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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica

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Volume 44, Issue 7


Maternal characteristics of pregnancies with intrauterine fetal demise

Asnat Walfisch / Richard Brown / Angela Mallozzi / Mordechai Hallak
  • Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera, Israel, affiliated with The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Alon Shrim
  • Department of Obstetrics and Gynecology, Hillel-Yaffe Medical Center, Hadera, Israel, affiliated with The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2015-06-30 | DOI: https://doi.org/10.1515/jpm-2015-0135



To identify maternal characteristics independently associated with pregnancies resulting in intrauterine fetal demise (IUFD).

Study design:

This was a population-based cohort study of all births taking place at the McGill University Health Centre in Montreal, Canada, between 2001 and 2007, using the McGill University Obstetrics and Neonatal Database. Maternal characteristics were compared between pregnancies that resulted in IUFD and control pregnancies resulting in live newborns. A logistic regression analysis was constructed to identify parameters independently associated with IUFD.


We identified 20,744 births during the study period, 87 of which were complicated by IUFD. Mothers with IUFD were more likely to be younger, with less formal education, higher rates of smoking during pregnancy, and more fetal anomalies (42.5% vs. 7.5%, P<0.001). After exclusion of pregnancies with congenital and/or chromosomal abnormalities, less formal education (7 vs. 13.6 school years, P<0.001) and smoking during pregnancy (24% vs. 7.7%, P<0.001) remained significantly more common in pregnancies resulting in IUFD. In the multivariable regression analysis both smoking and number of maternal school years were independently associated with IUFD pregnancies (OR 2.22 for smoking, P=0.007 and OR 0.865 for number of school years, P<0.001).


Lower levels of education and smoking during pregnancy are independent predictors of IUFD.

Keywords: Fetal death; maternal education; maternal smoking; maternal socioeconomical status; risk factors; stillbirth


  • [1]

    www.stillbirthalliance.org. Accessed on February 28, 2007.

  • [2]

    Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet. 2011;377:1319–30.Google Scholar

  • [3]

    Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: where? When? Why? How to make the data count? Lancet. 2011;377:1448–63.Google Scholar

  • [4]

    Incerpi MH, Miller DA, Samadi R, Settlage RH, Goodwin TM. Stillbirth evaluation: what tests are needed? Am J Obstet Gynecol. 1998;178:1121–5.Google Scholar

  • [5]

    Eller AG, Branch DW, Byrne JL. Stillbirth at term. Obstet Gynecol. 2006;108:442–7.Google Scholar

  • [6]

    Pathak S, Lees CC, Hackett G, Jessop F, Sebire NJ. Frequency and clinical significance of placental histological lesions in an unselected population at or near term. Virchows Arch. 2011;459:565–72.Google Scholar

  • [7]

    Pinar H, Goldenberg RL, Koch MA, Heim-Hall J, Hawkins HK, Shehata B, et al. Placental findings in singleton stillbirths. Obstet Gynecol. 2014;123:325–36.Google Scholar

  • [8]

    American College of Obstetricians and Gynecologists. Genetic evaluation of stillbirths and neonatal deaths. ACOG Committee Opinion No 257. Washington, DC: American College of Obstetricians and Gynecologists; 2001.Google Scholar

  • [9]

    Conde-Agudelo A, Bird S, Kennedy SH, Villar J, Papageorghiou AT. First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis. BJOG. 2015;122:41–55.Google Scholar

  • [10]

    Ohana O, Holcberg G, Sergienko R, Sheiner E. Risk factors for intrauterine fetal death (1988–2009). J Matern Fetal Neonatal Med. 2011;24:1079–83.Google Scholar

  • [11]

    Balchin I, Whittaker JC, Patel RR, Lamont RF, Steer PJ. Racial variation in the association between gestational age and perinatal mortality: prospective study. BMJ. 2007;334:833.Google Scholar

  • [12]

    McClure EM, Nalubamba-Phiri M, Goldenberg RL. Stillbirth in developing countries. Int J Gynaecol Obstet. 2006;94:82–90.Google Scholar

  • [13]

    McClure EM, Wright LL, Goldenberg RL, Goudar SS, Parida SN, Jehan I. The global network: a prospective study of stillbirths in developing countries. Am J Obstet Gynecol. 2007;197:247.e1–5.Google Scholar

  • [14]

    Huang DY, Usher RH, Kramer MS, Yang H, Morin L, Fretts RC. Determinants of unexplained antepartum fetal deaths. Obstet Gynecol. 2000;95:215–21.Google Scholar

  • [15]

    Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG. 2014;121(Suppl 4):141–53.Google Scholar

  • [16]

    Bel-Ange A, Harlev A, Weintraub AY, Sheiner E. Waiting for post-term in healthy women, is it an accident waiting to happen? J Matern Fetal Neonatal Med. 2013;26:779–82.Google Scholar

  • [17]

    Liran D, Vardi IS, Sergienko R, Sheiner E. Adverse perinatal outcome in teenage pregnancies: is it all due to lack of prenatal care and ethnicity? J Matern Fetal Neonatal Med. 2013;26:469–72.Google Scholar

  • [18]

    Di Mario S, Say L, Lincetto O. Risk factors for stillbirth in developing countries: a systematic review of the literature. Sex Transm Dis. 2007;34:S11–21.Google Scholar

  • [19]

