Trends and risk factors of stillbirth in Taiwan 2006–2013: a population-based study
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To examine temporal trends in stillbirth and its associated risk factors in Taiwan.
This was a population-based cohort study. Data were extracted from the Birth Certificate Application database. Singleton births at 28 or more gestational weeks were included. A total of 1,536,796 births, including 3741 stillbirths, were analyzed from January 2006 to December 2013.
The stillbirth rate was 2.4 per 1000 births and there was no change in the stillbirth rate during the study period. The adjusted odds ratio (aOR) for stillbirth was 1.28 for maternal age between 35 and 40 years and 1.79 for maternal age ≥ 41 years, with 21–34 years as the reference. The risk for stillbirth increased in single women (aOR, 2.4), female baby (aOR, 1.08), small for gestational age (aOR, 6.34) and large for gestational age (aOR, 1.52) infants, and women with hypertension (aOR, 3.78), diabetes mellitus (aOR, 2.04), anemia (aOR, 1.65), and oligohydramnios or polyhydramnios (aOR, 2.46).Women with heart disease and maternal age ≤ 20 years had no significant association with stillbirth after adjusting for various risk factors.
Although the rate of stillbirth was stable during the study period, the incidence of risk factors associated with stillbirth, such as advanced maternal age, hypertension, diabetes mellitus, and anemia, had increased over time. Understanding about the risk factors might change protocols and allow for earlier detection of problems and prevention of stillbirths. Prevention or management of risk factors should be undertaken to reduce stillbirth rate.
KeywordsStillbirth Trends Risk factors Third trimester
This study was supported by grants from the Cheng Hsin General Hospital (Grant number: CHGH105-35) and from the Chang Gung Medical Foundation (Grant number: BMRPA49) of Taiwan.
CCS: conceptualization, project administration and development, manuscript writing. HHC: methodology, resources manuscript writing. LLC: data management, data analysis, supervision manuscript review and editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Froen JF, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER, Flenady V, McClure EM, Franco L, Goldenberg RL, Kinney MV, Leisher SH, Pitt C, Islam M, Khera A, Dhaliwal L, Aggarwal N, Raina N, Temmerman M, Lancet Ending Preventable Stillbirths Series Study Group (2016) Stillbirths: progress and unfinished business. Lancet 387(10018):574–586. https://doi.org/10.1016/S0140-6736(15)00818-1 CrossRefGoogle Scholar
- 2.Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, Creanga AA, Tuncalp O, Balsara ZP, Gupta S, Say L, Lawn JE (2011) National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 377(9774):1319–1330. https://doi.org/10.1016/S0140-6736(10)62310-0 CrossRefGoogle Scholar
- 5.de Bernis L, Kinney MV, Stones W, Ten Hoope-Bender P, Vivio D, Leisher SH, Bhutta ZA, Gulmezoglu M, Mathai M, Belizan JM, Franco L, McDougall L, Zeitlin J, Malata A, Dickson KE, Lawn JE, Lancet Ending Preventable Stillbirths Series Study Group, Lancet Ending Preventable Stillbirths Series Advisory (2016) Stillbirths: ending preventable deaths by 2030. Lancet 387(10019):703–716. https://doi.org/10.1016/S0140-6736(15)00954-X CrossRefGoogle Scholar
- 6.Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Froen JF, Qureshi ZU, Calderwood C, Shiekh S, Jassir FB, You D, McClure EM, Mathai M, Cousens S, Lancet Ending Preventable Stillbirths Series Study Group, Lancet Stillbirth Epidemiology Investigator Group (2016) Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 387(10018):587–603. https://doi.org/10.1016/S0140-6736(15)00837-5 CrossRefGoogle Scholar
- 7.Lin CM, Lee PC, Teng SW, Lu TH, Mao IF, Li CY (2004) Validation of the Taiwan birth registry using obstetric records. J Formosan Med Assoc 103(4):297–301Google Scholar
- 9.Villar J, Ismail LC, Victora CG, Ohuma EO, Bertino E, Altman DG, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Gravett MG, Purwar M, Frederick IO, Noble AJ, Pang R, Barros FC, Chumlea C, Bhutta ZA, Kennedy SH (2014) International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet 384(9946):857–868. https://doi.org/10.1016/S0140-6736(14)60932-6 CrossRefGoogle Scholar
- 11.Hung TH, Hsieh TT (2015) The effects of implementing the International Association of Diabetes and Pregnancy Study Groups criteria for diagnosing gestational diabetes on maternal and neonatal outcomes. PLoS ONE 10(3):e0122261–e0122261. https://doi.org/10.1371/journal.pone.0122261 CrossRefGoogle Scholar
- 16.Chuwa FS, Mwanamsangu AH, Brown BG, Msuya SE, Senkoro EE, Mnali OP, Mazuguni F, Mahande MJ (2017) Maternal and fetal risk factors for stillbirth in Northern Tanzania: a registry-based retrospective cohort study. PLoS ONE 12(8):e0182250. https://doi.org/10.1371/journal.pone.0182250 CrossRefGoogle Scholar
- 20.Zhu J, Liang J, Mu Y, Li X, Guo S, Scherpbier R, Wang Y, Dai L, Liu Z, Li M, He C, Deng C, Yi L, Deng K, Li Q, Ma X, Wen C, Mu D, Ronsmans C (2016) Sociodemographic and obstetric characteristics of stillbirths in China: a census of nearly 4 million health facility births between 2012 and 2014. Lancet Glob health 4(2):e109–118. https://doi.org/10.1016/S2214-109X(15)00271-5 CrossRefGoogle Scholar
- 23.Bukowski R, Hansen NI, Willinger M, Reddy UM, Parker CB, Pinar H, Silver RM, Dudley DJ, Stoll BJ, Saade GR, Koch MA, Rowland Hogue CJ, Varner MW, Conway DL, Coustan D, Goldenberg RL, Eunice Kennedy Shriver National Institute of Child H, Human Development Stillbirth Collaborative Research (2014) Fetal growth and risk of stillbirth: a population-based case-control study. PLoS Med 11(4):e1001633. https://doi.org/10.1371/journal.pmed.1001633 CrossRefGoogle Scholar