Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis

Flenady, Vicki, Koopmans, Laura, Middleton, Philippa, Frøen, J. Frederik, Smith, Gordon C., Gibbons, Kristen, Coory, Michael, Gordon, Adrienne, Ellwood, David, McIntyre, Harold David, Fretts, Ruth and Ezzati, Majid (2011) Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. The Lancet, 377 9774: 1331-1340. doi:10.1016/S0140-6736(10)62233-7

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Author Flenady, Vicki
Koopmans, Laura
Middleton, Philippa
Frøen, J. Frederik
Smith, Gordon C.
Gibbons, Kristen
Coory, Michael
Gordon, Adrienne
Ellwood, David
McIntyre, Harold David
Fretts, Ruth
Ezzati, Majid
Title Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis
Journal name The Lancet   Check publisher's open access policy
ISSN 0140-6736
Publication date 2011-04
Sub-type Article (original research)
DOI 10.1016/S0140-6736(10)62233-7
Volume 377
Issue 9774
Start page 1331
End page 1340
Total pages 10
Place of publication London, United Kingdom
Publisher The Lancet Publishing Group
Collection year 2012
Language eng
Formatted abstract
Stillbirth rates in high-income countries have shown little or no improvement over the past two decades. Prevention strategies that target risk factors could be important in rate reduction. This systematic review and meta-analysis was done to identify priority areas for stillbirth prevention relevant to those countries.


Population-based studies addressing risk factors for stillbirth were identified through database searches. The factors most frequently reported were identified and selected according to whether they could potentially be reduced through lifestyle or medical intervention. The numbers attributable to modifiable risk factors were calculated from data relating to the five high-income countries with the highest numbers of stillbirths and where all the data required for analysis were available. Odds ratios were calculated for selected risk factors, from which population-attributable risk (PAR) values were calculated.


Of 6963 studies initially identified, 96 population-based studies were included. Maternal overweight and obesity (body-mass index >25 kg/m2) was the highest ranking modifiable risk factor, with PARs of 8-18 across the five countries and contributing to around 8000 stillbirths (≥22 weeks' gestation) annually across all high-income countries. Advanced maternal age (>35 years) and maternal smoking yielded PARs of 7-11 and 4-7, respectively, and each year contribute to more than 4200 and 2800 stillbirths, respectively, across all high-income countries. In disadvantaged populations maternal smoking could contribute to 20 of stillbirths. Primiparity contributes to around 15 of stillbirths. Of the pregnancy disorders, small size for gestational age and abruption are the highest PARs (23 and 15, respectively), which highlights the notable role of placental pathology in stillbirth. Pre-existing diabetes and hypertension remain important contributors to stillbirth in such countries.

The raising of awareness and implementation of effective interventions for modifiable risk factors, such as overweight, obesity, maternal age, and smoking, are priorities for stillbirth prevention in high-income countries.

The Stillbirth Foundation Australia, the Department of Health and Ageing, Canberra, Australia, and the Mater Foundation, Brisbane, Australia.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Public Health Publications
School of Medicine Publications
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Created: Mon, 18 Jul 2011, 12:37:44 EST by Matthew Lamb on behalf of School of Medicine