    Gibbs RS. The origins of stillbirth: infectious diseases. Semin Perinatol. 2002;26:75–8.Google Scholar

  • [20]

    Blackwell S, Romero R, Chaiworapongsa T, Refuerzo J, Gervasi MT, Yoshimatsu J, et al. Unexplained fetal death is associated with changes in the adaptive limb of the maternal immune response consistent with prior antigenic exposure. J Matern Fetal Neonatal Med. 2003;14:241–6.Google Scholar

  • [21]

    Blackwell S, Romero R, Chaiworapongsa T, Kim YM, Bujold E, Espinoza J, et al. Maternal and fetal inflammatory responses in unexplained fetal death. J Matern Fetal Neonatal Med. 2003;14:151–7.Google Scholar

  • [22]

    Lahra MM, Gordon A, Jeffery HE. Chorioamnionitis and fetal response in stillbirth. Am J Obstet Gynecol. 2007;196:229.e1–4.Google Scholar

  • [23]

    Morrison I, Olsen J. Weight-specific stillbirths and associated causes of death: an analysis of 765 stillbirths. Am J Obstet Gynecol. 1985;152:975–80.Google Scholar

  • [24]

    Strom CM, Ginsberg N, Applebaum M, Bozorgi N, White M, Caffarelli M, et al. Analyses of 95 first-trimester spontaneous abortions by chorionic villus sampling and karyotype. J Assist Reprod Genet. 1992;9:458–61.Google Scholar

  • [25]

    Mei-Dan E, Walfisch A, Weisz B, Hallak M, Brown R, Shrim A. The unborn smoker: association between smoking during pregnancy and adverse perinatal outcomes. J Perinat Med. 2015;43:553–8.Google Scholar

  • [26]

    Burton GJ, Palmer ME, Dalton KJ. Morphometric differences between the placental vasculature of non-smokers, smokers and ex-smokers. Br J Obstet Gynaecol. 1989;96:907–15.Google Scholar

  • [27]

    Larsen LG, Clausen HV, Jønsson L. Stereologic examination of placentas from mothers who smoke during pregnancy. Am J Obstet Gynecol. 2002;186:531–7.Google Scholar

  • [28]

    Bush PG, Mayhew TM, Abramovich DR, Aggett PJ, Burke MD, Page KR. A quantitative study on the effects of maternal smoking on placental morphology and cadmium concentration. Placenta. 2000;21:247–56.Google Scholar

  • [29]

    Lehtovirta P, Forss M. The acute effect of smoking on intervillous blood flow of the placenta. Br J Obstet Gynaecol. 1978;85:729–31.Google Scholar

  • [30]

    de la Chica RA, Ribas I, Giraldo J, Egozcue J, Fuster C. Chromosomal instability in amniocytes from fetuses of mothers who smoke. J Am Med Assoc. 2005;293:1212–22.Google Scholar

  • [31]

    Tuthill DP, Stewart JH, Coles EC, Andrews J, Cartlidge PH. Maternal cigarette smoking and pregnancy outcome. Paediatr Perinat Epidemiol. 1999;13:245–53.Google Scholar

  • [32]

    Angell RR, Sandison A, Bain AD. Chromosome variation in perinatal mortality: a survey of 500 cases. J Med Genet. 1984;21:39–44.Google Scholar

  • [33]

    Fretts RC, Boyd ME, Usher RH, Usher HA. The changing pattern of fetal death, 1961–1988. Obstet Gynecol. 1992;79:35–9.Google Scholar

  • [34]

    Windsor RA, Lowe JB, Perkins LL, Smith-Yoder D, Artz L, Crawford M, et al. Health education for pregnant smokers: its behavioral impact and cost benefit. Am J Public Health. 1993;83:201–6.Google Scholar

  • [35]

    U.S. Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:551–5.Google Scholar

  • [36]

    Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2009; CD001055.Google Scholar

  • [37]

    Melvin CL, Dolan-Mullen P, Windsor RA, Whiteside HP Jr, Goldenberg RL. Recommended cessation counselling for pregnant women who smoke: a review of the evidence. Tob Control. 2000;9(Suppl 3):III80–4.Google Scholar

  • [38]

    Pariente G, Shoham-Vardi I, Kessous R, Sergienko R, Sheiner E. Is stillbirth associated with long-term atherosclerotic morbidity? Am J Obstet Gynecol. 2014;211:416.e1–12.Google Scholar

About the article

Corresponding author: Dr. Asnat Walfisch, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, Tel.: +972 50 4492200, Fax: +972 4 6188225, E-mail:

Received: 2015-04-26

Accepted: 2015-06-02

Published Online: 2015-06-30

Published in Print: 2016-10-01

Disclosure of interests: All authors declare that no authors (nor their institutions) received payments for their efforts on this project. The authors report no conflict of interest.

Contribution to authorship: AS conceived the study, led the design and plans for analysis, drafted the manuscript, and is the guarantor for the study. All co-authors (AW, RB, AM, MH, AS) contributed to the design, analysis plan, and editing of the manuscript. All authors approved the final version of the submitted manuscript.

Details of ethics approval: The study was approved by the institutional review board of McGill University Health Center (reference number: 12-438-SDR) April 2013.

Funding: This study was not funded.

The authors stated that there are no conflicts of interest regarding the publication of this article.

Citation Information: Journal of Perinatal Medicine, Volume 44, Issue 7, Pages 779–784, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2015-0135.

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