medicine & Health, University of Manchester, United Kingdom
| | - Rebecca E Scott
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Lauren Rockliffe
- Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Jayne Budd
- St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Robin Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Tomasina Stacey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom; Calderdale and Huddersfield NHS Foundation Trust, Lindley, Huddersfield, United Kingdom
| | - Devender Roberts
- Liverpool Women's Hospital NHS Foundation Trust, Crown Street, Liverpool, United Kingdom
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
7
|
Huang C, Han W, Fan Y. Correlation study between increased fetal movement during the third trimester and neonatal outcome. BMC Pregnancy Childbirth 2019; 19:467. [PMID: 31801506 PMCID: PMC6894290 DOI: 10.1186/s12884-019-2637-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 11/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to analyze the correlation between increased fetal movements in the third trimester and neonatal outcomes. Methods We enrolled pregnant women (n = 219) who reported increased/excessive fetal movements in the third trimester in our hospital. A control group of healthy women (n = 278) who had undergone regular childbirth and delivery in our hospital during the same period and did not report abnormal fetal movements were also recruited. All pregnant women underwent fetal non-stress test. We analyzed the neonatal weight, appearance, pulse, grimace, activity, and respiration score, degrees of amniotic fluid contamination, amniotic fluid volume, conditions of umbilical cord around the neck and cord length, and incidence of small for gestational age. In addition, the incidence of preterm delivery, cesarean section rate, postpartum hemorrhage, and other postpartum complications were also analyzed. We then analyzed the correlation between increased/excessive fetal activity and neonatal outcomes. Results Women with complaints of increased/excessive fetal movements exhibited increased fetal movements mainly around 31 and 39 weeks of gestation. Several pregnancy variables, including number of previous delivery, gestational age (less than 34 weeks and more than 37 weeks) and vaginal birth rate, were associated with increased/excessive fetal movements. In addition, women who reported increased/excessive fetal movements had higher odds of large for gestational age (LGA), particularly those with gestational age over 37 weeks. Conclusion Increased/excessive fetal movements may be used to predict adverse neonatal outcome such as LGA.
Collapse
Affiliation(s)
- Cuiqin Huang
- Department of Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600# Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Wei Han
- Department of Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600# Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yajing Fan
- Department of Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600# Yishan Road, Xuhui District, Shanghai, 200233, China.
| |
Collapse
|
8
|
Escañuela Sánchez T, Meaney S, O'Donoghue K. Modifiable risk factors for stillbirth: a literature review. Midwifery 2019; 79:102539. [PMID: 31585399 DOI: 10.1016/j.midw.2019.102539] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 12/22/2022]
Abstract
A stillbirth is defined as an infant born weighing 500 g and/or more or at a gestational age of 24 weeks who shows no signs of life. Having a stillborn baby has a wide range of consequences that can affect parents, family and the healthcare professionals involved. Several risk factors have been associated with an increased risk of stillbirth: including maternal medical factors, maternal characteristics, fetal factors, sociodemographic factors and behavioral factors. The aim of this work is to review the literature on risk factors that have a behavioral component. The main behaviors modulating the risk of stillbirth that have been more widely studied in the literature include use of substances (smoking, alcohol, illicit drugs and medical drugs), weight management, attendance at antenatal care and sleeping position. There is evidence in the literature that supports that all those behaviors have an impact on the risk of stillbirth, especially in the cases of smoking and drugs consumption during the pregnancy. Hence, more research is needed to establish interventions targeting these behaviors as preventive measures to reduce the risk of adverse obstetric outcomes.
