Risk Factors for Intrauterine Fetal Demise (IUFD) From 2000-2006
Michael S. McLemore, Department of Pathology, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, NY
Somnath Pal, Department of Pharmacy and Administrative Sciences, College of Pharmacy and Health Sciences
Sandra E. Reznik, Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences
Abstract: The aim of the present study is to evaluate the incidences of various risk factors for IUFD among autopsy cases and to compare these to the incidences found among live-birth control deliveries from 2000-2006.
Hypothesis: We hypothesize that the incidences of diabetes mellitus (DM) and hypertension (HTN) are significantly greater among IUFDs than live-birth control cases from 2000-2006.
Design: Reports of IUFD autopsies (n=117) from 2000-2006 were reviewed and compared to records of live-birth control deliveries (n=222) randomly selected during this same time interval. Both the medical records of the neonates and of their mothers were investigated for IUFD risk factors.
Results: Maternal risk factors for IUFD made a significant impact on fetal outcome. The incidence of DM (Gestational or Type II) was significantly greater among IUFD cases (n=117) than live-birth controls (n=222) (13.0% v. 6.8%, Fishers Exact, p=0.045). The incidence of HTN was greater among IUFDs (12.2% v. 5.9%, p=0.037), and the incidence of advanced maternal age was greater among IUFD cases as well (23.3% v. 13.1%, p=0.013). Several placental risk factors and several fetal risk factors were also associated with a higher incidence of IUFD.
Conclusions: Our live-birth data has elucidated the significant associations that exist between IUFD and several maternal, placental and fetal risk factors. The incidences of diabetes and hypertension are both significantly greater among IUFD cases than among controls, suggesting that these factors seriously impact fetal outcome. As the rates of diabetes and obesity continue to rise in the US, pregnant minority women are likely to become increasingly vulnerable to these diseases. Our results can guide healthcare providers in the provision of tailored prenatal screening and obstetric care for minority women, and in the development of prenatal programs for medically underserved regions.