Incidence of stillbirth: effect of deprivation

We aimed to examine the relationship between the English Index of Multiple Deprivation (IMD) and the incidence of stillbirth and to assess whether IMD contributes to the prediction of stillbirth over and above what is provided by the combination of maternal demographic characteristics and elements of medical history. This was a prospective, observational study of 159125 women with singleton pregnancies who attended their first routine hospital visit at 11+0 to 13+6 weeks' gestation, in two maternity hospitals in the UK. The inclusion criteria were delivery at ≥24 weeks' gestation of babies without major abnormalities. Participants completed a questionnaire on demographic characteristics and obstetric and medical history. We used IMD as a measure of socioeconomic status; this creates a score by taking into account income, employment, education skills and training, health and disability, crime, barriers to housing and services, and living environment. Each neighborhood is then ranked according to their level of deprivation relative to that of other areas into one of five equal groups; quintile 1 contains those areas that are in the 20% most deprived and quintile 5 contains those areas that are in the 20% least deprived. Logistic regression analysis was used to determine whether IMD provided significant independent contribution to stillbirth after adjustment for known maternal risk factors. The overall incidence of stillbirth was 0.35% (551/159125) and this was significantly higher in the most than the least deprived group (quintile 1 vs. quintile 5); the odds ratio (OR) in quintile 1 was 1.57 (95% CI 1.16 - 2.14) for all stillbirths, 1.64 (1.20 - 2.28) for antenatal stillbirths and 1.89 (1.23 - 2.98) for placental dysfunction-related stillbirths. In quintile 1 (vs. quintile 5) there was a higher incidence of factors that contribute to stillbirth, including Black race, increased body mass index, smoking, chronic hypertension and previous stillbirth. The OR of Black (vs. White) race was 2.58 (95% CI 2.14 - 3.10) for all stillbirths, 2.62 (2.16 - 3.17) for antenatal stillbirth and 3.34 (2.59 - 4.28) for placental dysfunction-related stillbirth. Multivariate analysis found that IMD did not provide a significant contribution to the prediction of stillbirth provided by maternal race and other maternal risk factors. In contrast, in Black (vs. White) women, the risk of all and antenatal stillbirth, after adjustment for other maternal risk factors, was 2.4-fold higher and the risk of placental dysfunction-related stillbirth was 2.9-fold higher. The incidence of stillbirth, particularly placental dysfunction-related stillbirth, is higher in women living in the most deprived areas in England. However, in screening for stillbirth, inclusion of IMD does not improve the prediction provided by race and other maternal characteristics and elements of medical history. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.]