Analysis Of Risk Factors Related To Stillbirth Based On Longitudinal Cohort

Objective:To study the related factors of stillbirth through a systematic review,at the same tiame,using the data collected from 2010-2018 in the pre-pregnancy eugenics program of Yunnan Province analyzes the related factors of stillbirth in our province.Finally,both are jointly discussed to syudy the risk factors of stillbirth.Methods:Using the computer searched for VIP,Wanfang,CNKI?CBM?Cochrane library?PubMed?Web of Science,and EMBASE databases to search for case-control studies,cohort studies,RCT studies of the chinese and english literature on stillbirth-related risk factors published between january 1,2007 and january 1,2018.Two researchers independently screened the literature,extracted data and evaluated the risk of bias included in the study,and used Stata 12.0 software for Meta analysis.The longitudinal data from the data of the "National Free Pre-Pregnancy Eugenics Health Check(NPCP)" project in Yunnan region from December 2010 to September 2018 were collected by means of questionnaire information of wife's general socio-economic characteristics,disease history,lifestyle,exposure to environmental risk factors,physical examination,clinical examination,early pregnancy follow-up and pregnancy outcome follow-up,and analyzed the above information through t test,chi-square test and Logistic regression model.Results:Systematic review part:3838 articles related to initial inspection,including 2311 articles in Chinese,1527 articles in English,1376 articles excluding duplicates,first screening of titles and abstracts of the remaining 2462 articles,after excluding 1514 articles,further reading the remaining 948 articles,and finally included 130 studies.(1)Demographic and socioeconomic factors:4 social background-related risk factors were included,maternal age ?20 years is not related to stillbirth(P>0.05),pregnant women BMI,place of residence is urban,pregnant women age?35,smoking are all related to premature birth(P<0.05);including pregnant women BMI<18.5kg/m2,pregnant women BMI?25kg/m2,pregnant women BMI 25-29.9kg/m2,pregnant women age?35,smoking,are risk factors for stillbirth(OR>1.00),and the higher the BMI value of pregnant women,the higher the correlation with stillbirth;the residence of the town is the protective factor of stillbirth(OR<1.00).(2)Clinical background-related risk factors:A total of 27 risk factors related to the clinical background of stillbirth were included.Meta analysis showed that the homogeneity test results of 6 factors including anemia,gestational diabetes,blood type,and fetal growth restriction were I2<50%.by using Analysis of fixed effect model;the consistency of the remaining 22 factors I2?50%by using random effect model analysis.HIV-positive,syphilis-positive,blood type O,no correlation between pre-pregnancy diabetes and stillbirth(P>0.05),prenatal bleeding,history of miscarriage,history of premature birth,stillbirth,anemia,placenta previa,gestational diabetes,male fetus,preeclampsia,gestational age,ABblood type,B blood type,primipara,multiple pregnancy,assisted reproduction,chronic hypertension,pregnancy hypertension,fetal malposition,congenital malformations,fetal growth restriction,placental abruption are stillbirth risk factors,history of cesarean section,premature rupture of membranes,and residence in cities or towns are protective factors for stillbirth.The data part of the NPCP project in Yunnan:From 2010 to 2018,the "National Free Pre-Pregnancy Eugenics Health Check(NPCP)" project in Yunnan reported a total of 1311 cases of intrauterine demisesand stillbirths;211126 cases of normal pregnancy(99.38%),The average age of mothers is 26.17±4.72 years old,there are 4284 people under the age of 18,accounting for 2.02%,and there are 12919 people over the age of 35,accounting for 6.1%;the education level is mainly junior high school,accounting for 54.8%;the nature of the household registration is mostly Rural registration accounts for about 97.0%,194227 farmers(92.6%),61.9%Han,and the top three ethnic minorities are Yi(16.91%),Dai(4.38%),and Miao(2.83%).The single factor results show:(1)Basic situation of mothers:primary school and below,housewives,age?45 years old,BMI=25-29.9kg/m2 are risk factors for stillbirth(OR>1.00),younger than 18 years old and 18-24 years old are protective factors of stillbirth(OR<1.00);(2)History of pregnancy:low menstruation,previous pregnancy,history of adverse pregnancy outcomes,1 full term normal pregnancy,2 full term normal pregnancy are all risk factors for stillbirth(OR>1.00);high menstrual flow,1 pregnancy,are protective factors for stillbirth(OR<1.00);(3)Family history:The marriage history of close relatives in two generations of grandparents/maternal grandparentsis a risk factor for stillbirth(OR>1.00);(4)Eating habits:using cocaine and other narcotics is risk factors for stillbirth(OR>1.00);(5)Socio-psychological factors:The relationship with relatives,friends and colleagues is very tense,and the feeling of little economic pressure,are risk factors for stillbirth(OR>1.00);a little or very little tension with friends,family,and colleagues,are protective factors forstillbirth(OR<1.00);(6)Physical examination:hypertension before pregnancy is a risk factor for stillbirth(OR>1.00);(7)Early pregnancy follow-up:not taking folic acid or taking folic acid irregularly is a risk factor for stillbirth(OR>1.00),and taking folic acid at least three months before menopause is a protective factor for stillbirth(OR<1.00).The results of multivariate analysis showed that age over 45 years(OR=8.54,95%CI(1.12?65.02))and blood pressure 140/90mm/Hg(OR=3.11,95%CI(1.54?6.27))are the risk factors for stillbirth.Conclusion:The stillbirth rate in Yunnan is generally higher than that in other regions of China.The stillbirth rate is relatively low in areas with better economics in Yunnan province,and the stillbirth rate in Dai is higher.It should strengthen maternal management in economically backward areas.Pregnant women ?45 years old,overweight before pregnancy,adverse pregnancy outcomes,high blood pressure before pregnancy,are still risk factors for stillbirths and stillbirths,and are still protective factors for stillbirths aged 18-24 years.