Poster Session 2
Sabrina Montgomery, BA
Medical Student
Charles R. Drew University of Medicine and Science, College of Medicine
Inglewood, California, United States
Katherine Bianco, MD
Professor
Stanford University
Palo Alto, California, United States
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Hayley E. Miller, MD
Stanford University
Palo Alto, California, United States
Ruth B. Lathi, MD
PROFESSOR OF OBSTETRICS AND GYNECOLOGY (REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY)
Stanford University
Palo Alto, California, United States
Stephanie A. Leonard, PhD (she/her/hers)
Assistant Professor
Stanford University
Palo Alto, California, United States
Efforts to eliminate well-known disparities in stillbirth require an improved understanding of the causes of death. Clinical guidelines recommend fetal autopsy and placental histopathology following a stillbirth, but many stillbirths do not receive these evaluations and remain unexplained. We sought to examine whether rates of fetal autopsy and placental histopathology following a stillbirth differ among racial/ethnic and education groups.
Study Design: We conducted a population-based study using the U.S. CDC national fetal death files between 2020-2022. We included singleton births ≥20 weeks’ gestation with complete information on study variables. The study outcomes were fetal autopsy and placental histopathology, categorized as none or yes: completed or planned. Birth parent race, ethnicity, and education were self-reported and categorized by the CDC. We performed multivariable logistic regression models to evaluate differences in the outcomes among racial/ethnic and education groups. Covariates included age, late or no prenatal care, prior live birth, and gestational age.
Results: In this study of 43,954 stillbirths, 18% received a fetal autopsy and 67% had placental histopathology performed (Table 1). Among racial/ethnic groups, Non-Hispanic (NH) Black people had higher rates of fetal autopsy (aOR 1.34, 95% CI: 1.26-1.42) but lower rates of placental histopathology (aOR 0.87, 95% CI: 0.82-0.92) than NH White people (Table 2). NH American Indian or Alaska Native and NH Asian people also had significantly lower rates of placental histopathology. Among education groups, increasing level of education was associated with increasing rate of both fetal autopsy and placental histopathology.
Conclusion: Utilization of fetal autopsy and placental histopathology was lower than expected across all groups, with differences among racial/ethnic and education groups. Further research is needed to understand structural barriers, patient preferences, and causes of disparities in clinical evaluation following stillbirth.
