Stillbirth rates following the change in definition of fetal mortality in Quebec.

IF 2.9 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Canadian Journal of Public Health-Revue Canadienne De Sante Publique Pub Date : 2024-09-05 DOI:10.17269/s41997-024-00930-5

Golden Welsh, Aimina Ayoub, Marianne Bilodeau-Bertrand, Antoine Lewin, Nathalie Auger

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引用次数: 0

Abstract

Objectives: In 2019, Quebec changed its stillbirth definition to include fetal deaths at 20 weeks gestation or more. Previously, the criterion was a minimum birth weight of 500 g. We assessed the impact of the new definition on stillbirth rates.

Methods: We conducted a retrospective study of stillbirth rates between 2010 and 2021 in Quebec. The exposure consisted of the period during the new definition versus the preceding period. We assessed how the new definition affected stillbirth rates using interrupted time series regression, and compared the period during the new definition with the preceding period using prevalence differences and prevalence ratios with 95% confidence intervals (CI). We determined the extent to which fetuses at the limit of viability (under 500 g or 20‒23 weeks) accounted for any increase in rates.

Results: Stillbirth rates went from 4.11 before the new definition to 6.76 per 1000 total births immediately after. Overall, the change in definition led to an absolute increase of 2.58 stillbirths per 1000 total births, for a prevalence ratio of 1.76 (95% CI 1.61‒1.92) compared with the preceding period. Fetal deaths due to congenital anomalies increased by 6.82 per 10,000 (95% CI 4.85‒8.78), while deaths due to pregnancy termination increased by 10.47 per 10,000 (95% CI 8.04‒12.89). Once the definition changed, 37% of stillbirths were under 500 g and 42% were between 20 and 23 weeks, with around half of these caused by congenital anomalies and terminations.

Conclusion: Stillbirth rates increased after the definition changed in Quebec, mainly due to congenital anomalies and pregnancy terminations.

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魁北克省改变胎儿死亡率定义后的死胎率。

目标：2019 年，魁北克省更改了死胎定义，将妊娠 20 周或以上的胎儿死亡纳入其中。我们评估了新定义对死胎率的影响：我们对魁北克省 2010 年至 2021 年的死胎率进行了回顾性研究。研究对象包括新定义实施期间和实施前的死胎率。我们使用间断时间序列回归法评估了新定义对死胎率的影响，并使用患病率差异和患病率比率（带 95% 置信区间 (CI)）比较了新定义期间与之前期间的死胎率。我们确定了胎儿存活极限（500 克以下或 20-23 周）在多大程度上导致了死亡率的上升：结果：死胎率从新定义前的每千名新生儿 4.11 例上升到新定义后的每千名新生儿 6.76 例。总体而言，定义的改变导致每 1000 名新生儿中的死胎绝对数增加了 2.58 例，与前一时期相比，流行率为 1.76（95% CI 1.61-1.92）。先天性畸形导致的胎儿死亡增加了 6.82‰（95% CI 4.85-8.78），而终止妊娠导致的死亡增加了 10.47‰（95% CI 8.04-12.89）。定义改变后，37%的死胎体重在 500 克以下，42%的死胎在 20 到 23 周之间，其中大约一半是先天性畸形和终止妊娠造成的：结论：魁北克省的死胎率在定义改变后有所上升，主要原因是先天畸形和妊娠终止。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Public Health-Revue Canadienne De Sante Publique PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.10

自引率

4.70%

发文量

128

期刊介绍： The Canadian Journal of Public Health is dedicated to fostering excellence in public health research, scholarship, policy and practice. The aim of the Journal is to advance public health research and practice in Canada and around the world, thus contributing to the improvement of the health of populations and the reduction of health inequalities. CJPH publishes original research and scholarly articles submitted in either English or French that are relevant to population and public health. CJPH is an independent, peer-reviewed journal owned by the Canadian Public Health Association and published by Springer. Énoncé de mission La Revue canadienne de santé publique se consacre à promouvoir l’excellence dans la recherche, les travaux d’érudition, les politiques et les pratiques de santé publique. Son but est de faire progresser la recherche et les pratiques de santé publique au Canada et dans le monde, contribuant ainsi à l’amélioration de la santé des populations et à la réduction des inégalités de santé. La RCSP publie des articles savants et des travaux inédits, soumis en anglais ou en français, qui sont d’intérêt pour la santé publique et des populations. La RCSP est une revue indépendante avec comité de lecture, propriété de l’Association canadienne de santé publique et publiée par Springer.