{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:46:29Z","timestamp":1789778789355,"version":"4.0.1"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The relationship between specific clusters of prepregnancy cardiovascular risk factors and stillbirth, particularly across racial and ethnic groups, remains understudied. We aimed to evaluate the association between 16 distinct cardiovascular risk clusters and stillbirth, emphasizing racial disparities.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">We conducted a nationwide, population\u2010based study using Centers for Disease Control and Prevention Natality and Fetal Death Data Files (2014\u20132022), including 31\u2009408\u2009776 singleton births and 131\u2009047 stillbirths (\u226520\u2009weeks' gestation). Prepregnancy cardiovascular risk factors\u2014diabetes, hypertension, smoking, and nonideal body mass index\u2014were categorized into 16 mutually exclusive clusters. Modified Poisson regression with robust variance estimation was used to estimate adjusted relative risks and 95% CIs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">The analysis of the 16 groups defined by the 4 binary risk factors revealed that, compared with clusters without any risk factors, clusters with a single risk factor, absent the other 3, displayed varying degrees of stillbirth risk: prepregnancy diabetes posed the greatest risk (adjusted relative risk, 4.05 [95% CI, 3.74\u20134.39]), followed by prepregnancy hypertension (adjusted relative risk, 2.44 [95% CI, 2.27\u20132.63]), smoking (adjusted relative risk, 1.62 [95% CI, 1.58\u20131.67]), and unhealthy body mass index (adjusted relative risk, 1.33 [95% CI, 1.31\u20131.35]). The absolute excess risk attributable to biological interaction between 2 risk factors was observed in 2 of 6 risk combinations, predominantly those involving diabetes. Racial disparities were pronounced, with non\u2010Hispanic Black mothers exhibiting the highest relative and absolute risks of stillbirth, nearly double that of non\u2010Hispanic White mothers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Prepregnancy cardiovascular risk profiles are strongly associated with stillbirth, with marked racial and ethnic disparities. Simplified scoring systems may obscure heterogeneity in risk, reinforcing the need for race\u2010conscious, targeted interventions.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.042319","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T11:49:45Z","timestamp":1753789785000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Prepregnancy Cardiovascular Risk Factors Clusters With Stillbirth Risk Across Racial and Ethnic Groups: A Nationwide Population\u2010Based Study of 31.4\u2009Million Singleton Births and 131\u2009047 Stillbirths"],"prefix":"10.1161","volume":"14","author":[{"given":"Jing","family":"Nie","sequence":"first","affiliation":[{"name":"Population Research Institute, Nanjing University of Posts and Telecommunications","place":["Nanjing, China"]},{"name":"High\u2010Quality Development Evaluation Research Institute, Nanjing University of Posts and Telecommunications","place":["Nanjing, China"]},{"name":"Nanjing University of Posts and Telecommunications","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7469-1399","authenticated-orcid":false,"given":"Leandro F. M.","family":"Rezende","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo","place":["Sao Paulo, Brazil"]},{"name":"Universidad Aut\u00f3noma de Chile","place":["Providencia, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3177-6576","authenticated-orcid":false,"given":"Gerson","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Universidad Aut\u00f3noma de Chile","place":["Providencia, Chile"]},{"name":"Universidad de Santiago de Chile (USACH), Escuela de Ciencias de La Actividad F\u00edsica, El Deporte y La Salud","place":["Santiago, Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Qiu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoling","family":"Wang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentao","family":"Huang","sequence":"additional","affiliation":[{"name":"Sun Yat\u2010sen University Cancer Center","place":["Guangzhou, China"]},{"name":"Sun Yat\u2010sen University Cancer Center","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5204-7308","authenticated-orcid":false,"given":"Zhiping","family":"Niu","sequence":"additional","affiliation":[{"name":"Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5620-6785","authenticated-orcid":false,"given":"Xiong","family":"Chen","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"Wenzhou Key Laboratory of Diabetes Research","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4533-1722","authenticated-orcid":false,"given":"Dagfinn","family":"Aune","sequence":"additional","affiliation":[{"name":"Imperial College London","place":["London, United Kingdom"]},{"name":"Oslo New University College","place":["Oslo, Norway"]},{"name":"Cancer Registry of Norway, Norwegian Institute of Public Health","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","first-page":"1","article-title":"Fetal mortality: United States, 2022","volume":"73","author":"Gregory ECW","year":"2024","unstructured":"Gregory ECW, Valenzuela CP, Hoyert DL. 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