Ethnic variation in causes of stillbirth in high income countries: A systematic review and meta-analysis

Background: Inequities in stillbirth rate according to ethnicity persist in high income nations. Objectives: To investigate whether causes of stillbirth differ by ethnicity in high-income nations. Search strategy: Medline, Embase, Scopus, CINAHL, Cochrane Library, and Global Health databases since their inception to 1 February 2021. Selection criteria: Cohort, cross-sectional, and retrospective studies investigating the causes of stillbirth in various ethnic groups. Data collection and analysis: Systems of classification and causes of stillbirth were aligned to the International Classification of Disease 10 for Perinatal Mortality (ICD10-PM) and pooled estimates were derived by meta-analysis. Main results: Fifteen reports from 3 countries (72,555 stillbirths) were included. Seven ethnic groups – “Caucasian” (n = 11 studies, n = 37,578 stillbirths), “African” (n = 11 studies, n = 17,883 stillbirths), “Hispanic” (n = 7 studies, n = 12,810 stillbirths), “Indigenous Australian” (n = 4 studies, n = 1,117 stillbirths), “Asian” (n = 2 studies, n = 15 stillbirths), “South Asian” (n = 2 studies, n = 55 stillbirths), and “American Indian” (n = 1 study, n = 27 stillbirths) – were identified. There was an overall paucity of recent, high-quality data for many ethnicities. For those with the greatest amount of data – Caucasian, African, and Hispanic – no major differences in the causes of stillbirth were identified. Conclusion: There is a paucity of high-quality information on causes of stillbirth for many ethnicities. Improving investigation and standardising classification of stillbirths is needed to assess whether causes of stillbirth differ across more diverse ethnic groups.