Collapse
Affiliation(s)
- Tamara Escañuela Sánchez
- INFANT Research Centre, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
| | - Sarah Meaney
- National Perinatal Epidemiology Centre (NPEC), University College Cork, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
| | - Keelin O'Donoghue
- INFANT Research Centre, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
| |
Collapse
|
9
|
Stacey T, Tennant P, McCowan L, Mitchell EA, Budd J, Li M, Thompson J, Martin B, Roberts D, Heazell A. Gestational diabetes and the risk of late stillbirth: a case-control study from England, UK. BJOG 2019; 126:973-982. [PMID: 30891907 DOI: 10.1111/1471-0528.15659] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the separate effects of being 'at risk' of gestational diabetes mellitus (GDM) and screening for GDM, and of raised fasting plasma glucose (FPG) and clinical diagnosis of GDM, on the risk of late stillbirth. DESIGN Prospective case-control study. SETTING Forty-one maternity units in the UK. POPULATION Women who had a stillbirth ≥28 weeks of gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733). METHODS Causal mediation analysis explored the joint effects of (i) 'at risk' of GDM and screening for GDM and (ii) raised FPG (≥5.6 mmol/l) and clinical diagnosis of GDM on the risks of late stillbirth. Adjusted odds ratios (aOR) were estimated by logistic regression adjusted for confounders identified by directed acyclic graphs. MAIN OUTCOME MEASURES Screening for GDM and FPG levels RESULTS: Women 'at risk' of GDM, but not screened, experienced 44% greater risk of late stillbirth than those not 'at risk' (aOR 1.44, 95% CI 1.01-2.06). Women 'at risk' of GDM who were screened experienced no such increase (aOR 0.98, 95% CI 0.70-1.36). Women with raised FPG not diagnosed with GDM experienced four-fold greater risk of late stillbirth than women with normal FPG (aOR 4.22, 95% CI 1.04-17.02). Women with raised FPG who were diagnosed with GDM experienced no such increase (aOR 1.10, 95% CI 0.31-3.91). CONCLUSIONS Optimal screening and diagnosis of GDM mitigate the higher risks of late stillbirth in women 'at risk' of GDM and/or with raised FPG. Failure to diagnose GDM leaves women with raised FPG exposed to avoidable risk of late stillbirth. TWEETABLE ABSTRACT Risk of #stillbirth in gestational diabetes is mitigated by effective screening and diagnosis.
Collapse
Affiliation(s)
- T Stacey
- School of Healthcare, University of Leeds, Leeds, UK
| | - Pwg Tennant
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,School of Medicine, University of Leeds, Leeds, UK.,The Alan Turing Institute, London, UK
| | - Lme McCowan
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - J Budd
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Li
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Jmd Thompson
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - B Martin
- Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - D Roberts
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Aep Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
10
|
Pollock D, Ziaian T, Pearson E, Cooper M, Warland J. Breaking through the silence in antenatal care: Fetal movement and stillbirth education. Women Birth 2019; 33:77-85. [PMID: 30824375 DOI: 10.1016/j.wombi.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/02/2019] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal movements are a key indicator of fetal health. Research has established significant correlations between altered fetal activity and stillbirth. However, women are generally unaware of this relationship. Providing pregnant women with information about the importance of fetal movements could improve stillbirth rates. However, there are no consistent fetal movements awareness messages globally for pregnant women. AIMS This study aimed to explore the antenatal care experiences of Australian mothers who had recently had a live birth to determine their knowledge of fetal movements, the nature and source of that information. METHODS An online survey method was used for 428 women who had a live birth and received antenatal care in Australia. Women's knowledge of fetal movements, stillbirth risk, and the sources of this knowledge was explored. FINDINGS A large proportion of participants (84.6%; n=362) stated they had been informed by health care professionals of the importance of fetal movements during pregnancy. Open-ended responses indicate that fetal movements messages are often myth based. Awareness that stillbirth occurs was high (95.2%; n=398), although, 65% (n=272) were unable to identify the current incidence of stillbirth in Australia. CONCLUSION Women who received antenatal care have high-awareness of fetal movements, but the information they received was inconsistent. Participants knew stillbirth occurred but did not generally indicate they had obtained that knowledge from health care professionals. We recommend a consistent approach to fetal movements messaging throughout pregnancy which focuses on stillbirth prevention.
