title: Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil.
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.
authors.affiliation: Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil. marfural@usp.br
authors.forename: Marcia
authors.initials: M
authors.lastname: Furquim de Almeida
authors.forename: Gizelton Pereira
authors.initials: GP
authors.lastname: Alencar
authors.forename: Hillegonda Maria Dutilh
authors.initials: HM
authors.lastname: Novaes
authors.forename: Ivan
authors.initials: I
authors.lastname: França
authors.forename: Arnaldo Augusto
authors.initials: AA
authors.lastname: Franco de Siqueira
authors.forename: Oona M R
authors.initials: OM
authors.lastname: Campbell
authors.forename: Daniela
authors.initials: D
authors.lastname: Schoeps
authors.forename: Laura Cunha
authors.initials: LC
authors.lastname: Rodrigues
mesh_terms: 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