Race, Ethnicity, and Social Vulnerability in the Evaluation of Stillbirth

To examine the relationship between race, ethnicity, and social vulnerability on evaluation of stillbirth.

Retrospective cohort study examined stillbirths occurring at two sites within a single tertiary care center from 2015 to 2024. Cases included stillbirths occurring at or after 20 weeks of gestation. Exclusion criteria were spontaneous periviable (before 23 weeks) deliveries, medically indicated deliveries, and multiple gestations. Outcome variables included measures of laboratory and pathologic stillbirth evaluation and social vulnerability using the Social Vulnerability Index and Area Deprivation Index.

A total of 555 stillbirth cases were analyzed, with an overall stillbirth rate of 5.8 per 1,000 births. Non-Hispanic Black women experienced the highest stillbirth rate at 9.6 per 1,000 births. Non-Hispanic Black and Hispanic women had significantly greater social vulnerability compared with non-Hispanic White women (η²=0.16, 95% CI, 0.01-0.23, P<.001; η²=0.12, 95% CI, 0.06-0.175, P<.001). Diagnostic genetic testing was performed in 46.7% of cases, autopsy in 34.2%, and placental pathology in 91.9%. Non-Hispanic Black women were less likely to receive genetic testing after stillbirth compared with non-Hispanic White women (36.0% vs 57.3%, P=.004, Cramér V=0.154). Only 20.9% of all cases underwent a complete evaluation. Multivariate logistic regression demonstrated that increasing social vulnerability was independently associated with lower odds of complete postmortem evaluation for both Social Vulnerability Index (AOR Social Vulnerability Index 0.91, 95% CI, 0.84-0.98) and Area Deprivation Index (AOR Area Deprivation Index 0.87, 95% CI, 0.79-0.95) and that non-Hispanic Black individuals had lower odds of receiving diagnostic genetic testing than non-Hispanic White individuals (AOR 0.47, 95% CI, 0.28-0.79; AOR 0.49, 95% CI, 0.30-0.82).

There are gaps in the provision of the recommended stillbirth evaluation. In addition, racial and ethnic disparities are present in the provision of postmortem care, particularly for diagnostic genetic testing.