Collapse
Affiliation(s)
- Danielle Pollock
- University of South Australia, School of Nursing and Midwifery, Australia.
| | - Tahereh Ziaian
- University of South Australia, School of Psychology, Social Work and Social Policy, City East Campus, 108 North Terrace, Adelaide, South Australia, 5001, Australia
| | - Elissa Pearson
- University of South Australia, School of Psychology, Social Work and Social Policy, City East Campus, 108 North Terrace, Adelaide, South Australia, 5001, Australia
| | - Megan Cooper
- University of South Australia, School of Nursing and Midwifery, Australia
| | - Jane Warland
- University of South Australia, School of Nursing and Midwifery, Australia
| |
Collapse
|
11
|
A Comprehensive Update on Stillbirth Prevention: from Preconception to Postpartum, Individuals to Public Health Administrations. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
12
|
Jayawardena L, Sheehan P. Introduction of a customised growth chart protocol increased detection of small for gestational age pregnancies in a tertiary Melbourne hospital. Aust N Z J Obstet Gynaecol 2018; 59:493-500. [PMID: 30302752 DOI: 10.1111/ajo.12902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Growth charts customised for maternal height, weight, ethnicity and parity have been proposed as more effective at detecting infants who are small for gestational age (SGA) than routine screening with symphysio-fundal height measurement alone. Our non-randomised, prospective cohort study assessed antenatal SGA detection rates in a general maternity cohort following the introduction of the Perinatal Institute's Growth Assessment Protocol (GAP) program (consisting of customised growth chart software for plotting symphysio-fundal height, staff training and serial auditing). METHODS The GAP program was implemented into the routine antenatal schedule of 882 women who delivered at The Royal Women's Hospital, Melbourne, during our study period. SGA detection was compared to 936 women from the same team who delivered prior to the intervention. Secondary outcomes assessed were infant gestation at birth and method of delivery, neonatal Apgar scores and admission to the Neonatal Intensive and Special Care nursery (NISC). RESULTS Identification of SGA infants increased from 21% to 41% with the introduction of the GAP program (OR 2.6, 95% CI 1.3-4.9, P < 0.05). This was not associated with an increase in false-positive rates. Following the introduction of the GAP Program, SGA babies were more likely to be born by vaginal delivery (OR 2.7; 95% CI 1.4-5.1, P < 0.005). There was no overall increase in the induction of labour or caesarean delivery rates. Overall rates of admission to NISC were reduced. CONCLUSIONS In our increasingly culturally heterogenous society, the use of the GAP program is a safe and potentially more sensitive tool for detecting in utero growth restriction.
Collapse
Affiliation(s)
- Lulusha Jayawardena
- Maternity Services, The Royal Women's Hospital Parkville, Melbourne, Australia
| | - Penelope Sheehan
- Maternity Services, The Royal Women's Hospital Parkville, Melbourne, Australia.,Pregnancy Research Centre, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
13
|
Heazell AEP, Budd J, Li M, Cronin R, Bradford B, McCowan LME, Mitchell EA, Stacey T, Martin B, Roberts D, Thompson JMD. Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study. BMJ Open 2018; 8:e020031. [PMID: 29982198 PMCID: PMC6042603 DOI: 10.1136/bmjopen-2017-020031] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth. DESIGN Case-control study. SETTING 41 maternity units in the UK. PARTICIPANTS Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age. METHODS Data were collected using an interviewer-administered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders. PRIMARY OUTCOME MEASURE Association of maternally perceived fetal movements in relation to late stillbirth. RESULTS In multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56). CONCLUSIONS Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth. TRIAL REGISTRATION NUMBER NCT02025530.
