{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:03:37Z","timestamp":1785441817556,"version":"3.56.0"},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K01HL171699"],"award-info":[{"award-number":["K01HL171699"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>One in 175 births in the United States is a stillbirth\u2014approximately 21,000 births annually. Pathology (fetal autopsy and placental histopathology) is recommended to help determine the aetiology of a stillbirth. However, socioeconomic factors, such as education level and insurance status, may influence whether stillbirth pathology is pursued.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We evaluated associations between socioeconomic factors and the use of pathology following stillbirth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed linked fetal death certificates and maternal hospitalisation discharge records from stillbirths occurring in California from 2007 to 2020. Socioeconomic indicators included maternal education level and insurance status. Study outcomes were fetal autopsy and placental histopathology, categorised as none or yes (completed or planned), as reported on the fetal death certificate. We used modified Poisson regression models with robust standard errors to estimate risk ratios (RRs) with 95% confidence intervals (CIs), adjusting for prespecified covariates: Birth year, maternal age, and racial and ethnic group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 34,668 stillbirths, 22% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097557) had an autopsy, and 55% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200919,000) had placental histopathology. Compared with public insurance, those with private insurance were more likely to have a fetal autopsy (adjusted RR 1.19, 95% confidence interval [CI] 1.12, 1.26) and placental histopathology (adjusted RR 1.13, 95% CI 1.09, 1.17). Compared with having less than a high school degree, those with a graduate degree were more likely to have a fetal autopsy (adjusted RR 1.48, 95% CI 1.32, 1.64); however, placental histopathology utilisation did not differ by education level after adjustment for covariates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this population\u2010based study, we found that higher socioeconomic advantage is associated with higher use of pathology following stillbirth, particularly the use of fetal autopsy. Determining causes of stillbirth remains an important perinatal priority, and these results identify an important disparity to address.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ppe.70156","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T10:15:21Z","timestamp":1778840121000},"page":"603-607","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pathology Following Stillbirth: Differences by Insurance Status and Educational Attainment"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0273-7687","authenticated-orcid":false,"given":"Ellie","family":"Diamond","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Population Health Stanford University School of Medicine  California USA"},{"name":"Department of Obstetrics, Gynaecology, and Reproductive Sciences University of Vermont School of Medicine  Burlington Vermont USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzan L.","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Division of Neonatal and Developmental Medicine, Department of Paediatrics Stanford University School of Medicine  California USA"},{"name":"Division of Maternal\u2010Fetal Medicine and Obstetrics, Department of Obstetrics and Gynaecology Stanford University School of Medicine  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7562-7850","authenticated-orcid":false,"given":"Elliott K.","family":"Main","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine and Obstetrics, Department of Obstetrics and Gynaecology Stanford University School of Medicine  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley E.","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine and Obstetrics, Department of Obstetrics, Gynaecology &amp; Reproductive Sciences University of California, San Francisco  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8112-6929","authenticated-orcid":false,"given":"Anna","family":"Booman","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8213-1319","authenticated-orcid":false,"given":"Stephanie A.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine and Obstetrics, Department of Obstetrics and Gynaecology Stanford University School of Medicine  California USA"},{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine  California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"CDC Data and Statistics on Stillbirth. Stillbirth 2025accessed at April 9 2025 https:\/\/www.cdc.gov\/stillbirth\/data\u2010research\/index.html."},{"key":"e_1_2_11_3_1","unstructured":"Stillbirth Working Group Working to Address the Tragedy of Stillbirth. Eunice Kennedy Shriver Natl Inst Child Health Hum Dev NICHD Counc. 2023."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.01.017"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41372\u2010025\u201002381\u20103"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.82.6.816"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/og9.0000000000000025"},{"key":"e_1_2_11_8_1","unstructured":"D.Eldeib After a Stillbirth an Autopsy Can Provide Answers. Too Few of Them Are Being Performed. 2022accessed at May 24 2025 https:\/\/www.propublica.org\/article\/stillbirths\u2010autopsy\u2010placenta\u2010exams\u2010pregnancy."},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000287616.71602.d0"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.03.014"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2022.12.014"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.01.035"},{"issue":"9","key":"e_1_2_11_13_1","first-page":"1013","article-title":"Measurement of Socioeconomic Status in Health Disparities Research","volume":"99","author":"Shavers V. L.","year":"2007","journal-title":"Journal of the National Medical Association"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.044305"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1823"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2011.02.019"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2017.07.001"}],"container-title":["Paediatric and Perinatal Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ppe.70156","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ppe.70156","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ppe.70156","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T19:40:12Z","timestamp":1785440412000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ppe.70156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":16,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/ppe.70156"],"URL":"https:\/\/doi.org\/10.1111\/ppe.70156","archive":["Portico"],"relation":{},"ISSN":["0269-5022","1365-3016"],"issn-type":[{"value":"0269-5022","type":"print"},{"value":"1365-3016","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]},"assertion":[{"value":"2025-11-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}