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Clinical Obstetrics

Poster Session 4

(1143) Social determinants of health and stillbirth evaluation

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Intrauterine fetal demise (IUFD) is defined as fetal death at ≥20 weeks’ gestation and complicates about 1 in 160 pregnancies. Several important social determinants of health (SDOH) have been associated with higher rates of stillbirth, such as race, income, education, and access to antenatal care, however SDOH haven't been examined relative to stillbirth evaluation. Our objective was to examine the role of SDOH factors on post-delivery evaluation of stillbirth.

Study Design: Retrospective cross-sectional analysis was conducted to examine IUFD deliveries occurring at two tertiary care centers from 2016 to 2022.  Cases included IUFD occurring ≥20 weeks gestation. Exclusion criteria were elective termination, pre-viable preterm premature rupture of membranes, or multiple gestation. 340 cases were included. Descriptive statistics were calculated for study variables and Student’s T-test and Chi-squared tests used for analysis.

Results: The stillbirth rate (7.2 per 1000 live births) was comparable to the 2020 US stillbirth rate of 5.7 per 1000 live births. Higher rates of stillbirth were observed for non-Hispanic Black women and Hispanic women, compared to White women.  Fewer non-Hispanic Black women received diagnostic genetic testing (27%) and autopsy (30%) following IUFD compared to non-Hispanic White women (54%, 46%, respectively) (p=0.0005, p=0.037). There were no other factors associated with a difference in rate of diagnostic testing or autopsy. Additionally, non-Hispanic Black women were administered urine toxicology testing 3X as often as non-Hispanic White women (39% vs. 11%) (p=0.016), despite lower positivity rates (24% vs. 50%).

Conclusion: Our data shows that disparities are present in both the occurrence of stillbirth and the evaluation performed thereafter, particularly for diagnostic genetic testing and autopsy. Further studies are needed to elucidate the reasons behind observed differences in stillbirth evaluation. Future efforts should focus on standardization of the counseling recommended for stillbirth evaluation and elimination of testing that is neither helpful nor equitably performed.