Evidence map›Paper›PMID 38991996›Full record

ArticleBJOG : an international journal of obstetrics and gynaecology2025

Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020: A fetuses-at-risk approach.

Yemisrach B Okwaraji, Lorena Suárez-Idueta, Eric O Ohuma, Ellen Bradley, Judith Yargawa, Veronica Pingray, Gabriela Cormick, Adrienne Gordon, Vicki Flenady, Erzsébet Horváth-Puhó and 24 more

Abstract read
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In one paragraph

Article in BJOG : an international journal of obstetrics and gynaecology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

34 authors.

Yemisrach B OkwarajiMaternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.ORCID https://orcid.org/0000-0002-4541-2856
Lorena Suárez-IduetaMexican Society of Public Health, Mexico City, Mexico.
Eric O OhumaMaternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
Ellen BradleyMaternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
Judith YargawaMaternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
Veronica PingrayInstitute for Clinical Effectiveness and Health Policy, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.ORCID https://orcid.org/0000-0002-7889-2825
Gabriela CormickInstitute for Clinical Effectiveness and Health Policy, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
Adrienne GordonFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Vicki FlenadyCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Queensland, Australia.
Erzsébet Horváth-PuhóDepartment of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Henrik Toft SørensenDepartment of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Liili AbuladzeEstonian Institute for Population Studies, School of Governance, Law and Society, Tallinn University, Tallinn, Estonia.
Mohammed HeidarzadehPaediatrics Department, Alzahra Hospital Iran, Tabriz, Iran.
Narjes KhaliliPreventive Medicine and Public Health Research Centre, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.ORCID https://orcid.org/0000-0001-8075-7529
Khalid A YunisThe National Collaborative Perinatal Neonatal Network (NCPNN) Coordinating Center at the Department of Paediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
Ayah Al BizriThe National Collaborative Perinatal Neonatal Network (NCPNN) Coordinating Center at the Department of Paediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
Arturo BarrancoDirectorate of Health Information, Ministry of Health, Mexico City, Mexico.
Aimée E van DijkPerined, Utrecht, the Netherlands.
Lisa BroedersPerined, Utrecht, the Netherlands.
Fawzya AlyafeiHamad General Hospital, Doha, Qatar.
Tawa O OlukadeHamad General Hospital, Doha, Qatar.
Neda RazazClinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
Jonas SöderlingClinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
Lucy K SmithDepartment of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK.
Ruth J MatthewsDepartment of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK.
Rachael WoodPublic Health Scotland, Edinburgh, UK.
Kirsten MonteathPregnancy, Birth and Child Health Team, Public Health Scotland, Edinburgh, UK.
Isabel PereyraFaculty of Health Sciences, Catholic University of Maule, Talca, Chile.
Gabriella PraviaCatholic University of Uruguay, Montevideo, Uruguay.
Sarka LisonkovaDepartment of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
Qi WenDepartment of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
Joy E LawnMaternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
Hannah BlencoweMaternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.ORCID https://orcid.org/0000-0003-1556-3159
National Vulnerable Newborn Mortality Collaborative Group and 15 Vulnerable Newborn Measurement Core Group

Funding

Children's Investment Fund Foundation and Bill & Melinda Gates Foundation
6 · The paper itself

Abstract

objectiveTo compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs.

designPopulation-based, multi-country study.

settingNational data systems in 15 high- and middle-income countries. POPULATION: Live births and stillbirths.

methodsA total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation.

main outcome measuresGestation-specific stillbirth rates and risks according to size at birth.

resultsThe overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed.

conclusionsSmall for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA.

Indexed as

Fetal MacrosomiaInfant, Small for Gestational AgeStillbirthBirth WeightFemaleGestational AgeHumansInfant, NewbornPregnancyRisk Factorsfetuses‐at‐risk approachgestational agepreterm birthsize for gestational agestillbirth

Identifiers

PMID38991996
PMCPMC12678068

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.