Late stillbirths and long-term mortality of mothers.
OBJECTIVE
To assess whether women who experienced stillbirths have an excess risk of long-term mortality.


METHODS
We conducted a cohort study in the setting of the Jerusalem Perinatal Study, a population-based database of all births to West Jerusalem residents. Through data linkage with the Israeli Population Registry, we followed mothers who gave birth at least twice between 1964 and 1976 and compared the survival of women who had at least one stillbirth (n=595) with that of women who had only live births (n=24,523), using Cox proportional hazards models.


RESULTS
During the study period, 78 (13.1%) mothers with stillbirths died, compared with 1,518 (6.2%) women without stillbirth (crude hazard ratio 2.08, 95% confidence interval [CI] 1.65-2.61). The mortality risk remained significantly increased after adjustments for sociodemographic variables, maternal diseases at pregnancy, placental abruption, and preeclampsia (hazard ratio 1.40, 95% CI 1.11-1.77). Stillbirth was associated with an increased risk of death from coronary heart disease (adjusted hazard ratio 2.00, 95% CI 1.02-3.93), all circulatory (adjusted hazard ratio 1.70, 95% CI 1.02-2.84) and renal (adjusted hazard ratio 4.70, 95% CI 1.47-15.0) causes. Stratifying by country of origin, an increased risk was evident particularly among women of North African origin (all-cause mortality, adjusted hazard ratio 2.47, 95% CI 1.69-3.63).


CONCLUSIONS
Stillbirth may be a risk marker for premature mortality among parous women.
Calderon-Margalit
Ronit
R
Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel. ronit@md.huji.ac.il
Friedlander
Yechiel
Y
Yanetz
Rivka
R
Deutsch
Lisa
L
Manor
Orly
O
Harlap
Susan
S
Paltiel
Ora
O
D000328:Adult; D001775:Blood Circulation; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D016001:Confidence Intervals; D003327:Coronary Disease / Q000401:mortality; D005006:Ethnicity; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007674:Kidney Diseases / Q000401:mortality*; D008428:Maternal Mortality; D016017:Odds Ratio; D011247:Pregnancy; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D050497:Stillbirth; D013997:Time Factors