Risk factors for perinatal death in high-risk pregnant women at a tertiary hospital in Curitiba-PR, Brazil: a case-control study

Szyhta, Carla Caroline; Silva, Zilda Pereira da; Alencar, Gizelton Pereira; Almeida, Marcia Furquim de

doi:10.1590/1413-81232023284.16042022EN

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ARTICLE • Ciênc. saúde coletiva 28 (4) • Apr 2023 • https://doi.org/10.1590/1413-81232023284.16042022EN copy

Risk factors for perinatal death in high-risk pregnant women at a tertiary hospital in Curitiba-PR, Brazil: a case-control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

A case-control study was carried out to estimate risk factors for perinatal mortality in a referral hospital for high-risk pregnancies in Curitiba-PR. Sociodemographic, maternal, pregnancy and concept characteristics data were obtained from the hospital records of 316 cases and 316 controls from 2013 to 2017. A hierarchical multiple logistic regression analysis was performed, remaining in the final model variables with p < 0.05. The results show an increased risk of perinatal death in mothers with blood type B (OR = 2.82; 95%CI: 1.07-7.43), who did not undergo prenatal care (OR = 30.78; 95%CI: 4.23-224.29), fetuses with congenital malformations (OR = 63.90; 95%CI: 27.32-149.48), born under 28 (OR = 24.21; 95%CI: 1, 10-531.81) and between 28-31 weeks of gestation (OR = 6.03; 95%CI: 1.34-27.17) and birth weight below 1,000g (OR = 51.94; 95%CI: 4.31-626.46), between 1,000-1,499g (OR = 11.17; 95%CI: 2.29-54.41) and between 1,500-2,499g (OR = 2.75; 25-6.06). Concepts of pregnancies with premature outcome, low birth weight and the presence of congenital malformations are the main risk factors for perinatal death. On the other hand, adequate prenatal care is an important protective factor.

Key words:
Perinatal death; High-risk pregnancy; Risk factors; Case-control studies

