Theoverarchinggoalofthisproposalistoexpandknowledgeofhealthrisksofwomenwhohaveastillbirth, specificallybyinvestigatingpostpartumhospitalreadmissions.Stillbirthisdefinedasdeliveryatorafter20 weeks?gestationofaninfantwhodiedinutero.Itisoneofthemostdevastatingoutcomesaffectingpregnant women.Evidencesuggeststhatrelativetowomenwhohavealivebirth,womenwhohaveastillbirthmaybe atincreasedriskofadversehealthoutcomesnotjustatdeliverybutalsopostpartum.Veryfewstudieshave examinedmaternalmorbidityafterstillbirth,theoneexceptionbeingmentalhealthproblems,suchas depression.Thisproposalfocusesonaspecificaspectofmaternalhealthafterstillbirth?postpartumhospital readmission?asakeyindicatorforthemostseverematernalmorbiditythatoccursafterstillbirth.Weare unawareofanypriorlarge-scalestudiesofhospitalreadmissionafterstillbirth.Ourobjectiveistodetermine theincidence,indicationsandpredictorsofhospitalreadmissionafterstillbirth.Wewilluseauniquedataset thatincludes35,000stillbirthsfromacohortof8millionbirthsfrom1998-2012inCalifornia,whichrepresents1 in8U.S.births.Eachbirthyearincludesdatafrombirthandfetaldeathcertificateslinkedwithmaternal hospitaldischargerecords.
Our SpecificAims areasfollows.
Aim1 :Determinetheincidenceofand indicationsforpostpartumhospitalreadmissionupto1yearafterdeliveryamongwomenwhohadastillbirth. Thiswillincludeaninvestigationofwhethertheseoutcomesaredifferentamongwomenwhohadalivebirth, andwhetherthemostcommonindicationsforhospitalizationvarybasedontimefromdelivery(e.g.,<42days versuslater).Ourhypothesesarethatincidenceofreadmissionishigheramongwomenwhohadastillbirth versuslivebirth,andthatthemostcommonindicationsforreadmissionvaryasthefirstyearpostpartum progresses.
Aim2 :Identifyriskfactorsforpostpartumreadmissionamongwomenwhohadastillbirth.Wewill examinesociodemographicfactors(e.g.,race/ethnicity,education,parity),pregnancy-anddelivery-related factors(e.g.,maternalmorbidities,gestationalageatdelivery,modeofdelivery),andhospitalcharacteristics (e.g.,obstetricvolume).Ourhypothesisisthatacombinationofpatient-andhospital-levelfactorsinfluence theriskofmaternalreadmissionafterstillbirth.Wewillprimarilyusesurvivalanalysistechniquestoaddress bothAims.Ourproposalisinnovativeinthatitrepresentsashiftforresearchonstillbirth?mostresearch focusesonitsimmediatecauses,whereasweproposetofocusonitsconsequencesforthemother.Insum, ouruniquestudyquestions,data,andrigorousanalyticapproacheswillenableustosubstantiallyadvance currentunderstandingoftheimpactofstillbirthonmaternalhealthandmakesubstantialstridestoward understandinghowbesttominimizetheadverseimpactsofthisunfortunateoutcome.Ourfindingswillpave thewayforthedevelopmentofareliablesystemforimprovingthepostpartumcare,counseling,and, ultimately,thehealthofthispotentiallyhigh-riskgroupofwomen.

Public Health Relevance

Theproposedresearchwillexaminetheincidence,indications,andriskfactorsforhospital readmissionintheyearafterdelivery,amongwomenwhohavehadastillbirth.Thenew knowledgegeneratedbythisresearchwillpavethewayforimprovingpostpartumcare, counseling,and,ultimately,thehealthofwomenwhoexperiencestillbirth.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Small Research Grants (R03)
Project #
5R03HD095034-02
Application #
9653182
Study Section
National Institute of Child Health and Human Development Initial Review Group (CHHD)
Program Officer
Davis, Maurice
Project Start
2018-04-01
Project End
2020-03-31
Budget Start
2019-04-01
Budget End
2020-03-31
Support Year
2
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Stanford University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94304