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Am J Perinatol
DOI: 10.1055/a-2099-8494
Original Article

Racial and Ethnic Disparities in Stillbirth among Pregnant Women with Obesity

Deepa Dongarwar
1   Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas
,
Veronica Ajewole
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Kiara K. Spooner
3   Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
,
Vincent Tran
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Tolulope Adebusuyi
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Collins Onyenaka
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Oluwatoyin Bakare
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Clinton Emeh
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Kameren Baines
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Danielle Boua
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Yhenew Mossi
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Anuoluwapo Egbejimi
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Samira Ibrahim
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Omonike Olaleye
2   Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas
,
Hamisu M. Salihu
1   Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas
3   Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
› Author Affiliations Funding Research funding was provided by the U.S. Department of Health and Human Services, Health Resources and Services Administration for the Maternal and Child Health Pipeline Training Program: TSU-BCM Maternal and Child Health Student Training for Academic Readiness and Success (MCH STARS) Undergraduate Fellowship Program, grant no: T16MC29831, and Center for Biomedical and Minority Health Research (CBMHR), National Institute of Health (NIH), grant no: U54MD007605.
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Abstract

Objective The aim of this study was to examine the relationship between obesity and risk of stillbirth among pregnant women with obesity in the United States, with a focus on racial and ethnic disparities.

Study Design We conducted a retrospective cross-sectional analysis of birth and fetal data from the 2014 to 2019 National Vital Statistics System (N = 14,938,384 total births) to examine associations between maternal body mass index (BMI) and risk of stillbirth. Cox's proportional hazards regression model was used to compute adjusted hazard ratios (HR) as a measure of risk of stillbirth in relation to maternal BMI.

Results The stillbirth rate was 6.70 per 1,000 births among women with prepregnancy obesity, while the stillbirth rate among women with a normal (nonobese) prepregnancy BMI was 3.85 per 1,000 births. The risk of stillbirth was greater among women with obesity compared with women without obesity (HR: 1.39; 95% confidence interval [CI]: 1.37–1.41). Compared with non-Hispanic (NH) Whites, women identifying as NH-other (HR: 1.66; 95% CI: 1.61–1.72) and NH-Black (HR: 1.31; 95% CI: 1.26–1.35) were at higher risk of stillbirth, while Hispanic women had a decreased likelihood of stillbirth (HR: 0.38; 95% CI: 0.37–0.40).

Conclusion Obesity is a modifiable risk factor for stillbirth. Public health awareness campaigns and strategies targeting weight management in women of reproductive age and racial/ethnic populations at highest risk for stillbirth, are needed.

Key Points

  • Stillbirth rates differ by race and ethnicity.

  • Risk of stillbirth was greatest among women with obesity.

  • Stillbirth rates rise with ascending prepregnancy BMI.