Collapse
Affiliation(s)
- Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jayne Budd
- Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Robin Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Billie Bradford
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | | | - Edwin A Mitchell
- Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | | | - Bill Martin
- Department of Obstetrics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - Devender Roberts
- Department of Obstetrics, Liverpool Women's NHS Foundation Trust, Liverpool, Liverpool, UK
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - John M D Thompson
- Department of Paediatrics, Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
14
|
Heazell AE, Stacey T, O'Brien LM, Mitchell EA, Warland J. Excessive fetal movements are a sign of fetal compromise which merits further examination. Med Hypotheses 2018; 111:19-23. [DOI: 10.1016/j.mehy.2017.12.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/17/2017] [Indexed: 11/30/2022]
|
15
|
Heazell A, Li M, Budd J, Thompson J, Stacey T, Cronin RS, Martin B, Roberts D, Mitchell EA, McCowan L. Association between maternal sleep practices and late stillbirth - findings from a stillbirth case-control study. BJOG 2017; 125:254-262. [PMID: 29152887 PMCID: PMC5765411 DOI: 10.1111/1471-0528.14967] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 12/01/2022]
Abstract
Objective To report maternal sleep practices in women who experienced a stillbirth compared with controls with ongoing live pregnancies at similar gestation. Design Prospective case‐control study. Setting Forty‐one maternity units in the United Kingdom. Population Women who had a stillbirth after ≥ 28 weeks’ gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733). Methods Data were collected using an interviewer‐administered questionnaire that included questions on maternal sleep practices before pregnancy, in the four weeks prior to, and on the night before the interview/stillbirth. Main outcome measures Maternal sleep practices during pregnancy. Results In multivariable analysis, supine going‐to‐sleep position the night before stillbirth had a 2.3‐fold increased risk of late stillbirth [adjusted Odds Ratio (aOR) 2.31, 95% CI 1.04–5.11] compared with the left side. In addition, women who had a stillbirth were more likely to report sleep duration less than 5.5 hours on the night before stillbirth (aOR 1.83, 95% CI 1.24–2.68), getting up to the toilet once or less (aOR 2.81, 95% CI 1.85–4.26), and a daytime nap every day (aOR 2.22, 95% CI 1.26–3.94). No interaction was detected between supine going‐to‐sleep position and a small‐for‐gestational‐age infant, maternal body mass index, or gestational age. The population‐attributable risk for supine going‐to‐sleep position was 3.7% (95% CI 0.5–9.2). Conclusions This study confirms that supine going‐to‐sleep position is associated with late stillbirth. Further work is required to determine whether intervention(s) can decrease the frequency of supine going‐to‐sleep position and the incidence of late stillbirth. Tweetable abstract Supine going‐to‐sleep position is associated with 2.3× increased risk of stillbirth after 28 weeks’ gestation. Plain Language Summary Stillbirth, the death of a baby before birth, is a tragedy for mothers and families. One approach to reduce stillbirths is to identify factors that are associated with stillbirth. There are few risk factors for stillbirth that can be easily changed, but this study is looking at identifying how mothers may be able to reduce their risk. In this study, we interviewed 291 women who had a stillbirth and 733 women who had a live‐born baby from 41 maternity units throughout the UK. The mothers who had a stillbirth were interviewed as soon as practical after their baby died. Mothers who had a live birth were interviewed during their pregnancies at the same times in pregnancy as when the stillbirths occurred. We did not interview mothers who had twins or who had a baby with a major abnormality. Mothers who went to sleep on their back had at least twice the risk of stillbirth compared with mothers who went to sleep on their left‐hand side. This study suggests that 3.7% of stillbirths after 28 weeks of pregnancy were linked with going to sleep lying on the back. This study also shows that the link between going‐to‐sleep position and late stillbirth was not affected by the duration of pregnancy after 28 weeks, the size of the baby, or the mother's weight. Women who got up to the toilet once or more at night had a reduced risk of stillbirth. This is the largest of four similar studies that have all shown the same link between the position in which a mother goes to sleep and stillbirth after 28 weeks of pregnancy. Further studies are needed to see whether women can easily change their sleep position in late pregnancy and whether changing the position a mother goes to sleep in reduces stillbirth. Tweetable abstract Supine going‐to‐sleep position is associated with 2.3× increased risk of stillbirth after 28 weeks’ gestation. This paper includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights14967
