Stillbirth is one of the most common adverse outcomes of pregnancy. Yet, there is little research that examines common risk factors for stillbirth in terms of the timing of stillbirth. This study examined ten bio-psycho-social variables considered to be risk factors for stillbirth (Maternal Age, Race, Socioeconomic Status, Level of Education, Marital Status, Licit and Illicit Drug Use, Obesity, Diabetes, Hypertension, and Adequacy of Pre-natal Care) and their relationship to the estimated gestational age (EGA) when stillbirth occurs. The nominal, dependent variable, the EGA of stillbirth, was dichotomized into two categories: (1) Early Stillbirth which equaled stillbirth 20 to 28 weeks EGA, and (2) Late Stillbirth, which equaled stillbirth after 28 weeks EGA. Data were collected via a retrospective review of the obstetrical medical records of 231 singleton stillbirths that occurred between January 2000 and December 2005, in two tertiary-care publicly funded hospitals located on Long Island, in New York State. Although the study sample was not a probability sample, rather a population of subjects, the data analysis involved descriptive statistics and two logistic regression models. Due to the sample being treated as a population, the results of the analysis are not statistically inferential in nature, and therefore cannot be freely generalized to other pregnant women in the greater obstetrical population.
After obtaining the results of the logistic regression, as the variables Race and Diabetes showed the most variation in relation to the EGA of stillbirth, the association between these risk factors and the dependent variable became the focus of this study. Specifically, the results suggest that in this population black women were at an increased risk (Odds Ratio 2.24) of experiencing an Early Stillbirth instead of a Late Stillbirth compared with women who were not black. The results also suggest that the women in this study diagnosed with diabetes during their pregnancy were at an increased risk (Odds Ratio 2.27) of experiencing a Late Stillbirth instead of an Early Stillbirth compared with women without diabetes during their pregnancy.
Although the results of this study represent association, not causation, and cannot be inferred outside of its population, it can be said that the findings suggest that future research might focus on racism and discrimination in relation to the EGA of stillbirth. They also suggest that future research might concentrate on methods of intervention (such as reducing the number of women who are over-weight and obese prior to pregnancy), the goal being a reduction in the prevalence of gestational diabetes as it relates to the EGA of stillbirth.
These results may have several policy and program implications. In terms of prevention and early detection of chronic diseases, it would be beneficial to implement universal health insurance as this will ease access to health care for all women throughout their lifetime. It would also be beneficial to develop and implement universal policies and programs to improve working and social conditions (e.g. paid and extended family leave after an infant is born, safe and affordable childcare services, flexible work schedules, and job security) to optimize the long-term health of women, children, and families. Last, but not least, the results suggest that it would be prudent to promote greater investments in women’s health in terms of time, money and research.