For a study, researchers sought to determine the prevalence of fetal autopsies in the United States and the clinical and demographic factors that were associated with consent to autopsy following stillbirth.
The U.S. fetal death certificates for stillborn babies (20 weeks or more in gestation) delivered between January 2014 and December 2016 were used in the population-based retrospective cohort analysis. Multiple pregnancies were disregarded. Gestational age, maternal age, self-reported race and ethnicity, education, and having at least one live child were used to compute the rates of fetal autopsies. In order to account for possible confounders, multivariate logistic regression was used.
Over 60,328 stillbirths that met the criterion for inclusion were recorded. Fetal autopsies were completed in 20.9% of stillbirths overall. Compared to non-Hispanic White women (20.4%, 95% CI 20.0-20.9%) and Hispanic women (19.6%, 95% CI 19.0-20.3%) (P<.001), non-Hispanic Black women had the greatest rate of fetal autopsy (22.9%, 95% CI 22.3-23.6%). Maternal non-Hispanic Black race (aOR 1.22, 95% CI 1.16-1.29), higher education (graduate degree: aOR 1.62, 95% CI 1.47-1.79), and longer gestational age (term: aOR 2.08, 95% CI 1.95-2.23) were all linked to higher aORs for fetal autopsy after controlling for possible confounders. A lower aOR of fetal autopsy was linked with maternal age 40 years or older (aOR 0.77, 95% CI 0.63-0.92) and having at least one live child (aOR 0.74, 95% CI 0.71-0.78). Compared to non-Hispanic White mothers, women of American Indian or Alaska Native ancestry had lower fetal autopsy uptake (aOR 0.72, 95% CI 0.58-0.90).
The United States had a low prevalence of fetal autopsies. It was important to investigate the causes of the low autopsy rates in order to develop methods to improve accessibility and adoption.
