Risk of Antenatal Fetal Death at Different Stages of Gestation

Aim. To identify clinical and anamnestic risk factors for antenatal fetal death (AFD) depending on the gestational age.

Design. Retrospective case — control study.

Materials and methods. The study included 82 patients with AGP and 30 women who gave birth to live children. The participants were stratified into 4 groups depending on the gestational age and pregnancy outcome: Group I — patients with AGP at 22⁰-27⁶ weeks of gestation (n = 26), Group II — patients with AGP at 28⁰-36⁶ weeks of gestation (n = 29), Group III — patients with AGP at 37⁰-41⁶ weeks of gestation (n = 27), Group IV — women who have given birth tolive children. The following parameters were assessed using questionnaires, extracts from individual cards of pregnant and parturient women, birth histories, metabolic and outpatient cards: age, height and weight indicators, menstrual cycle, bad habits before pregnancy, gynecological and extragenital diseases, the time of registration for pregnancy and first trimester screening at 11-13⁶ weeks of gestation were also taken into account.

Results. In patients with AFD at any stage of gestation, weight and body mass index were statistically significantly higher than in women withlive births. Acute respiratory viral infections during pregnancy with fever and asymptomatic bacteriuria were more common in patients with AFD at 22⁰-27⁶ weeks of gestation than participants with live births. Anemia and a history of smoking were more common in two groups of patients with AFD: at 28⁰-36⁶ weeks of gestation and at full term than in women withlive birth. Preeclampsia and umbilical cord abnormalities were additional risk factors for AFD at 37⁰-41⁶ weeks of gestation.

Conclusion. The study of risk factors plays a crucial role in the prediction and prevention of AFD. Awareness of them by women planning pregnancy is of great importance for making informed decisions.

1. De Bernis L., Kinney M.V., Stones W., Hoope-Bender P.T. et al.; Lancet Ending Preventable Stillbirths Series Study Group; Lancet Ending Preventable Stillbirths Series Advisory Group. Stillbirths: ending preventable deaths by 2030. Lancet. 2016;387(10019):703–16. DOI: 10.1016/S0140-6736(15)00954-X

2. Zhakanova L.K., Espaeva R.N., Seralieva Zh.E., Orymbaeva L.A. et al. Analysis of perinatal mortality indicators in the city of Almaty for 2018–2019. Life and Health Science. 2020;2:163–7. (in Russian). DOI: 10.24411/1995-5871-2020-10100

3. Ivanov I.I., Lyashenko E.N., Kosolapova N.V., Cheripko M.V. et al. Antenatal fetal death: unsolved problems. Tavricheskiy MedikoBiologicheskiy Vestnik. 2020;23(1):37–41. (in Russian). DOI: 10.37279/2070-8092-2020-23-1-37-41

4. Kamilova M.Ya., Dzhonmakhmadova P.A., IshanKhodzhaeva F.R. The relationship of rates and causes of stillbirth to obstetric facility level. Doctor.Ru. 2020;19(8):61–5. (in Russian). DOI: 10.31550/1727-2378-2020-19-8-55-61-65

5. Li Z., Kong Y., Chen S., Subramanian M. et al. Independent and cumulative effects of risk factors associated with stillbirths in 50 low- and middle-income countries: a multi-country cross-sectional study. EClinicalMedicine. 2022;54:101706. DOI: 10.1016/j.eclinm.2022.101706

6. Saccone G., Gragnano E., Ilardi B., Marrone V. et al. Maternal and perinatal complications according to maternal age: a systematic review and meta-analysis. Int. J. Gynaecol. Obstet. 2022;159(1):43– 55. DOI: 10.1002/ijgo.14100

7. Dunne J., Tessema G.A., Gebremedhin A.T., Pereira G. Bias in the association between advanced maternal age and stillbirth using left truncated data. Sci. Rep. 2022;12(1):19214. DOI: 10.1038/s41598-022-23719-3

8. Avagliano L., Loghi M., D'Errico A., Simeoni S. et al. Risk of stillbirth in older mothers: a specific delivery plan might be considered for prevention. J. Matern. Fetal Neonatal Med. 2022;35(21):4137–41. DOI: 10.1080/14767058.2020.1847075

9. Ikedionwu C.A., Dongarwar D., Yusuf K.K., Ibrahimi S. et al. Prepregnancy maternal obesity, macrosomia, and risk of stillbirth: a population-based study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020;252:1–6. DOI: 10.1016/j.ejogrb.2020.06.004

10. Mahomed K., Chan G., Norton M. Obesity and the risk of stillbirth — a reappraisal — a retrospective cohort study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020;255:25–8. DOI: 10.1016/j.ejogrb.2020.09.044

11. Kenmoe S., Chu H.Y., Dawood F.S., Milucky J. et al. Burden of respiratory syncytial virus-associated acute respiratory infections during pregnancy. J. Infect. Dis. 2024;229(suppl.1):S51–60. DOI: 10.1093/infdis/jiad449

12. Kayem N.D., Benson C., Aye C.Y.L., Barker S. et al. Lassa fever in pregnancy: a systematic review and meta-analysis. Trans. R Soc. Trop. Med. Hyg. 2020;114(5):385–96. DOI: 10.1093/trstmh/traa011

13. Regan A.K., Klein N.P., Langley G., Drews S.J. et al. Respiratory syncytial virus hospitalization during pregnancy in 4 high-income countries, 2010–2016. Clin. Infect. Dis. 2018;67(12):1915–18. DOI: 10.1093/cid/ciy439

14. Muthiani Y., Hunter P.J., Näsänen-Gilmore P.K., Koivu A.M. et al. Antenatal interventions to reduce risk of low birth weight related to maternal infections during pregnancy. Am. J. Clin. Nutr. 2023;117(suppl.2):S118–33. DOI: 10.1016/j.ajcnut.2023.02.025

15. Hamadneh S., Hamadneh J. Active and passive maternal smoking during pregnancy and birth outcomes: a study from a developing country. Ann. Glob. Health. 2021;87(1):122. DOI: 10.5334/aogh.3384

16. Adibelli D., Kirca N. The relationship between gestational active and passive smoking and early postpartum complications. J. Matern. Fetal Neonatal Med. 2020;33(14):2473–9. DOI: 10.1080/14767058.2020.1763294

17. Chen M.M., Chiu C.H., Yuan C.P., Liao Y.C. et al. Influence of environmental tobacco smoke and air pollution on fetal growth: a prospective study. Int. J. Environ. Res. Public Health. 2020;17(15):5319. DOI: 10.3390/ijerph17155319

18. Qu Y., Chen S., Pan H., Zhu H. et al. Exposure to tobacco smoke and stillbirth: a national prospective cohort study in rural China. J. Epidemiol. Community Health. 2020;74(4):315–20. DOI: 10.1136/jech-2019-213290

19. Shi H., Chen L., Wang Y., Sun M. et al. Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw. Open. 2022;5(2):e2147046. DOI: 10.1001/jamanetworkopen.2021.47046

20. Yang Y., Le Ray I., Zhu J., Zhang J. et al. Preeclampsia prevalence, risk factors, and pregnancy outcomes in Sweden and China. JAMA Netw. Open. 2021;4(5):e218401. DOI: 10.1001/jamanetworkopen.2021.8401

21. Hammad I.A., Blue N.R., Allshouse A.A., Silver R.M. et al. Umbilical cord abnormalities and stillbirth. Obstet. Gynecol. 2020;135(3):644–52. DOI: 10.1097/AOG.0000000000003676