Keywords

stillbirth - fetal death - obesity - racial disparities


Publication History

Received: 11 July 2022

Accepted: 22 May 2023

Accepted Manuscript online:
25 May 2023

Article published online:
26 June 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Centers for Disease Control and Prevention. . Adult Obesity Facts. Accessed April 1, 2022 at: https://www.cdc.gov/obesity/data/adult.html
    PubMed
  • 2 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief 2020; (360) 1-8
    PubMedGoogle Scholar
  • 3 Centre for Maternal and Child Enquiries (CMACE). Maternal Obesity in the UK: Findings from a National Project. London: CMACE; 2010
    Google Scholar
  • 4 American Diabetes Association. . Gestational diabetes and a healthy baby? Yes. Accessed April 1, 2022 at: https://www.diabetes.org/diabetes/gestational-diabetes
    PubMed
  • 5 Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG 2013; 120 (08) 932-939
    CrossrefPubMedGoogle Scholar
  • 6 Yao R, Ananth CV, Park BY, Pereira L, Plante LA. Perinatal Research Consortium. Obesity and the risk of stillbirth: a population-based cohort study. Am J Obstet Gynecol 2014; 210 (05) 457.e1-457.e9
    CrossrefPubMedGoogle Scholar
  • 7 Åmark H, Westgren M, Persson M. Prediction of stillbirth in women with overweight or obesity: a register-based cohort study. PLoS One 2018; 13 (11) e0206940
    CrossrefPubMedGoogle Scholar
  • 8 Fretts R. Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention. Clin Obstet Gynecol 2010; 53 (03) 588-596
    CrossrefPubMedGoogle Scholar
  • 9 Reddy UM, Laughon SK, Sun L, Troendle J, Willinger M, Zhang J. Prepregnancy risk factors for antepartum stillbirth in the United States. Obstet Gynecol 2010; 116 (05) 1119-1126
    CrossrefPubMedGoogle Scholar
  • 10 Centers for Disease Control and Prevention. . What Is Stillbirth? Accessed April 1, 2022 at: www.cdc.gov/ncbddd/stillbirth/facts.html
    PubMed
  • 11 Zile I, Ebela I, Rumba-Rozenfelde I. Maternal risk factors for stillbirth: a registry-based study. Medicina (Kaunas) 2019; 55 (07) 326
    CrossrefPubMedGoogle Scholar
  • 12 Tavares Da Silva F, Gonik B, McMillan M. et al; Brighton Collaboration Stillbirth Working Group. Stillbirth: case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2016; 34 (49) 6057-6068
    CrossrefPubMedGoogle Scholar
  • 13 Centers for Disease Control and Prevention. . Data and Statistics: How Many Babies Are Stillborn? Accessed April 1, 2022 at: https://www.cdc.gov/ncbddd/stillbirth/data.html
    PubMed
  • 14 National Center for Health Statistics. . Vital Statistics Online Data Portal. Accessed October 1, 2021 at: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm
    PubMed
  • 15 Stephansson O, Dickman PW, Johansson A, Cnattingius S. Maternal weight, pregnancy weight gain, and the risk of antepartum stillbirth. Am J Obstet Gynecol 2001; 184 (03) 463-469
    CrossrefPubMedGoogle Scholar
  • 16 Willinger M, Ko CW, Reddy UM. Racial disparities in stillbirth risk across gestation in the United States. Am J Obstet Gynecol 2009; 201 (05) 469.e1-469.e8
    CrossrefPubMedGoogle Scholar
  • 17 Woolner AM, Bhattacharya S. Obesity and stillbirth. Best Pract Res Clin Obstet Gynaecol 2015; 29 (03) 415-426
    CrossrefPubMedGoogle Scholar
  • 18 Bodnar LM, Parks WT, Perkins K. et al. Maternal prepregnancy obesity and cause-specific stillbirth. Am J Clin Nutr 2015; 102 (04) 858-864
    CrossrefPubMedGoogle Scholar
  • 19 Salihu HM, Dunlop AL, Hedayatzadeh M, Alio AP, Kirby RS, Alexander GR. Extreme obesity and risk of stillbirth among black and white gravidas. Obstet Gynecol 2007; 110 (03) 552-557
    CrossrefPubMedGoogle Scholar
  • 20 McTigue K, Larson JC, Valoski A. et al. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA 2006; 296 (01) 79-86
    CrossrefPubMedGoogle Scholar
  • 21 Ramos GA, Caughey AB. The interrelationship between ethnicity and obesity on obstetric outcomes. Am J Obstet Gynecol 2005; 193 (3, Pt 2): 1089-1093
    CrossrefPubMedGoogle Scholar
  • 22 Salihu HM. Maternal obesity and stillbirth. Semin Perinatol 2011; 35 (06) 340-344
    CrossrefPubMedGoogle Scholar
  • 23 Boldt HB, Conover CA. Pregnancy-associated plasma protein-A (PAPP-A): a local regulator of IGF bioavailability through cleavage of IGFBPs. Growth Horm IGF Res 2007; 17 (01) 10-18
    CrossrefPubMedGoogle Scholar
  • 24 Wells G, Bleicher K, Han X. et al. Maternal diabetes, large-for-gestational-age births, and first trimester pregnancy-associated plasma protein-A. J Clin Endocrinol Metab 2015; 100 (06) 2372-2379
    CrossrefPubMedGoogle Scholar
  • 25 Smith R, Maiti K, Aitken RJ. Unexplained antepartum stillbirth: a consequence of placental aging?. Placenta 2013; 34 (04) 310-313
    CrossrefPubMedGoogle Scholar
  • 26 Driscoll AK, Gregory ECW. Increases in prepregnancy obesity: United States, 2016-2019. NCHS Data Brief 2020; (392) 1-8
    PubMedGoogle Scholar