Yemisrach B Okwaraji, Lorena Suárez-Idueta, Eric O Ohuma, Ellen Bradley, Judith Yargawa, Veronica Pingray, Gabriela Cormick, Adrienne Gordon, Vicki Flenady, Erzsébet Horváth-Puhó, Henrik Toft Sørensen, Liili Abuladze, Mohammed Heidarzadeh, Narjes Khalili, Khalid A Yunis, Ayah Al Bizri, Arturo Barranco, Aimée E van Dijk, Lisa Broeders, Fawzya Alyafei, Tawa O Olukade, Neda Razaz, Jonas Söderling, Lucy K Smith, Ruth J Matthews, Rachael Wood, Kirsten Monteath, Isabel Pereyra, Gabriella Pravia, Sarka Lisonkova, Qi Wen, Joy E Lawn, Hannah Blencowe
{"title":"2000 年至 2020 年 15 个国家 1.265 亿新生儿中按胎儿大小分列的死胎风险：胎儿风险方法。","authors":"Yemisrach B Okwaraji, Lorena Suárez-Idueta, Eric O Ohuma, Ellen Bradley, Judith Yargawa, Veronica Pingray, Gabriela Cormick, Adrienne Gordon, Vicki Flenady, Erzsébet Horváth-Puhó, Henrik Toft Sørensen, Liili Abuladze, Mohammed Heidarzadeh, Narjes Khalili, Khalid A Yunis, Ayah Al Bizri, Arturo Barranco, Aimée E van Dijk, Lisa Broeders, Fawzya Alyafei, Tawa O Olukade, Neda Razaz, Jonas Söderling, Lucy K Smith, Ruth J Matthews, Rachael Wood, Kirsten Monteath, Isabel Pereyra, Gabriella Pravia, Sarka Lisonkova, Qi Wen, Joy E Lawn, Hannah Blencowe","doi":"10.1111/1471-0528.17890","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs.</p><p><strong>Design: </strong>Population-based, multi-country study.</p><p><strong>Setting: </strong>National data systems in 15 high- and middle-income countries.</p><p><strong>Population: </strong>Live births and stillbirths.</p><p><strong>Methods: </strong>A total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation.</p><p><strong>Main outcome measures: </strong>Gestation-specific stillbirth rates and risks according to size at birth.</p><p><strong>Results: </strong>The overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed.</p><p><strong>Conclusions: </strong>Small for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA.</p>","PeriodicalId":4,"journal":{"name":"ACS Applied Energy Materials","volume":" ","pages":""},"PeriodicalIF":5.4000,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020: A fetuses-at-risk approach.\",\"authors\":\"Yemisrach B Okwaraji, Lorena Suárez-Idueta, Eric O Ohuma, Ellen Bradley, Judith Yargawa, Veronica Pingray, Gabriela Cormick, Adrienne Gordon, Vicki Flenady, Erzsébet Horváth-Puhó, Henrik Toft Sørensen, Liili Abuladze, Mohammed Heidarzadeh, Narjes Khalili, Khalid A Yunis, Ayah Al Bizri, Arturo Barranco, Aimée E van Dijk, Lisa Broeders, Fawzya Alyafei, Tawa O Olukade, Neda Razaz, Jonas Söderling, Lucy K Smith, Ruth J Matthews, Rachael Wood, Kirsten Monteath, Isabel Pereyra, Gabriella Pravia, Sarka Lisonkova, Qi Wen, Joy E Lawn, Hannah Blencowe\",\"doi\":\"10.1111/1471-0528.17890\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs.</p><p><strong>Design: </strong>Population-based, multi-country study.</p><p><strong>Setting: </strong>National data systems in 15 high- and middle-income countries.</p><p><strong>Population: </strong>Live births and stillbirths.</p><p><strong>Methods: </strong>A total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation.</p><p><strong>Main outcome measures: </strong>Gestation-specific stillbirth rates and risks according to size at birth.</p><p><strong>Results: </strong>The overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed.</p><p><strong>Conclusions: </strong>Small for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA.</p>\",\"PeriodicalId\":4,\"journal\":{\"name\":\"ACS Applied Energy Materials\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.4000,\"publicationDate\":\"2024-07-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Energy Materials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/1471-0528.17890\",\"RegionNum\":3,\"RegionCategory\":\"材料科学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CHEMISTRY, PHYSICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Energy Materials","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/1471-0528.17890","RegionNum":3,"RegionCategory":"材料科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CHEMISTRY, PHYSICAL","Score":null,"Total":0}
引用次数: 0
摘要
目的采用基于出生和胎儿风险的方法，比较妊娠 24-44 周时小胎龄（SGA）、大胎龄（LGA）和适龄（AGA）妊娠的死胎率和风险：设计：基于人口的多国研究：研究背景：15 个中高收入国家的国家数据系统：活产和死产：编制了 151 个国家年的数据，包括 15 个国家从 2000 年到 2020 年的 126 543 070 例新生儿。采用 INTERGROWTH-21st 标准将新生儿分为 SGA、AGA 和 LGA。以出生总数为分母计算妊娠24周至44周的妊娠特异性死胎率，以仍在宫内的胎儿为分母计算妊娠特异性死胎风险：主要结果测量指标：根据胎儿出生时的大小计算特定妊娠期的死胎率和死胎风险：所有妊娠期的总死胎率为每千名新生儿 4.22 例（95% CI 4.22-4.23）。采用以出生为基础的方法，死胎率在妊娠 24 周时最高，SGA 孕妇的死胎率为每 1000 名新生儿中有 621.6 例（95% CI 620.9-622.2），AGA 孕妇的死胎率为每 1000 名新生儿中有 298.4 例（95% CI 298.1-298.7），LGA 孕妇的死胎率为每 1000 名新生儿中有 338.5 例（95% CI 337.9-339.0）。根据风险胎儿的方法，妊娠 29 周之前的 SGA 孕妇的妊娠特异性死胎风险最高（每 1000 个风险胎儿中 1.3-1.4 个）。这一风险在妊娠 30 至 34 周之间保持稳定，然后从妊娠 35 周开始逐渐上升，在妊娠≥42 周时达到最高，为每 1000 个高危胎儿 8.4 例（95% CI 8.3-8.4）。与AGA妊娠相比，SGA妊娠的死胎风险比（RR）一直较高，妊娠≥42周的死胎风险比最高（RR 9.2，95% CI 15.2-13.2），妊娠24周的死胎风险比最低（RR 3.1，95% CI 1.9-4.3）。在所有国家中，SGA 与 AGA 妊娠的死胎死亡率也一直较高，各国的差异从墨西哥的 RR 0.70（95% CI 0.43-0.97）到乌拉圭的 RR 8.6（95% CI 8.1-9.1）不等。没有观察到LGA妊娠的风险增加：结论：在这项基于中高收入国家高质量数据的研究中，胎龄小（SGA）与死胎风险密切相关。早产妊娠的死亡率最高，三分之二的死产为早产。为了增进我们对死胎的了解，应使用来自低收入环境的高质量数据集进行进一步分析，尤其是那些 SGA 发生率相对较高的环境。
Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020: A fetuses-at-risk approach.
Objective: To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs.
Design: Population-based, multi-country study.
Setting: National data systems in 15 high- and middle-income countries.
Population: Live births and stillbirths.
Methods: A total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation.
Main outcome measures: Gestation-specific stillbirth rates and risks according to size at birth.
Results: The overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed.
Conclusions: Small for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA.
期刊介绍：
ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.
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