Disparities in the workup of stillbirths in the NICHD's stillbirth collaborative research network study

To identify racial and sociocultural disparities in the hospital workup of stillbirth in the National Institute of Child Health and Human Development’s Stillbirth Collaborative Research Network Study (SCRN). We conducted a secondary analysis of publicly-accessible data from SCRN, a multi-center study of factors linked to stillbirth—fetal death at 20+ weeks. Using X2-tests, we identified disparities in the receipt of recommended evaluations for stillbirth by race, education, and language (English versus Spanish), restricted to cases with a non-anomalous fetus. The SCRN evaluated 3,383 stillbirths, 34.5% Black and 16.3% Hispanic, average age 28 years, and average gestational age at stillbirth was 31.3 +/- 6.4 weeks. Approximately half (51.5%) were college educated. Nearly 10% had a previous stillbirth. Black and Hispanic people were more likely than White people to have had fetal autopsy (87.8% and 89.1% vs 82.4%; p< 0.01) and less likely to have had fetal karyotyping (80.6% and 84.1% vs 87.2%; p< 0.01). Among those without prior stillbirth, Black and Hispanic people were less likely to have had lupus anticoagulant testing (32.5% and 31.6% vs 59.6%; p< 0.01). Even if no substance use in pregnancy, Black and Hispanic people were more likely to receive toxicology testing (47.6% and 60.3% vs 12.9%; p< 0.01). Among those without prior stillbirth, those who did not finish high school were less likely to have lupus anticoagulant testing than those who completed high school or attended college (70.7% vs 58.9% and 49.8%; p< 0.01). Despite no substance use in pregnancy, those who did not finish high school were more likely to undergo toxicology testing at the time of stillbirth compared to those with a high school diploma or some college education(100% vs 11.1% and 39.1%; p< 0.01). Even in a federally funded, multicenter, cohort study, we noted racial and sociocultural disparities in stillbirth evaluation. Explanations for these disparities warrant further examination.View Large Image Figure ViewerDownload Hi-res image Download (PPT)