Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil

Author(s)

Marcia Furquim de Almeida ^[1] ; Gizelton Pereira Alencar ^[2] ; Hillegonda Maria Dutilh Novaes ^[3] ; Ivan França Jr ^[4] ; Arnaldo Augusto Franco de Siqueira ^[5] ; Oona M R Campbell ^[6] ; Daniela Schoeps ^[7] ; Laura Cunha Rodrigues ^[8]

Affiliation

^[1] Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia - Brasil

^[2] Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia - Brasil

^[3] USP. Faculdade de Medicina. Departamento de Medicina Preventiva

^[4] USP. FSP. Departamento de Saúde Materno-Infantil - Brasil

^[5] USP. FSP. Departamento de Saúde Materno-Infantil - Brasil

^[6] London School of Hygiene and Tropical Medicine. Infectious Diseases Epidemiology Unit - Ucrânia

^[7] Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia - Brasil

^[8] London School of Hygiene and Tropical Medicine. Infectious Diseases Epidemiology Unit - Ucrânia

• Document type: Journal article
• Source: Revista de Saúde Pública; v. 41, n. 1, p. 35-43, 2007-02-00.

Abstract

OBJECTIVE: To assess risk factors for antepartum fetal deaths. METHODS: A population-based case-control study was carried out in the city of São Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS: Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS: Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors - mother's low education and marital status - are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality. (AU)