Maternal region of birth and stillbirth trends in Victoria, Australia, 2012-2019: a cohort study.

Introduction: Given the increasing attention to reduce stillbirth rates in migrant women and variable clinical guidance, we quantified contemporary trends in stillbirth based on maternal region of birth. Methods: Population-based study of singleton births ≥20 weeks of gestation between 2012 and 2019 from the Victorian Perinatal Data Collection (N=571 998). We investigated the association between maternal self-reported region of birth and stillbirth overall using logistic regression, and gestation and timing of stillbirth using multinomial regression. Trends in stillbirth overall, iatrogenic births, admission to a neonatal intensive care unit or special care nursery, neonatal death and cause of stillbirth by region of birth were also investigated. Results: Rates of stillbirth were significantly higher in women born in Africa (adjusted OR (aOR) 1.76: 1.47 to 2.12) and South Asia (aOR 1.26: 1.11 to 1.43) when compared with locally born non-Indigenous women. For women born in Africa, this was irrespective of gestation, while for women born in South Asia, this was specific to preterm stillbirths. Overall, we observed a decreasing trend in stillbirth among women born in Australia, while the stillbirth rate remained consistently higher and did not significantly decrease in women born in Africa, Oceania, New Zealand and South Asia. Over the same period, iatrogenic births significantly increased. Causes of stillbirth also differed by maternal region of birth. Conclusions: While we observed some improvements in stillbirth rates and increasing rates of iatrogenic birth, maternal region of birth remains an independent risk factor for stillbirth requiring targeted approaches.