J Zhu1,2, J Zhang1, H Xia3, J Ge4, X Ye5, B Guo6, M Liu7, L Dai8, L Zhang9, L Chen10, Y Wang15, X Wang12, H Liu13, C Chen14, Y Wang15, G Wang16, M Cai17, X Yang18, F Li19, C Fan20, Y Ruan21, L Yu22, R Zhang23, H Xu24, J Zhang1, X Ma26, D Yuan27, Y Zhu28, D Wang29, A P Betran30, H Qi18, T Duan7, J Zhang1. 1. MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 2. Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 3. Department of Obstetrics, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. 4. Department of Obstetrics, Shijiazhuang Obstetrics and Gynecology Hospital, Hebei, China. 5. Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Jiangsu, China. 6. Department of Obstetrics, The Maternal and Child Health Hospital of Dongchangfu District, Shangdong, China. 7. Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China. 8. Department of Obstetrics, The Maternal and Child Healthcare Hospital of Xiangtan, Hunan, China. 9. Department of Obstetrics, Qihetai Maternal and Child Health Hospital, Heilongjiang, China. 10. Department of Obstetrics, Fujian Provincial Maternity and Children's Hospital, Fujian, China. 11. Department of Obstetrics and Gynecology, Suzhou Municipal Hospital, Nanjing University Medical School, Jiangsu, China. 12. Department of Obstetrics and Gynecology, Traditional Chinese Medicine Integrated Hospital of Tongzhou District, Beijing, China. 13. Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an Jiao Tong University, Shaanxi, China. 14. Department of Obstetrics, Maternity and Child Care Center of Xingyang, Henan, China. 15. Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, China. 16. Department of Obstetrics, Inner Mongolia Maternity and Child Health Care Hospital, Hohhot, Inner Mongolia Autonomous Region, China. 17. Department of Obstetrics, Changsha Hospital for Maternal and Child Health Care, Hunan, China. 18. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 19. Department of Obstetrics, Haidian Maternal and Child Health Hospital, Beijing, China. 20. Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Hubei, China. 21. Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China. 22. Department of Obstetrics and Gynecology, Jinhua People's Hospital, Zhejiang, China. 23. Department of Obstetrics and Gynecology, Wenling Maternal and Child Health Hospital, Zhejiang, China. 24. Department of Obstetrics, Shaoxing Maternal and Child Health Hospital, Zhejiang, China. 25. Department of Obstetrics and Gynecology, The Fifth Hospital of Xiamen, Fujian, China. 26. Department of Obstetrics, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China. 27. Department of Obstetrics, Gaizhou Maternal and Child Health Hospital, Liaoning, China. 28. Department of Obstetrics and Gynecology, Jiangyin People's Hospital, Southeast University School of Medicine, Jiangsu, China. 29. Department of Obstetrics and Gynecology, The First Hospital Affiliated to Army Medical University, Chongqing, China. 30. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland.
Abstract
OBJECTIVE: To estimate a stillbirth rate at 24 or more gestational weeks in 2015-2016 and to explore potentially preventable causes in China. DESIGN: A multi-centre cross-sectional study. SETTING: Ninety-six hospitals distributed in 24 (of 34) provinces in China. POPULATION: A total of 75 132 births at 24 completed weeks of gestation or more. METHODS: COX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region-specific risk factors for stillbirths. MAIN OUTCOME MEASURES: Stillbirth rate and risk factors for stillbirth. RESULTS: A total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9-18.5). Small for gestational age (SGA) and pre-eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre-pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre-eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China. CONCLUSIONS: The prevalence of stillbirth was 13.2 per 1000 births in China in 2015-2016. Nearly one-third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China. TWEETABLE ABSTRACT: The stillbirth rate was 13.2 per 1000 births in China in 2015-2016 and nearly one-third of all stillbirths may be preventable.
OBJECTIVE: To estimate a stillbirth rate at 24 or more gestational weeks in 2015-2016 and to explore potentially preventable causes in China. DESIGN: A multi-centre cross-sectional study. SETTING: Ninety-six hospitals distributed in 24 (of 34) provinces in China. POPULATION: A total of 75 132 births at 24 completed weeks of gestation or more. METHODS: COX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region-specific risk factors for stillbirths. MAIN OUTCOME MEASURES: Stillbirth rate and risk factors for stillbirth. RESULTS: A total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9-18.5). Small for gestational age (SGA) and pre-eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre-pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre-eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China. CONCLUSIONS: The prevalence of stillbirth was 13.2 per 1000 births in China in 2015-2016. Nearly one-third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China. TWEETABLE ABSTRACT: The stillbirth rate was 13.2 per 1000 births in China in 2015-2016 and nearly one-third of all stillbirths may be preventable.
Authors: Barbara J Stoll; Nellie I Hansen; Edward F Bell; Michele C Walsh; Waldemar A Carlo; Seetha Shankaran; Abbot R Laptook; Pablo J Sánchez; Krisa P Van Meurs; Myra Wyckoff; Abhik Das; Ellen C Hale; M Bethany Ball; Nancy S Newman; Kurt Schibler; Brenda B Poindexter; Kathleen A Kennedy; C Michael Cotten; Kristi L Watterberg; Carl T D'Angio; Sara B DeMauro; William E Truog; Uday Devaskar; Rosemary D Higgins Journal: JAMA Date: 2015-09-08 Impact factor: 56.272
Authors: Alexander E P Heazell; Dimitrios Siassakos; Hannah Blencowe; Christy Burden; Zulfiqar A Bhutta; Joanne Cacciatore; Nghia Dang; Jai Das; Vicki Flenady; Katherine J Gold; Olivia K Mensah; Joseph Millum; Daniel Nuzum; Keelin O'Donoghue; Maggie Redshaw; Arjumand Rizvi; Tracy Roberts; H E Toyin Saraki; Claire Storey; Aleena M Wojcieszek; Soo Downe Journal: Lancet Date: 2016-01-19 Impact factor: 79.321
Authors: J Zhu; J Zhang; H Xia; J Ge; X Ye; B Guo; M Liu; L Dai; L Zhang; L Chen; Y Wang; X Wang; H Liu; C Chen; Y Wang; G Wang; M Cai; X Yang; F Li; C Fan; Y Ruan; L Yu; R Zhang; H Xu; J Zhang; X Ma; D Yuan; Y Zhu; D Wang; A P Betran; H Qi; T Duan; J Zhang Journal: BJOG Date: 2020-09-02 Impact factor: 6.531
Authors: J Zhu; J Zhang; H Xia; J Ge; X Ye; B Guo; M Liu; L Dai; L Zhang; L Chen; Y Wang; X Wang; H Liu; C Chen; Y Wang; G Wang; M Cai; X Yang; F Li; C Fan; Y Ruan; L Yu; R Zhang; H Xu; J Zhang; X Ma; D Yuan; Y Zhu; D Wang; A P Betran; H Qi; T Duan; J Zhang Journal: BJOG Date: 2020-09-02 Impact factor: 6.531