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The single largest risk factor is unrecognised fetal growth restriction, and preventive strategies need to focus on improving antenatal detection.Stillbirths represent a devastating pregnancy outcome, and the need for increased efforts in prevention has been highlighted by SANDS (Stillbirth and Neonatal Death Charity)1 and other parent led campaigns.A mother can opt out at any time from her data being used, in which case her NHS number is added to an “opt-out register” and further analysis is blocked.The Perinatal Institute’s confidentiality and consent protocol has been reviewed and passed as appropriate by UK Connecting for Health, the NHS, and the Information Commissioner.To reduce the over-reliance in the estimates and the selection mechanism that may arise due to rarity of stillbirths, we used the bootstrapping approach to calculate standard errors.In the multivariable analysis all variables reaching a 0.05 significance level were retained in the model.
We therefore explored the risk factors in pregnancies with normally formed singletons and estimated the respective contribution of these factors to the overall burden of stillbirth in our population.
After initial exploratory analysis, we assessed the independent and multiple variable effects of explanatory variables on stillbirths in Poisson regression models.
Variables entered in the multivariable analysis are those of known clinical relevance and from previous publications2 14 and included maternal age, parity, ethnic origin, place of birth, body mass index, history of mental health problems, pre-existing hypertension, pre-existing diabetes, cardiac disease, previous stillbirths, smoking in pregnancy, alcohol consumption, antenatal folic acid intake, late booking (≥13 weeks), gestational diabetes, pregnancy induced hypertension, pre-eclampsia, antepartum haemorrhage, and fetal growth restriction.
The data originated from prospective records created in the standardised hand held maternity notes during pregnancy by the midwives and doctors.17 Trained data clerks in the respective hospitals transfer information from the notes on to the perinatal episode electronic record at the end of pregnancy.
Quality was assured by central project staff through training workshops and regular on-site data quality audits.
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In addition to the index of multiple deprivation, we included maternal and paternal employment status as social factors in the multivariable analysis.