Research
Obstetrics
Racial disparities in stillbirth risk across gestation in the United States

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Objective

We sought to determine factors associated with racial disparities in stillbirth risk.

Study Design

Stillbirth hazard was analyzed using 5,138,122 singleton gestations from the National Center of Health Statistics perinatal mortality and birth files, 2001–2002.

Results

Black women have a 2.2-fold increased risk of stillbirth compared with white women. The black/white disparity in stillbirth hazard at 20–23 weeks is 2.75, decreasing to 1.57 at 39–40 weeks. Higher education reduced the hazard for whites more than for blacks and Hispanics. Medical, pregnancy, and labor complications accounted for 30% of the hazard in blacks and 20% in whites and Hispanics. Congenital anomalies and small for gestational age contributed more to preterm stillbirth risk among whites than blacks. Pregnancy and labor conditions contributed more to preterm stillbirth risk among blacks than whites.

Conclusion

The excess stillbirth risk for blacks was greatest at preterm gestations, and factors contributing to stillbirth risk vary by race and gestational age.

Section snippets

Materials and Methods

The sources of data were the NCHS Perinatal Mortality Data Files and the Birth Cohort Linked Birth/Infant Death Data Sets for 2001–2002 combined. We selected the following 36 states for analyses, because they met the criteria of ≥80% complete reporting for the specific data entry fields on Hispanic origin, method of delivery, and prenatal care history: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland,

Results

Cumulative hazard of stillbirth at a gestation interval estimates the probability of having a stillbirth while in that given interval of pregnancy. The cumulative hazard for stillbirth/1000 pregnancies from 20–41 weeks' gestation was 22.07 for non-Hispanic blacks, 10.02 for non-Hispanic whites, and 10.58 for Hispanics. The stillbirth hazard was highest at 20–23 weeks' and 39–41 weeks' gestation (Figure). Increased hazard was observed at every gestation interval for blacks compared with the

Comment

This study examines the hazard of stillbirth using ongoing pregnancies as the comparison group, which provides a clinically relevant estimate of stillbirth risk at intervals in gestation.6 The risk of stillbirth is greatest at the beginning (20–23 weeks) and at the end (39–41 weeks) of gestation regardless of race/ethnicity, as has been previously described.7 Non-Hispanic black women have a 2.2-fold increased risk of stillbirth compared with non-Hispanic white women. We found that the

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  • Cited by (0)

    Cite this article as: Willinger M, Ko C-W, Reddy UM. Racial disparities in stillbirth risk across gestation in the United States. Am J Obstet Gynecol 2009;201:469.e1-8.

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