Epidemiology
Understanding the epidemiology of stillbirth is key to identifying and managing risk factors. Epidemiological studies use rigorous research methods to explore the incidence, distribution and possible risk factors related to health. Case-control is one such method, longitudinal study is another.
To-date I have been involved in two case-control studies, one with a group of international researchers called the “STARS consortium” and one was my PhD research. The Longitudinal study follows the successful STARS study and is called the "pregnancy research project"
Click the tabs to find out more:
Understanding the epidemiology of stillbirth is key to identifying and managing risk factors. Epidemiological studies use rigorous research methods to explore the incidence, distribution and possible risk factors related to health. Case-control is one such method, longitudinal study is another.
To-date I have been involved in two case-control studies, one with a group of international researchers called the “STARS consortium” and one was my PhD research. The Longitudinal study follows the successful STARS study and is called the "pregnancy research project"
Click the tabs to find out more:
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STARS
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My PhD
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Pregnancy research project
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Study of trends and risks for stillbirth (STARS)
The STARS study was a cohort study with a nested case-control arm. The study was entirely funded by the Star Legacy foundation USA. Findings from this study have been reported in the following papers:
- O’Brien LM, Warland J, Stacey T, Heazell AEP, Mitchell EA; on behalf of the STARS Consortium (2019) Maternal sleep practices and stillbirth: Findings from an international case‐control study. Birth; 46 (2) 344-354.
- Warland, J, Heazell, AE, Stacey, T, Coomarasamy, C, Budd, J, Mitchell, E & O'Brien, L 2018, ''They told me all mothers have worries', stillborn mother's experiences of having a 'gut instinct' that something is wrong in pregnancy: findings from an international case-control study', Midwifery, vol. 62, pp. 171-176.
- Heazell, AE, Warland, J, Stacey, T, Coomarasamy, C, Budd, J, Mitchell, EA & O'Brien, LM (2017) 'Stillbirth is associated with perceived alterations in fetal activity - findings from an international case control study', BMC pregnancy and childbirth, vol.17, no. 1, article no. 369, pp. 1-11.
- Warland, J, O'Brien, LM, Heazell, AE & Mitchell, EA (2015) 'An international internet survey of the experiences of 1,714 mothers with a late stillbirth: the STARS cohort study', BMC Pregnancy and childbirth, vol. 15, article no. 172, pp. 1-11.
We also wrote this paper based on our finding that some stillborn babies had one episode of "crazy" movements before they died:
Heazell, AE, Stacey, T, O'Brien, LM, Mitchell, EA & Warland, J 2018, 'Excessive fetal movements are a sign of fetal compromise which merits further examination', Medical Hypothesis, vol. 111, pp. 19-23.
Key findings from my PhD
My PhD study was a case-control study conducted in two tertiary referral centres in Australia, one in Adelaide and the other in Melbourne. I conducted a retrospective case-note audit on 124 who had had a stillbirth (greater than 28 weeks) and compared these results with notes from a matched control group (n=243) who had a live birth. The following are key findings:
· Women who had three or more mean arterial pressure values less than or equal to 83 mmHg (equivalent to 110/70) during the course of their pregnancy were nearly twice the risk of stillbirth (OR 1.78: 95% CI 1.06 – 2.99; p=0.03)
· Women who had a posterior located placenta on the 20 week scan were more than 1 and a half times more likely to suffer a stillbirth (OR 1.64: 95% CI 1.02-2.65 p=0.04)
· Women who said they had recently “quit smoking” were at 3 times the risk of stillbirth (OR 3.03 95% CI 1.27-7.24 p=0.01) than either smokers (NS) or non-smokers (Reference group) Note I hypothesised that this meant that quitting per se was not likely to be causing increased risk but that quit smokers were likely relapsing and that the relapse was not being detected by the care provider probably because they were not asking about smoking after the first visit.
I have the following publications from my PhD:
My PhD study was a case-control study conducted in two tertiary referral centres in Australia, one in Adelaide and the other in Melbourne. I conducted a retrospective case-note audit on 124 who had had a stillbirth (greater than 28 weeks) and compared these results with notes from a matched control group (n=243) who had a live birth. The following are key findings:
· Women who had three or more mean arterial pressure values less than or equal to 83 mmHg (equivalent to 110/70) during the course of their pregnancy were nearly twice the risk of stillbirth (OR 1.78: 95% CI 1.06 – 2.99; p=0.03)
· Women who had a posterior located placenta on the 20 week scan were more than 1 and a half times more likely to suffer a stillbirth (OR 1.64: 95% CI 1.02-2.65 p=0.04)
· Women who said they had recently “quit smoking” were at 3 times the risk of stillbirth (OR 3.03 95% CI 1.27-7.24 p=0.01) than either smokers (NS) or non-smokers (Reference group) Note I hypothesised that this meant that quitting per se was not likely to be causing increased risk but that quit smokers were likely relapsing and that the relapse was not being detected by the care provider probably because they were not asking about smoking after the first visit.
I have the following publications from my PhD:
- Warland J, McCutcheon H (2011), The ‘quit’ smoker and stillbirth risk: A review of contemporary literature in the light of findings from a case–control study. Midwifery 27 (5) 607-611
- Warland J, McCutcheon H, Baghurst P (2009). Placental position and late stillbirth: a case-control study. Journal of Clinical Nursing 18 (11): 1602-1606
- Warland J, McCutcheon H, Baghurst P (2008). Maternal blood pressure in pregnancy and third trimester stillbirth: A case-control study. American Journal of Perinatology 25 (5): 311-7
- Warland J and McCutcheon H (2002) Is there an association between maternal hypotension and poor pregnancy outcome? a review of the literature. Australian Journal of Midwifery 15 (4) 22 – 26
The STARS study findings led us to think that there was more to be discovered at a population level about stillbirth risks.
We have established a longitudinal study called the" pregnancy research project" which aims to explore some of the findings from the first STARS study but also to explore pregnancy and pregnancy risk factors more generally
You can find out more about the project here: https://starlegacyfoundation.org/prp-live/