(356) Adherence to recommended prenatal visits and stillbirth risk: a Stillbirth Collaborative Research Network secondary analysis

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: Suboptimal prenatal care is linked to increased risk of stillbirth, but the association between stillbirth cause of death (COD) and adherence to recommended prenatal visit (PNV) schedules is less understood. The objective of this study was to evaluate the relationship between appropriate PNV schedules according to established guidelines and COD in stillbirths.

Study Design: This is a secondary analysis from the Stillbirth Collaborative Research Network, which collected data from 2006-2009 across five regions of the United States. In the parent study, dates and gestational age (GA) at all PNV and at birth were collected and COD was evaluated via INCODE assessment. For this analysis, stillbirths with complete COD evaluation were included and appropriateness of PNV frequency—per the Michigan Plan for Appropriately Tailored Healthcare in Pregnancy guidelines—was added. Demographics and COD categories were compared between pregnancies resulting in stillbirth to which PNV guidelines were adhered and not adhered, based on PNV intervals and delivery GA. Multivariate regression for each COD controlled for obstetric or demographic differences between groups.

Results: Among 417 stillbirths included, 225 (54.0%) were non-adherent to PNV guidelines. Parturients who were younger, of minority race, and with fewer years of education were more likely to be non-adherent. For most COD categories—including obstetric COD—there was no association between non-adherence to PNV and COD. However, those who were non-adherent to recommended PNV had more than four-fold odds of hypertensive disorder-related COD (aOR 4.28 (95% CI 1.50 – 15.43)). Conversely, those who were non-adherent to PNV guidelines had 40% higher odds of having identifiable COD.

Conclusion:

Adherence to PNV guidelines is associated with hypertension-related COD, but not other stillbirth etiologies. These findings can help providers not only counsel pregnant patients with hypertension on the importance of adhering to recommended PNV but console patients after stillbirth from other etiologies that the frequency of their PNV was not associated with this outcome.

Primary & Presenting Author(s)

Tess E.K Cersonsky, BS (she/her/hers)
Medical Student
Alpert Medical School of Brown University
Providence, Rhode Island, United States

Coauthor(s)

Nina K. Ayala, MD
Attending Physician
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
George R. Saade, MD
Professor & Chief of Obstetrics & Maternal-Fetal Medicine
University of Texas Medical Branch
Galveston, Texas, United States
DD
Donald J. Dudley, MD
University of Virginia
Charlottesville, Virginia, United States
HP
Halit Pinar, MD
Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island
Providence, Rhode Island, United States
RS
Robert M. Silver, MD
University of Utah Health
Salt Lake City, Utah, United States
Uma M. Reddy, MD,MPH
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
Adam K. Lewkowitz, MD, MPHS
Assistant Professor
Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island
Providence, Rhode Island, United States