Racial variation in the association between gestational age and perinatal mortality: prospective study

Objectives To determine if the risks of perinatal mortality and antepartum stillbirth associated with post term birth increase earlier during pregnancy in South Asian and black women than in white women, and to investigate differences in the factors associated with antepartum stillbirth between the racial groups. Design Prospective study using logistic regression analysis. Setting 15 maternity units in north west London from 1988 to 2000. Participants 197 061 nulliparous women self reported as white, South Asian, or black, who delivered a single baby weighing at least 500 g at 24-43 completed weeks' gestation. Main outcome measures Gestation specific perinatal mortality, antepartum stillbirth rates, and independent factors for antepartum stillbirth by racial groups. Results The crude gestation specific perinatal mortality patterns for the three racial groups differed (P < 0.001). The perinatal mortality rate among black women was tower than among white women before 32 weeks but was higher thereafter. Perinatal mortality was highest among South Asian women at all gestational ages and increased the fastest at term. After adjusting for the confounders of antepartum stillbirth (placental abruption, congenital abnormality, low birth weight, birth weight < 10th centile, meconium passage, fever, maternal body mass index >= 30, and maternal age >= 30), the excess mortality among black women after 32 weeks was not significant. After adjusting for confounding, South Asian women still had a significantly higher risk of antepartum stillbirth (1.8, 95% confidence interval 1.2 to 2.7). Conclusions The risk of perinatal mortality increased earlier in gestation among South Asian women than among white women. The most important factor associated with antepartum stillbirth among white women was placental abruption, but among South Asian and black women it was birth weight below 2000 g.