Collapse
Affiliation(s)
- Aep Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Li
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - J Budd
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jmd Thompson
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - T Stacey
- School of Healthcare, University of Leeds, Leeds, UK
| | - R S Cronin
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - B Martin
- Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - D Roberts
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - E A Mitchell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Lme McCowan
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
16
|
McCowan LME, Thompson JMD, Cronin RS, Li M, Stacey T, Stone PR, Lawton BA, Ekeroma AJ, Mitchell EA. Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study. PLoS One 2017; 12:e0179396. [PMID: 28609468 PMCID: PMC5469491 DOI: 10.1371/journal.pone.0179396] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/29/2017] [Indexed: 11/20/2022] Open
Abstract
Objective Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation). Methods A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n = 164) were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n = 569) were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going-to-sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders. Results Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR) 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI) were: BMI (1.04, 1.01 to 1.08) per unit, maternal age ≥40 (2.88, 1.31 to 6.32), birthweight <10th customised centile (2.76, 1.59 to 4.80), and <6 hours sleep on the last night (1.81, 1.14 to 2.88). The risk associated with supine-going-to-sleep position was greater for term (aOR 10.26, 3.00 to 35.04) than preterm stillbirths (aOR 3.12, 0.97 to 10.05). Conclusions Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%.
Collapse
Affiliation(s)
- Lesley M. E. McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - John M. D. Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Robin S. Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Tomasina Stacey
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Peter R. Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Beverley A. Lawton
- Women’s Health Research Centre, University of Otago, Wellington, New Zealand
| | - Alec J. Ekeroma
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Edwin A. Mitchell
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
17
|
Flenady V, Wojcieszek AM, Middleton P, Ellwood D, Erwich JJ, Coory M, Khong TY, Silver RM, Smith GCS, Boyle FM, Lawn JE, Blencowe H, Leisher SH, Gross MM, Horey D, Farrales L, Bloomfield F, McCowan L, Brown SJ, Joseph KS, Zeitlin J, Reinebrant HE, Cacciatore J, Ravaldi C, Vannacci A, Cassidy J, Cassidy P, Farquhar C, Wallace E, Siassakos D, Heazell AEP, Storey C, Sadler L, Petersen S, Frøen JF, Goldenberg RL. Stillbirths: recall to action in high-income countries. Lancet 2016; 387:691-702. [PMID: 26794070 DOI: 10.1016/s0140-6736(15)01020-x] [Citation(s) in RCA: 384] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.
Collapse
Affiliation(s)
- Vicki Flenady
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA.
| | - Aleena M Wojcieszek
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA
| | - Philippa Middleton
- International Stillbirth Alliance, NJ, USA; Women's & Children's Health Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - David Ellwood
- International Stillbirth Alliance, NJ, USA; Griffith University and Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Jan Jaap Erwich
- International Stillbirth Alliance, NJ, USA; University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Michael Coory
- International Stillbirth Alliance, NJ, USA; Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - T Yee Khong
- International Stillbirth Alliance, NJ, USA; SA Pathology, University of Adelaide, Adelaide, SA, Australia
| | - Robert M Silver
- International Stillbirth Alliance, NJ, USA; University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Gordon C S Smith
- National Institute for Health Research, Biomedical Research Centre and Cambridge University, Cambridge, UK
| | - Frances M Boyle
- School of Public Health, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA
| | - Joy E Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Susannah Hopkins Leisher
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA
| | - Mechthild M Gross
- Hannover Medical School, Hannover, Germany; Zurich University of Applied Sciences, Institute for Midwifery, Winterthur, Switzerland
