International Journal of Epidemiology, Vol 28, 475-478, Copyright © 1999 by International Epidemiological Association
E Forssas, M Gissler, M Sihvonen and E Hemminki
BACKGROUND: Many maternal characteristics increase the risk for perinatal
death. To locate potential sites for intervention, it is important to
identify these risk factors and examine how much of the excess mortality is
explained by infants' low birthweight. METHODS: Data on all newborns in
Finland born between 1991 and 1993 (N = 199,291, of which 1461 were
perinatal deaths) were obtained from the Medical Birth Register. Logistic
regression analysis was used to adjust for background variables, both
including and excluding infants' birthweight. The percentage reduction in
odds ratios after adjustment for infants' birthweight was used to estimate
the contribution of infants' low birthweight to the excess mortality.
RESULTS: After adjusting confounding factors, increased risk for perinatal
death was found for eight maternal characteristics. In the following the
increased risk is given as odds ratios and the proportions of the excess
mortality explained by infants' low birthweight are in parentheses:
in-vitro fertilization 4.12 (> 100%); earlier stillbirth 3.43 (87%);
higher maternal age, from 1.21 to 3.08 (38-99%); maternal diabetes 2.87
(50%); lower socioeconomic status, from 1.30 to 1.70 (27- 44%); smoking
during pregnancy 1.45 (> 100%); single mother 1.44 (50%); first birth
1.36 (75%). CONCLUSIONS: Excess mortality due to maternal risk factors
occurred mainly through their tendency to cause low birthweight. However,
the excess mortality associated with low socioeconomic status, single
motherhood, and diabetes was mediated by other mechanisms in addition to
low birthweight.
ARTICLES
Maternal predictors of perinatal mortality: the role of birthweight
National Research and Development Centre for Welfare and Health, Health Services Research Unit, Helsinki, Finland. erja.forssas@stakes.fi
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