Epidemiology of fetal death in Latin America.
BACKGROUND
To identify risk factors associated with fetal death, and to measure the rate and the risk of fetal death in a large cohort of Latin American women.


METHODS
We analyzed 837,232 singleton births recorded in the Perinatal Information System Database of the Latin American Center for Perinatology and Human Development (CLAP) between 1985 and 1997. The risk factors analyzed included fetal factors and maternal sociodemographic, obstetric, and clinical characteristics. Adjusted relative risks were obtained, after adjustment for potential confounding factors, through multiple logistic regression models based on the method of generalized estimating equations.


RESULTS
There were 14,713 fetal deaths (rate=17.6 per 1000 births). The fetal death risk increased exponentially as pregnancy advanced. Thirty-seven percent of all fetal deaths occurred at term, and 64% were antepartum. The main risk factors associated with fetal death were lack of antenatal care (adjusted relative risk [aRR]=4.26; 95% confidence interval, 3.84-4.71) and small for gestational age (aRR=3.26; 95% CI, 3.13-3.40). In addition, the risk of death during the intrapartum period was almost tenfold higher for fetuses in noncephalic presentations. Other risk factors associated with stillbirth were: third trimester bleeding, eclampsia, chronic hypertension, preeclampsia, syphilis, gestational diabetes mellitus, Rh isoimmunization, interpregnancy interval<6 months, parity > or =4, maternal age > or =35 years, illiteracy, premature rupture of membranes, body mass index > or =29.0, maternal anemia, previous abortion, and previous adverse perinatal outcomes.


CONCLUSIONS
There are several preventable factors that should be dealt with in order to reduce the gap in fetal mortality between Latin America and developed countries.
Conde-Agudelo
A
A
Latin American Center for Perinatology and Human Development (CLAP), Division of Health Promotion and Protection, PAHO, WHO, Montevideo, Uruguay.
Belizán
J M
JM
Díaz-Rossello
J L
JL
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000150:complications; D002648:Child; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000150:complications; D004461:Eclampsia / Q000150:complications; D004522:Educational Status; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000209:etiology; D005322:Premature Rupture of Fetal Membranes / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007843:Latin America / Q000453:epidemiology; D008297:Male; D017533:Marital Status; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011295:Prenatal Care; D012204:Rh-Hr Blood-Group System; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013587:Syphilis / Q000150:complications
D012204:Rh-Hr Blood-Group System