Variables	Cases		Controls		OR	95%CI	P
Variables	n	%	n	%
Sociodemographic characteristics
Maternal age
< 20	36	11.39	44	13.92	0.81	0.50 - 1.32	0.403
20 to 34	201	63.61	200	63.29	1.00	Reference
≥ 35	79	25.00	72	22.78	1.09	0.75 - 1.59	0.646
Maternal education level
0 to 8 years	97	30.70	110	34.81	0.79	0.46 - 1.35	0.389
9 to11 years	176	55.70	166	52.53	0.95	0.57 - 1.57	0.847
12 or more years	39	12.34	35	11.08	1.00	Reference
Ignored	4	1.27	5	1.58	0.72	0.18 - 2.92	0.642
Maternal marital status
With partner	227	71.84	228	72.15	1.00	Reference
Without partner	87	27.53	87	27.53	1.00	0.71 - 1.42	0.980
Ignored	2	0.63	1	0.32	2.01	0.18 - 22.39	0.563
Municipality of residence
Curitiba	194	61.39	215	68.04	1.00	Reference
Other	122	38.61	101	31.96	1.34	0.96 - 1.86	0.081
Maternal characteristics
Knew she was pregnant
Yes	308	97.47	315	99.68	1.00	Reference
No	8	2.53	1	0.32	8.18	1.01 - 66.52	0.019
Smoker
Yes	53	16.77	58	18.35	0.92	0.61 - 1.40	0.710
No	249	78.80	252	79.75	1.00	Reference
Ignored	14	4.43	6	1.90	2.36	0.89 - 6.27	0.075
Drinker
Yes	17	5.38	17	5.38	1.04	0.52 - 2.08	0.906
No	281	88.92	293	92.72	1.00	Reference
Ignored	18	5.70	6	1.90	3.13	1.22 - 8.04	0.013
Drug addiction
Yes	11	3.48	13	4.11	0.88	0.39 - 2.00	0.764
No	285	90.19	297	93.99	1.00	Reference
Ignored	20	6.33	6	1.90	3.47	1.37 - 8.83	0.005
Maternal blood type
A	109	34.49	126	39.87	1.00	0.70 - 1.41	0.983
B	42	13.29	34	10.76	1.42	0.85 - 2.37	0.174
O	132	41.77	152	48.10	1.00	Reference
AB	13	4.11	4	1.27	3.74	1.18 - 11.91	0.016
Ignored	20	6.33	0	0.00	.	.	.
Underlying condition
Yes	197	62.34	250	79.11	0.44	0.30 - 0.63	< 0.001
No	119	37.66	66	20.89	1.00	Reference
Number of pregnancies
Nulliparous	115	36.39	101	31.96	1.24	0.88 - 1.75	0.211
1 to 3	163	51.58	178	56.33	1.00	Reference
4 or more	38	12.03	37	11.71	1.12	0.68 - 1.85	0.653
Previous miscarriage
Yes	80	25.32	74	23.42	1.26	0.84 - 1.88	0.257
No	121	38.29	141	44.62	1.00	Reference
Not applicable*	115	36.39	101	31.96	1.33	0.92 - 1.91	0.125
Previous fetal death
Yes	24	7.59	12	3.80	2.29	1.11 - 4.75	0.021
No	177	56.01	203	64.24	1.00	Reference
Not applicable*	115	36.39	101	31.96	1.31	0.93 - 1.83	0.118
Previous neonatal death
Yes	10	3.16	4	1.27	2.76	0.85 - 9.00	0.079
No	191	60.44	211	66.77	1.00	Reference
Not applicable*	115	36.39	101	31.96	1.26	0.90 - 1.75	0.175
Current pregnancy characteristics
Type of pregnancy
Singleton	288	91.14	296	93.67	1.00	Reference
Multiple	28	8.86	20	6.33	1.44	0.79 - 2.62	0.230
Adequacy of antenatal care
Adequate	97	30.70	248	78.48	1.00	Reference
Inadequate	11	3.48	17	5.38	1.65	0.75 - 3.67	0.211
Did not attend antenatal care	13	4.11	3	0.95	11.08	2.97 - 41.33	< 0.001
Ignored	195	61.71	48	15.19	10.39	6.56 - 16.44	< 0.001
Admission during pregnancy
Yes	52	16.46	51	16.14	1.02	0.67 - 1.56	0.914
No	264	83.54	265	83.86	1.00	Reference
Preeclampsia or eclampsia
Yes	24	7.59	12	3.80	2.08	1.02 - 4.25	0.040
No	292	92.41	304	96.20	1.00	Reference
Diabetes during pregnancy
Yes	33	10.44	57	18.04	0.53	0.33 - 0.84	0.006
No	283	89.56	259	81.96	1.00	Reference
Thyroid disorders
Yes	54	17.09	67	21.20	0.77	0.51 - 1.14	0.189
No	262	82.91	249	78.80	1.00	Reference
Chorioamnionitis
Yes	17	5.38	5	1.58	3.54	1.28 - 9.77	0.009
No	299	94.62	311	98.42	1.00	Reference
Amniotic fluid volume changes
Yes	38	12.03	15	4.75	2.74	1.47 - 5.13	0.001
No	278	87.97	301	95.25	1.00	Reference
Placental abruption
Yes	20	6.33	6	1.90	3.49	1.37 - 8.87	0.005
No	296	93.67	310	98.10	1.00	Reference
Centralization of fetal blood flow
Yes	15	4.75	4	1.27	3.89	1.27 - 11.92	0.011
No	301	95.25	312	98.73	1.00	Reference
Use of pregnancy medications
Yes	199	62.97	181	57.28	1.27	0.92 - 1.75	0.144
No	117	37.03	135	42.72	1.00	Reference
Conceptus characteristics
Sex
Female	142	44.94	157	49.68	1.00	Reference
Male	167	52.85	159	50.32	1.16	0.85 - 1.59	0.351
Ignored	7	2.22	0	0.00	.	.	.
Gestational age
Under 28	94	29.75	1	0.32	322.82	23.72 - 4393	< 0.001
28 to 31	70	22.15	7	2.22	34.34	12.82 - 92.03	< 0.001
32 to 36	70	22.15	46	14.56	5.23	3.22 - 8.47	< 0.001
37 and over	76	24.05	261	82.59	1.00	Reference
Ignored	6	1.90	1	0.32	20.61	2.32 - 182.98	< 0.001
Birth weight
≥ 999	116	36.71	2	0.63	198.17	28.50 - 1378	< 0.001
1,000 to 1,499	44	13.92	7	2.22	21.48	8.27 - 55.77	< 0.001
1,500 to 2,499	78	24.68	44	13.92	6.06	3.70 - 9.92	< 0.001
2,500 to 3,999	72	22.78	246	77.85	1.00	Reference
≥ 4,000	4	1.27	17	5.38	0.80	0.26 - 2.47	0.703
Ignored	2	0.63	0	0.00	.	.	.
Intrauterine fetal growth
SGA	105	33.23	40	12.66	4.51	2.89 - 7.03	< 0.001
AGA	138	43.67	237	75.00	1.00	Reference
LGA	31	9.81	38	12.03	1.40	0.83 - 2.36	0.202
Ignored	42	13.29	1	0.32	72.13	8.38 - 620.70	< 0.001
Congenital birth defect
Yes	155	49.05	23	7.28	12.26	7.14 - 21.06	< 0.001
No	161	50.95	293	92.72	1.00	Reference