| | - Dell Horey
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; La Trobe University, Melbourne, VIC, Australia
| | - Lynn Farrales
- International Stillbirth Alliance, NJ, USA; Still Life Canada: Stillbirth and Neonatal Death Education, Research and Support Society, Vancouver, Canada; University of British Columbia, Vancouver, Canada
| | | | - Lesley McCowan
- International Stillbirth Alliance, NJ, USA; Liggins Institute, Auckland, New Zealand
| | - Stephanie J Brown
- Murdoch Childrens Research Institute and General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, VIC, Australia
| | - K S Joseph
- University of British Columbia, Vancouver, Canada
| | - Jennifer Zeitlin
- Institut National de la Santé et de la Recherche Médicale, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
| | - Hanna E Reinebrant
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA
| | | | - Claudia Ravaldi
- International Stillbirth Alliance, NJ, USA; CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy
| | - Alfredo Vannacci
- International Stillbirth Alliance, NJ, USA; CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Jillian Cassidy
- International Stillbirth Alliance, NJ, USA; Umamanita, Girona, Spain
| | - Paul Cassidy
- International Stillbirth Alliance, NJ, USA; Umamanita, Girona, Spain
| | | | - Euan Wallace
- International Stillbirth Alliance, NJ, USA; Monash University, Melbourne, VIC, Australia
| | - Dimitrios Siassakos
- International Stillbirth Alliance, NJ, USA; University of Bristol, Bristol, UK; Southmead Hospital, Bristol, UK
| | - Alexander E P Heazell
- International Stillbirth Alliance, NJ, USA; Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; St Mary's Hospital, Central Manchester University Hospitals, NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Lynn Sadler
- University of Auckland, Auckland, New Zealand
| | - Scott Petersen
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; Mater Health Services, Brisbane, QLD, Australia
| | - J Frederik Frøen
- Mater Research Institute, University of Queensland, Brisbane, QLD Australia; Griffith University and Gold Coast University Hospital, Gold Coast, QLD, Australia; Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| |
Collapse
|
18
|
Mitchell EA. Update from New Zealand. BMC Pregnancy Childbirth 2015. [PMCID: PMC4402592 DOI: 10.1186/1471-2393-15-s1-a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
19
|
|
20
|
|
21
|
|
22
|
Warland J, Dorrian J. Accuracy of self-reported sleep position in late pregnancy. PLoS One 2014; 9:e115760. [PMID: 25535960 PMCID: PMC4275245 DOI: 10.1371/journal.pone.0115760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
Abstract
Background There is emerging research to suggest that supine maternal sleep position in late pregnancy may adversely affect fetal wellbeing. However, these studies have all been based on maternal report of sleeping position. Before recommendations to change sleep position can be made it is important to determine the validity of these studies by investigating how accurate pregnant women are in reporting their sleep position. If avoiding the supine sleeping position reduces risk of poor pregnancy outcome, it is also important to know how well women can comply with the instruction to avoid this position and sleep on their left. Method Thirty women in late pregnancy participated in a three-night observational study and were asked to report their sleeping position. This was compared to sleep position as recorded by a night capable video recording. The participants were instructed to settle to sleep on their left side and if they woke overnight to settle back to sleep on their left. Results There was a moderate correlation between reported and video-determined left-side sleep time (r = 0.48), mean difference = 3 min (SD = 3.5 h). Participants spent an average of 59.60% (SD = 16.73%) of time in bed on their left side (ICC across multiple nights = 0.67). Those who included left side among their typical sleep positions reported significantly longer sleep during the study (p<0.01). Conclusions On average participant reports of sleep position were relatively accurate but there were large individual differences in reporting accuracy and in objectively-determined time on left side. Night-to-night consistency was substantial. For those who do not ordinarily sleep on that side, asking participants to sleep on their left may result in reduced sleep duration. This is an important consideration during a sleep-critical time such as late pregnancy.
Collapse
Affiliation(s)
- Jane Warland
- School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
- * E-mail:
| | - Jillian Dorrian
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
- Centre for Sleep Research, University of South Australia, Adelaide, Australia
| |
Collapse
|