Assessing the risks for stillbirth in São Paulo, Brazil: protocol for a multidisciplinary case-control study - FetRisks.
Rafael Junqueira BuralliZilda Pereira da SilvaGizelton Pereira AlencarGerusa Maria FigueiredoMara Sandra HoshidaExpedito José de Albuquerque LunaLuciana Duzolina Manfré PastroOsmara Alves Dos SantosLays Janaina Prazeres MarquesRodrigo Melim ZerbinatiAndrés Jimenez Galisteo JuniorHeitor de Andrade JuniorClarisse M MachadoLuciana Regina MeirelesRegina SchultzLaura Cunha RodriguesRossana Pulcinelli Vieira FranciscoHillegonda Maria Dutilh NovaesMarcia Furquim de AlmeidaNelson GouveiaPublished in: BMJ open (2024)
Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate public policies and protocols to prevent stillbirth, improve maternal care and support bereaved families. METHODS AND ANALYSIS: In this case-control study with stillbirths and live births in 14 public hospitals in São Paulo, mothers are interviewed at hospitals after delivery, and hospital records and prenatal care registries are reviewed. Maternal and umbilical cord blood samples and placentas are collected to analyse angiogenesis and infection biomarkers, and the placenta's anatomopathological exam. Air pollutant exposure is estimated through the participant's residence and work addresses. Traditional and non-invasive autopsies by image-guided histopathology are conducted in a subset of stillbirths. Subsample mothers of cases are interviewed at home 2 months after delivery on how they were dealing with grief. Information contained in the official prenatal care registries of cases and controls is being compiled. Hospital managers are interviewed about the care offered to stillbirth mothers. Data analysis will identify the main risk factors for stillbirth, investigate their interrelations, and evaluate health services care and support for bereaved families. We hope this project will contribute to the understanding of stillbirth's risk factors and related health services in Brazil, providing new knowledge about this central public health problem, contributing to the improvement of public policies and prenatal and puerperal care, helping to prevent stillbirths and improve the healthcare and support for bereaved families. ETHICS AND DISSEMINATION: This study protocol was approved by the Ethics Committee of the Municipal Health Secretary (process no 16509319.0.3012.5551) and of the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (process no 16509319.0.0000.0068). Results will be communicated to the study participants, policy-makers and the scientific community.
Keyphrases
- healthcare
- public health
- risk factors
- quality improvement
- palliative care
- data analysis
- pregnant women
- umbilical cord
- mesenchymal stem cells
- affordable care act
- mental health
- health information
- emergency department
- rheumatoid arthritis
- pain management
- type diabetes
- wastewater treatment
- endothelial cells
- systemic lupus erythematosus
- adverse drug
- machine learning
- acute care
- pregnancy outcomes
- heavy metals
- cardiovascular disease
- artificial intelligence
- early life
- human health
- social media
- climate change
- health insurance
- vascular endothelial growth factor