Variables	Cases		Controls		Crude OR	95%CI	P	Adjusted OR	95%CI	P
Variables	n	%	n	%
Logistic regression 1
Municipality of residence
Curitiba	194	61.39	215	68.04	1.00	Reference		1.00	Reference
Other	122	38.61	101	31.96	1.34	0.96 - 1.86	0.081	1.42	1.01 - 2.01	0.046
Knew she was pregnant
Yes	308	97.47	315	99.68	1.00	Reference		1.00	Reference
No	8	2.53	1	0.32	8.18	1.01 - 66.52	0.019	7.29	0.85 - 62.35	0.070
Maternal blood type
A	109	34.49	126	39.87	1.00	0.70 - 1.41	0.983	1.12	0.78 - 1.61	0.536
B	42	13.29	34	10.76	1.42	0.85 - 2.37	0.174	1.75	1.03 - 2.96	0.038
O	132	41.77	152	48.10	1.00	Reference		1.00	Reference
AB	13	4.11	4	1.27	3.74	1.18 - 11.91	0.016	4.14	1.28 - 13.37	0.018
Ignored	20	6.33	0	0.00	.	.	.	.	.	.
Underlying condition
Yes	197	62.34	250	79.11	0.44	0.30 - 0.63	<0.001	0.42	0.29 - 0.62	< 0.001
No	119	37.66	66	20.89	1.00	Reference		1.00	Reference
Previous fetal death
Yes	24	7.59	12	3.80	2.29	1.11 - 4.75	0.021	2.81	1.34 - 5.90	0.006
No	177	56.01	203	64.24	1.00	Reference		1.00	Reference
Not applicable*	115	36.39	101	31.96	1.31	0.93 - 1.83	0.118	1.28	0.90 - 1.83	0.173
Previous neonatal death
Yes	10	3.16	4	1.27	2.76	0.85 - 9.00	0.079	3.51	1.04 - 11.88	0.043
No	191	60.44	211	66.77	1.00	Reference		1.00	Reference
Not applicable*	115	36.39	101	31.96	1.26	0.90 - 1.75	0.175	.	.	.
Logistic regression 2
Municipality of residence
Curitiba	194	61.39	215	68.04	1.00	Reference		1.00	Reference
Other	122	38.61	101	31.96	1.34	0.96 - 1.86	0.081	1.07	0.71 - 1.63	0.738
Maternal blood type
A	109	34.49	126	39.87	1.00	0.70 - 1.41	0.983	1.16	0.75 - 1.80	0.497
B	42	13.29	34	10.76	1.42	0.85 - 2.37	0.174	1.68	0.89 - 3.18	0.108
O	132	41.77	152	48.10	1.00	Reference		1.00	Reference
AB	13	4.11	4	1.27	3.74	1.18 - 11.91	0.016	6.47	1.73 - 24.26	0.006
Ignored	20	6.33	0	0.00	.	.	.	.	.	.
Underlying condition
Yes	197	62.34	250	79.11	0.44	0.30 - 0.63	< 0.001	0.47	0.29 - 0.74	0.001
No	119	37.66	66	20.89	1.00	Reference		1.00	Reference
Previous fetal death
Yes	24	7.59	12	3.80	2.29	1.11 - 4.75	0.021	2.68	1.12 - 6.42	0.027
No	177	56.01	203	64.24	1.00	Reference		1.00	Reference
Not applicable*	115	36.39	101	31.96	1.31	0.93 - 1.83	0.118	1.22	0.80 - 1.87	0.356
Previous neonatal death
Yes	10	3.16	4	1.27	2.76	0.85 - 9.00	0.079	2.92	0.71 - 11.93	0.136
No	191	60.44	211	66.77	1.00	Reference		1.00	Reference
Not applicable*	115	36.39	101	31.96	1.26	0.90 - 1.75	0.175	.	.	.
Adequacy of antenatal care
Adequate	97	30.70	248	78.48	1.00	Reference		1.00	Reference
Inadequate	11	3.48	17	5.38	1.65	0.75 - 3.67	0.211	1.55	0.63 - 3.84	0.341
Did not attend antenatal care	13	4.11	3	0.95	11.08	2.97 - 41.33	< 0.001	10.13	2.47 - 41.60	0.001
Ignored	195	61.71	48	15.19	10.39	6.56 - 16.44	< 0.001	11.59	7.49 - 17.96	< 0.001
Preeclampsia or eclampsia
Yes	24	7.59	12	3.80	2.08	1.02 - 4.25	0.040	1.51	0.61 - 3.75	0.375
No	292	92.41	304	96.20	1.00	Reference		1.00	Reference
Diabetes during pregnancy
Yes	33	10.44	57	18.04	0.53	0.33 - 0.84	0.006	0.55	0.30 - 1.01	0.054
No	283	89.56	259	81.96	1.00	Reference		1.00	Reference
Thyroid disorders
Yes	54	17.09	67	21.20	0.77	0.51 - 1.14	0.189	1.10	0.65 - 1.87	0.720
No	262	82.91	249	78.80	1.00	Reference		1.00	Reference
Chorioamnionitis
Yes	17	5.38	5	1.58	3.54	1.28 - 9.77	0.009	3.13	0.97 - 10.13	0.057
