It is often acknowledged that stillbirth, which is the intrauterine death of a fetus that usually happens between 20 and 28 weeks of gestation, is a crucial sign of the calibre and efficacy of health care systems throughout pregnancy and childbirth. It has been determined that one modifiable and controllable risk factor for stillbirth is the cardiovascular health of the mother before to pregnancy.
It is still unclear how certain clusters of prenatal cardiovascular risk factors relate to stillbirth, especially when it comes to different racial and ethnic groupings. With a focus on racial inequities, this study sought to assess the relationship between stillbirth and 16 different cardiovascular risk groups.
Using the Centers for Disease Control and Prevention Natality and Fetal Death Data Files (2014–2022), researchers carried out a population-based analysis across the country that included 131,047 stillbirths (defined as births that occurred at least 20 weeks gestation) and 31,408,776 singleton births. 16 mutually incompatible clusters were created using the prepregnancy cardiovascular risk factors (smoking, hypertension, diabetes, and nonideal body mass index).
Pregnancy diabetes posed the highest risk, followed by prepregnancy hypertension (95% CI, 2.27–2.63), smoking (95% CI, 1.58–1.67), and unhealthy body mass index (95% CI, 1.31–1.35). These findings were obtained from the analysis of 16 groups defined by the four binary risk factors. 2 out of 6 risk combinations, mostly those involving diabetes, showed the absolute extra risk related to the biological interaction between 2 risk variables.
There were clear racial differences, with non-Hispanic Black women having the highest absolute and relative odds of stillbirth-nearly twice as high as non-Hispanic White mothers.
Overall, this study demonstrated a substantial correlation between the risk of stillbirth, specific risk clusters, and prepregnancy cardiovascular risk factor scores. This research created 16 different risk clusters by combining four binary risk variables, and they discovered that the relationships between these clusters with stillbirth varied, with some single risk factors (where no other factors were present) exhibiting larger connections.
Source:
Nie, J., Rezende, L. F. M., Ferrari, G., Qiu, Y., Wang, X., Huang, W., Niu, Z., Chen, X., & Aune, D. (2025). Association of prepregnancy cardiovascular risk factors clusters with stillbirth risk across racial and ethnic groups: A nationwide population-based study of 31.4 million singleton births and 131 047 stillbirths. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.124.042319
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