title: Ethnic variation in stillbirth risk and the role of maternal obesity: analysis of routine data from a London maternity unit.
abstract: BACKGROUND
  Approximately 5 in 1,000 deliveries in England and Wales result in stillbirth, with little improvement in figures over the last few decades. The aim of this study was to investigate the association between clinical and socio-demographic factors and stillbirth, with a particular focus on ethnicity and obesity.
  
  
  METHODS
  Analysis of routine maternity data on 53,293 singleton births occurring in a large London teaching hospital between 2004 and 2012. Logistic regression was used to investigate risk factors for stillbirth and to explore potential effect modification.
  
  
  RESULTS
  53,293 deliveries occurred during the time period, of which 329 resulted in a stillbirth (6.2 per 1,000 births). Compared to White women, non-White ethnicity was associated with a doubling of the odds of stillbirth (aOR for Black women 2.15, 95% CI 1.56-2.97; aOR for South Asian women 2.33, 95% CI 1.42-3.83). Obese women had a trend towards higher odds of stillbirth compared to women of recommended BMI (aOR 1.38, 95% CI 0.98-1.96), though this was not significant (p 0.07). Both higher parity (≥2 compared to para 1) and hypertension were associated with a higher odds of stillbirth (parity ≥2 aOR 1.65, 95% CI 1.13-2.39; hypertension aOR 1.84, 95% CI 1.22-2.78) but there was no evidence that area deprivation or maternal age were independently associated with stillbirth in this population. There was some evidence of effect modification between ethnicity and obesity (p value for interaction 0.06), with obesity a particularly strong risk factor for stillbirth in South Asian women (aOR 4.64, 95% CI 1.84-11.70).
  
  
  CONCLUSIONS
  There was a high prevalence of stillbirth in this multi-ethnic urban population. The increased risk of stillbirth observed in non-White women remains after adjusting for other factors. Our finding of possible effect modification between ethnicity and obesity suggests that further research should be conducted in order to improve understanding of the interplay between ethnicity, obesity and stillbirth.
authors.affiliation: King's College London School of Medicine, Capital House, King's College, London, SE1 3QD, UK. nicolepenn90@gmail.com.
authors.forename: Nicole
authors.initials: N
authors.lastname: Penn
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK. Eugene.Oteng-Ntim@gstt.nhs.uk.
authors.forename: Eugene
authors.initials: E
authors.lastname: Oteng-Ntim
authors.affiliation: Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. laura.oakley@lshtm.ac.uk.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Oakley
authors.affiliation: Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. pat.doyle@lshtm.ac.uk.
authors.forename: Pat
authors.initials: P
authors.lastname: Doyle
mesh_terms: D000328:Adult; D017677:Age Distribution; D044466:Asian People; D015992:Body Mass Index; D005006:Ethnicity; D005260:Female; D006801:Humans; D006973:Hypertension; D050498:Live Birth / Q000208:ethnology*; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008423:Maternal Age; D015999:Multivariate Analysis; D009765:Obesity / Q000208:ethnology*; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D012307:Risk Factors; D050497:Stillbirth / Q000208:ethnology*; D014505:Urban Population; D055815:Young Adult