No	299	94.62	311	98.42	1.00	Reference		1.00	Reference
Amniotic fluid volume changes
Yes	38	12.03	15	4.75	2.74	1.47 - 5.13	0.001	3.88	1.87 - 8.05	< 0.001
No	278	87.97	301	95.25	1.00	Reference		1.00	Reference
Placental abruption
Yes	20	6.33	6	1.90	3.49	1.37 - 8.87	0.005	2.32	0.72 - 7.48	0.160
No	296	93.67	310	98.10	1.00	Reference		1.00	Reference
Centralization of fetal blood flow
Yes	15	4.75	4	1.27	3.89	1.27 - 11.92	0.011	2.77	0.76 - 10.06	0.122
No	301	95.25	312	98.73	1.00	Reference		1.00	Reference
Use of pregnancy medications
Yes	199	62.97	181	57.28	1.27	0.92 - 1.75	0.144	1.53	1.01 - 2.34	0.047
No	117	37.03	135	42.72	1.00	Reference		1.00	Reference
Logistic regression 3
Maternal blood type
A	109	34.49	126	39.87	1.00	0.70 - 1.41	0.983	1.05	0.53 - 2.09	0.882
B	42	13.29	34	10.76	1.42	0.85 - 2.37	0.174	3.12	1.13 - 8.64	0.029
O	132	41.77	152	48.10	1.00	Reference		1.00	Reference
AB	13	4.11	4	1.27	3.74	1.18 - 11.91	0.016	4.06	0.62 - 26.71	0.145
Ignored	20	6.33	0	0.00	.	.	.	.	.	.
Underlying condition
Yes	197	62.34	250	79.11	0.44	0.30 - 0.63	< 0.001	1.56	0.72 - 3.38	0.255
No	119	37.66	66	20.89	1.00	Reference		1.00	Reference
Previous fetal death
Yes	24	7.59	12	3.80	2.29	1.11 - 4.75	0.021	3.12	0.64 - 15.22	0.159
No	177	56.01	203	64.24	1.00	Reference		1.00	Reference
Not applicable*	115	36.39	101	31.96	1.31	0.93 - 1.83	0.118	0.64	0.33 - 1.27	0.204
Adequacy of antenatal care
Adequate	97	30.70	248	78.48	1.00	Reference		1.00	Reference
Inadequate	11	3.48	17	5.38	1.65	0.75 - 3.67	0.211	1.25	0.24 - 6.57	0.789
Did not attend antenatal care	13	4.11	3	0.95	11.08	2.97 - 41.33	< 0.001	26.78	3.48 - 206.09	0.002
Ignored	195	61.71	48	15.19	10.39	6.56 - 16.44	< 0.001	24.42	10.72 - 55.60	< 0.001
Amniotic fluid volume changes
Yes	38	12.03	15	4.75	2.74	1.47 - 5.13	0.001	1.12	0.34 - 3.72	0.852
No	278	87.97	301	95.25	1.00	Reference		1.00	Reference
Use of pregnancy medications
Yes	199	62.97	181	57.28	1.27	0.92 - 1.75	0.144	0.52	0.25 - 1.05	0.069
No	117	37.03	135	42.72	1.00	Reference		1.00	Reference
Gestational age
Under 28	94	29.75	1	0.32	322.82	23.72 - 4393	< 0.001	24.66	0.82 - 744.27	0.065
28 to 31	70	22.15	7	2.22	34.34	12.82 - 92.03	< 0.001	6.63	1.07 - 41.28	0.043
32 to 36	70	22.15	46	14.56	5.23	3.22 - 8.47	< 0.001	2.24	0.88 - 5.69	0.089
37 and over	76	24.05	261	82.59	1.00	Reference		1.00	Reference
Ignored	6	1.90	1	0.32	20.61	2.32 - 182.98	< 0.001	0.00	.	0.990
Birth weight
≥ 999	116	36.71	2	0.63	198.17	28.50 - 1378	< 0.001	69.53	3.50 - 1381.85	0.005
1.000 to 1.499	44	13.92	7	2.22	21.48	8.27 - 55.77	< 0.001	16.72	2.45 - 114.09	0.004
1.500 to 2.499	78	24.68	44	13.92	6.06	3.70 - 9.92	< 0.001	2.94	1.04 - 8.29	0.042
2.500 to 3.999	72	22.78	246	77.85	1.00	Reference		1.00	Reference
≥ 4.000	4	1.27	17	5.38	0.80	0.26 - 2.47	0.703	0.55	0.08 - 3.81	0.543
Ignored	2	0.63	0	0.00	.	.	.	.	.	.
Intrauterine fetal growth
SGA	105	33.23	40	12.66	4.51	2.89 - 7.03	<0.001	1.66	0.65 - 4.25	0.286
AGA	138	43.67	237	75.00	1.00	Reference		1.00	Reference
LGA	31	9.81	38	12.03	1.40	0.83 - 2.36	0.202	2.48	0.80 - 7.65	0.114
Ignored	42	13.29	1	0.32	72.13	8.38 - 620.70	< 0.001	4687793	.	0.989
Congenital birth defect
Yes	155	49.05	23	7.28	12.26	7.14 - 21.06	< 0.001	85.37	33.01 - 220.77	< 0.001
No	161	50.95	293	92.72	1.00	Reference		1.00	Reference

