Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil.
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.
Furquim de Almeida
Marcia
M
Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil. marfural@usp.br
Alencar
Gizelton Pereira
GP
Novaes
Hillegonda Maria Dutilh
HM
França
Ivan
I
Franco de Siqueira
Arnaldo Augusto
AA
Campbell
Oona M R
OM
Schoeps
Daniela
D
Rodrigues
Laura Cunha
LC
D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006801:Humans; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors