Design, setting and participants: Retrospective cross-sectional study of all singleton births at 37–42 weeks’ gestation, excluding those with congenital abnormalities and intrapartum stillbirths, between 1 June 2001 and 31 May 2011 at Southern Health, a large metropolitan maternity service in Melbourne, Australia.
Results: Among 44 326 births, there was a significant difference in the stillbirth rate by maternal country of birth (P < 0.001). The rate of stillbirth per 1000 births was 1.48 among Australian-born women, 3.55 among South Asian-born women and 1.06 among South-East–East Asian-born women. Women born in South Asia were 2.4 (95% CI, 1.4–4.0) times more likely to have a late-pregnancy stillbirth than women born in Australia (P < 0.001). There was no significant difference between women born in Australia and women born in South-East–East Asia (P = 0.34). Adjusting for potential confounding factors, South Asian maternal birth remained an independent risk factor for stillbirth (adjusted odds ratio, 2.5; 95% CI, 1.3–5.1; P = 0.009).
Conclusion: Women born in South Asia have an increased risk of antepartum stillbirth in late pregnancy, compared with other women. This observation may have implications for the delivery of pregnancy care in Australia.
- 1. World Health Organization. World health statistics 2011. Geneva: WHO Publications, 2011. http://www.who.int/gho/publications/world_health_statistics/EN_WHS2011_Full.pdf (accessed Dec 2011).
- 2. Day P, Sullivan EA, Ford J, Lancaster P. Australia’s mothers and babies 1997. Sydney: Australian Institute of Health and Welfare, 1999. (AlHW Cat. No. PER 12; Perinatal Statistics Series No. 9.) http://www.preru.unsw.edu.au/PRERUWeb.nsf/resources/PS_6_10/$file/ps9.pdf (accessed Dec 2011).
- 3. Li Z, McNally L, Hilder L, Sullivan EA. Australia’s mothers and babies 2009. Canberra: Australian Institute of Health and Welfare, 2011. (AIHW Cat. No. PER 52; Perinatal Statistics Series No. 25.) http://aihw.gov.au/publication-detail/?id=10737420870&tab=2 (accessed Dec 2011).
- 4. Smith GCS, Fretts RC. Stillbirth. Lancet 2007; 370: 1715-1725.
- 5. Woods R. Long-term trends in fetal mortality: implications for developing countries. Bull World Health Organ 2008; 86: 460-466.
- 6. Flenady V, Middleton P, Smith GC, et al. Stillbirths: the way forward in high-income countries. Lancet 2011; 377: 1703-1717.
- 7. Flenady V, Koopmans L, Middleton P, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377: 1331-1340.
- 8. Lawn JE, Blencowe H, Pattinson R, et al. Stillbirths: Where? When? Why? How to make the data count? Lancet 2011; 377: 1448-1463.
- 9. Mohsin M, Bauman AE, Jalaludin B. The inuence of antenatal and maternal factors on stillbirths and neonatal deaths in New South Wales, Australia. J Biosoc Sci 2006; 38: 643-657.
- 10. Huang L, Sauve R, Birkett N, et al. Maternal age and risk of stillbirth: a systematic review. CMAJ 2008; 178: 165-172.
- 11. Gagnon AJ, Zimbeck M, Zeitlin J, et al. Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med 2009; 69: 934-946.
- 12. Gissler M, Alexander S, MacFarlane A, et al. Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstet Gynecol Scand 2009; 88: 134-148.
- 13. Parsons L, Duley L, Alberman E. Socio-economic and ethnic factors in stillbirth and neonatal mortality in the NE Thames Regional Health Authority (NETRHA) 1983. Br J Obstet Gynaecol 1990; 97: 237-244.
- 14. Balchin I, Whittaker JC, Patel RR, et al. Racial variation in the association between gestational age and perinatal mortality: prospective study. BMJ 2007; 334: 833. doi: 10.1136/bmj.39132.482025.80.
- 15. Ravelli ACJ, Tromp M, Eskes M, et al. Ethnic differences in stillbirth and early neonatal mortality in The Netherlands. J Epidemiol Community Health 2011; 65: 696-701.
- 16. Australian Bureau of Statistics. Migration, Australia, 2009–10. Canberra: ABS, 2011. http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/CAC6E05106F66A13CA2578B000119F19/$File/34120_2009-10.pdf (accessed Dec 2011).
- 17. MacDorman MF. Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: an overview. Semin Perinatol 2011; 35: 200-208.
- 18. United Nations Statistics Division. Composition of macro geographical (continental) regions, geographic sub-regions, and selected economic and other groupings. New York: UN, 2011. http://unstats.un.org/unsd/methods/m49/m49regin.htm (accessed Dec 2011).
- 19. Getahun D, Ananth CV, Kinzler WL. Risk factors for antepartum and intrapartum stillbirth: a population-based study. Am J Obstet Gynecol 2007; 196: 499-507.
- 20. Raleigh VS, Botting B, Balarajan R. Perinatal and postneonatal mortality in England and Wales among immigrants from the Indian subcontinent. Indian J Pediatr 1990; 57: 551-562.
- 21. Rowland Hogue CJ, Silver RM. Racial and ethnic disparities in United States: stillbirth rates: trends, risk factors, and research needs. Semin Perinatol 2011; 35: 221-233.
- 22. Kramer MS, Ananth CV, Platt RW, Joseph KS. US Black vs White disparities in foetal growth: physiological or pathological? Int J Epidemiol 2006; 35: 1187-1195.
- 23. Zhang X, Mumford SL, Cnattingius S, et al. Reduced birthweight in short or primiparous mothers: physiological or pathological? BJOG 2010; 117: 1248-1254.
- 24. Royal College of Obstetricians and Gynaecologists. The investigation and management of the small-for-gestational-age fetus. Guideline No. 31. London: RCOG, 2002.
- 25. Hutcheon JA, Zhang X, Platt RW, et al. The case against customised birthweight standards. Paediatr Perinat Epidemiol 2011; 25: 11-16.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.