title: Temporal trends in maternal medical conditions and stillbirth.
abstract: OBJECTIVE
  The objective of this study was to estimate the prevalence and temporal trends of medical conditions among women with stillbirth and to determine the effect of medical comorbidities on the trend of stillbirth.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) for the years 2008-2010 was first queried for all delivery-related discharges. A multivariable logistic regression model was constructed with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) calculated for medical conditions among women with stillbirth. The NIS was then queried for the years 2000-2010, and the effect of maternal medical conditions on the stillbirth rate was estimated.
  
  
  RESULTS
  From 2008 to 2010, there were 51,080 deliveries to women with stillbirth, giving a rate of 4.08 per 1000 live births. Women with stillbirth were more likely to be African American (OR, 2.12; 95% CI, 2.07-2.17), with an age less than 25 years (OR, 1.19; 95% CI, 1.16-1.22) or older than 35 years (OR, 1.40; 95% CI, 1.37-1.44) compared with women without stillbirth. Medical conditions such as cardiac, rheumatological, and renal disorders; hypertension; diabetes; thrombophilia; and drug, alcohol and tobacco use, were independent predictors of fetal demise in multivariable logistic regression modeling. From 2000 to 2010, despite an increase in the total number of births to women with comorbidities, there was a significant decrease in the stillbirth rate, which was more pronounced among women with comorbidities compared with women without comorbidities (P=.021).
  
  
  CONCLUSIONS
  From 2000 to 2010, there was a significantly greater decrease in the stillbirth rate among women with maternal medical conditions than there was among women without comorbidities. These findings occurred despite an overall increase in the number of pregnancies to women with medical comorbidities over the time period. Because the NIS does not include information on gestational age, birthweight, or whether subjects had antepartum testing, we are not able to determine the effect of these variables on the observed outcomes.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Patel
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: William H
authors.initials: WH
authors.lastname: Goodnight
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC.
authors.forename: Andra H
authors.initials: AH
authors.lastname: James
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC. Electronic address: chad.grotegut@duke.edu.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Grotegut
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology*; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000208:ethnology; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D012216:Rheumatic Diseases / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology* / Q000208:ethnology; D019966:Substance-Related Disorders / Q000453:epidemiology; D019851:Thrombophilia / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: nationwide inpatient sample; pregnancy; risk factors; stillbirth