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Comparison of stillbirth trends over two decades in Wales and Western Australia using pooled routinely collected health data: international retrospective cohort study

Bailey, Helen D., Kotecha, Sarah J., Watkins, William J., Adane, Akilew A., Shepherd, Carrington C. J. and Kotecha, Sailesh 2021. Comparison of stillbirth trends over two decades in Wales and Western Australia using pooled routinely collected health data: international retrospective cohort study. Paediatric and Perinatal Epidemiology 35 (3) , pp. 302-314. 10.1111/ppe.12739
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Abstract

Background Stillbirth is a critical public health issue worldwide. While the rates in high‐income countries are relatively low, there are persistent between‐country disparities. Objectives To compare stillbirth rates and trends in Wales and the State of Western Australia (WA), Australia, and provide insights into any differences. Methods In this international retrospective cohort study, we pooled population‐based data collections of all births ≥24 weeks’ gestation (excluding terminations for congenital anomalies) between 1993 and 2015, divided into six time periods. The stillbirth rate per 1000 births was estimated for each cohort in each time period. Multivariable Poisson regression analyses, adjusted for appropriateness of growth, socio‐economic status, maternal age, and multiple birth, were performed to evaluate the interaction between cohort and time period. Relative risk (RR) and 95% confidence interval (CI) for each time period and cohort were calculated. Results There were 767 731 births (3725 stillbirths) in Wales and 648 373 (2431 stillbirths) in WA. The overall stillbirth rate declined by 15.9% over the study period in Wales (from 5.3 in 1993‐96 to 4.5 per 1000 births in 2013‐15; Ptrend < .01) but by 40.4% in WA (from 4.9 to 2.9 per 1000 births in WA; Ptrend < .01). Using 1993‐96 in WA as the reference group, the adjusted RRs for stillbirths at 37‐38 weeks' gestation in the most recent study period (2013‐15) were 0.85 (95% CI 0.64, 1.13) in Wales and 0.51 (95% CI 0.36, 0.73) in WA. Conclusions The stillbirth rates between Wales and WA have widened in the last two decades (especially among late‐term births), although the absolute rates for both are distinctly higher than the best‐performing nations. While the differences may be partly explained by timing of birth and maternal life style behaviours such as smoking, it is important to identify and ameliorate the associated risk factors to support a reduction in preventable stillbirths.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Wiley
ISSN: 0269-5022
Date of First Compliant Deposit: 10 March 2021
Date of Acceptance: 18 October 2020
Last Modified: 10 May 2021 12:57
URI: http://orca.cf.ac.uk/id/eprint/139342

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