The Most Common Causes for Maternal/Fetal Morbidity 

Disparities

Information

Placental Abnormalities

· This risk is greatest for preterm fetuses. Cocaine use, smoking, hypertension, and preeclampsia increase the risk for placental abruption and stillbirth.

Diabetes

· Diabetes increases stillbirth risk up to five times

· In type 2 diabetics, the stillbirth rate is 22.9/1000 births. A higher BMI (OR 1.07) and elevated glycosylated hemoglobin before pregnancy (OR 1.02) were associated with stillbirth. 

Race

· Non-Hispanic, black women in the U.S. have a higher rate of stillbirth (11 per 1000 births) compared to other racial groups. This group also has a higher incidence of diabetes, hypertension, premature membrane rupture, and abruption may account for the higher rate of stillbirth

· Hispanic women in the U.S. also have a higher rate of stillbirth than non-Hispanic white women.

Obesity

· Obesity is an independent risk factor for stillbirth, even after controlling for diabetes, smoking, gestational diabetes, and preeclampsia. Obesity is a major health problem in developed countries and is defined as a body mass index greater than 30 kg/m2. Obese women are 1.5 times more prone to stillbirths than nonobese women.

Substance Misuse

· The most common finding in pregnancy complicated by substance use is growth restriction. Placental dysfunction, vasoconstriction, hypoxia, are attributed to the increased risk of stillbirth associated with substance misuse.

· Smoking, alcohol, and illicit drugs

Hypertension

Late-Onset Prenatal Care

Infection

· Even in developed countries, infection accounts for 19% of stillbirths before 28 weeks, Non-bacterial organisms causing stillbirth included cytomegalovirus 8%, parvovirus 3%, syphilis 2%, and herpes simplex virus 2%.

Prenatal Care and History

· The social history should include employment, nutrition, substance use, domestic violence, and travel history.

· Access to Prenatal vitamins including folic acid and Prenatal lab tests should include CBC, type and screen, HbsAg, syphilis, HIV, rubella, urine toxicology, and diabetic screening.

· Frequent Screening of weight, blood pressure, blood sugar and infections