title: Gestational age specific stillbirth risk among Indigenous and non-Indigenous women in Queensland, Australia: a population based study.
abstract: In Australia, significant disparity persists in stillbirth rates between Aboriginal and Torres Strait Islander (Indigenous Australian) and non-Indigenous women. Diabetes, hypertension, antepartum haemorrhage and small-for-gestational age (SGA) have been identified as important contributors to higher rates among Indigenous women. The objective of this study was to examine gestational age specific risk of stillbirth associated with these conditions among Indigenous and non-Indigenous women.
  
  
  
  Retrospective population-based study of all singleton births of at least 20 weeks gestation or at least 400 grams birthweight in Queensland between July 2005 and December 2011 using data from the Queensland Perinatal Data Collection, which is a routinely-maintained database that collects data on all births in Queensland. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95 % confidence intervals, adjusting for maternal demographic and pregnancy factors.
  
  
  
  Of 360987 births analysed, 20273 (5.6 %) were to Indigenous women and 340714 (94.4 %) were to non-Indigenous women. Stillbirth rates were 7.9 (95 % CI 6.8-9.2) and 4.1 (95 % CI 3.9-4.3) per 1000 births, respectively. For both Indigenous and non-Indigenous women across most gestational age groups, antepartum haemorrhage, SGA, pre-existing diabetes and pre-existing hypertension were associated with increased risk of stillbirth. There were mixed results for pre-eclampsia and eclampsia and a consistently raised risk of stillbirth was not seen for gestational diabetes.
  
  
  
  This study highlights gestational age specific stillbirth risk for Indigenous and non-Indigenous women; and disparity in risk at term gestations. Improving access to and utilisation of appropriate and responsive healthcare may help to address disparities in stillbirth risk for Indigenous women.
authors.affiliation: Mater Research Institute-University of Queensland (MRI-UQ), Level 2 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. ibinabo.ibiebele@uqconnect.edu.au.|School of Public Health, University of Queensland, Brisbane, Australia. ibinabo.ibiebele@uqconnect.edu.au.
authors.forename: Ibinabo
authors.initials: I
authors.lastname: Ibiebele
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Coory
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Biomedical Research Centre, Cambridge, UK.
authors.forename: Gordon C S
authors.initials: GC
authors.lastname: Smith
authors.affiliation: Mater Research Institute-University of Queensland (MRI-UQ), Level 2 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.|School of Public Health, University of Queensland, Brisbane, Australia.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Boyle
authors.affiliation: School of Public Health, University of Queensland, Brisbane, Australia.|Queensland Health Metro North Brisbane Public Health Unit, Brisbane, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Vlack
authors.affiliation: South Australian Health and Medical Institute & Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
authors.forename: Philippa
authors.initials: P
authors.lastname: Middleton
authors.affiliation: Institute for Urban Indigenous Health, Brisbane, Australia.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Roe
authors.affiliation: Mater Research Institute-University of Queensland (MRI-UQ), Level 2 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.|School of Public Health, University of Queensland, Brisbane, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
mesh_terms: D000293:Adolescent; D000328:Adult; D003920:Diabetes Mellitus / Q000208:ethnology*; D016640:Diabetes, Gestational / Q000208:ethnology; D005260:Female; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D007236:Infant, Small for Gestational Age; D011225:Pre-Eclampsia / Q000208:ethnology; D011247:Pregnancy; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000208:ethnology*; D014592:Uterine Hemorrhage / Q000208:ethnology; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal and Torres Strait Islander Australians; Antepartum haemorrhage; Diabetes; Fetal death; Hypertension; Indigenous; Risk; Small for gestational age; Stillbirth