Variables	Cases		Controls		Adjusted OR	95%CI	P
Variables	n	%	n	%	Adjusted OR	95%CI	P
Maternal blood type
A	109	34.49	126	39.87	1.07	0.55 - 2.06	0.848
B	42	13.29	34	10.76	2.82	1.07 - 7.43	0.035
O	132	41.77	152	48.10	1.00	Reference
AB	13	4.11	4	1.27	3.49	0.52 - 23.46	0.198
Ignored	20	6.33	0	0.00	.	.	.
Adequacy of antenatal care
Adequate	97	30.70	248	78.48	1.00	Reference
Inadequate	11	3.48	17	5.38	1.46	0.28 - 7.61	0.656
Did not attend antenatal care	13	4.11	3	0.95	30.78	4.23 - 224.29	0.001
Ignored	195	61.71	48	15.19	24.97	11.15 - 55.91	< 0.001
Gestational age
Under 28	94	29.75	1	0.32	24.21	1.10 - 531.81	0.043
28 to 31	70	22.15	7	2.22	6.03	1.34 - 27.17	0.019
32 to 36	70	22.15	46	14.56	1.75	0.78 - 3.93	0.176
37 and over	76	24.05	261	82.59	1.00	Reference
Ignored	6	1.90	1	0.32	4.67	0.32 - 68.9	0.262
Birth weight
≥ 999	116	36.71	2	0.63	51.94	4.31 - 626.46	0.002
1,000 to 1,499	44	13.92	7	2.22	11.17	2.29 - 54.41	0.003
1,500 to 2,499	78	24.68	44	13.92	2.75	1.25 - 6.06	0.012
2,500 to 3,999	72	22.78	246	77.85	1.00	Reference
≥ 4,000	4	1.27	17	5.38	1.11	0.22 - 5.60	0.900
Ignored	2	0.63	0	0.00	.	.	.
Congenital birth defect
Yes	155	49.05	23	7.28	63.90	27.32 - 149.48	< 0.001
No	161	50.95	293	92.72	1.00	Reference

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