Antenatal care, identification of suboptimal fetal growth and risk of late stillbirth: findings from the Auckland stillbirth study

Introduction: Stillbirth remains an important public health problem in Australia and New Zealand. The role that antenatal care plays in the prevention of stillbirth in high-income countries is unclear. Methods: Cases were women with a singleton, late stillbirth without congenital abnormality, booked to deliver in the Auckland region and born between July 2006 and June 2009. Two controls with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Data were collected through interview-administered questionnaires and from antenatal records. Results: One hundred and fifty five of 215 (72%) cases and 310 of 429 (72%) controls consented to take part in the study. Accessing <50% of recommended antenatal visits was associated with a more than twofold increase in late stillbirth (adjusted odds ratio, aOR, 2.68; 95% CI, 1.04-6.90) compared with accessing the recommended number of visits. Smallfor- gestational-age (SGA) babies that had not been identified as SGA prior to birth were significantly more at risk of being stillborn (aOR, 9.46; 95% CI, 1.98-45.13) compared with SGA babies that were identified as such in the antenatal period. No relationship was found between type or model of maternity care provider at booking and late stillbirth risk. Discussion: This study reinforces the importance of regular antenatal care attendance. Identification of SGA may be one way by which antenatal care reduces stillbirth.