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The clinical relevance of such findings is that although there are limited means by which to treat fetal growth restriction in utero, recognition that the fetus is at risk after appropriate maternal-fetal investigations can lead to well timed delivery and improved perinatal outcome.12 13 However, there are currently no established and routinely used means to predict stillbirth, and risk factors known at the beginning of pregnancy are considered weak predictors of outcome.14We investigated the role of demographic, social, and medical risk factors that can be ascertained at the beginning of pregnancy together with those that become apparent as pregnancy progresses, and their respective contributions to the incidence of stillbirths in an NHS region in England with a multiethnic population.15 To focus on potentially avoidable factors we excluded congenital anomalies, as their contribution to stillbirth is contingent on incidence as well as cultural choices on antenatal screening, prenatal diagnosis, and decisions in response to positive results.

Gestational age was determined on the basis of routinely offered dating scans, which were carried out in the first or second trimester (Data on fetal, neonatal, and infant deaths and congenital anomalies were notified to the Perinatal Institute by a network of coordinators, and had a consistently high level of ascertainment.Mothers are informed at their first antenatal visit about the intention of collection and analysis of secondary data, and this is also explained in text printed in their standardised, hand held pregnancy notes.That this information has been given and explained is recorded in the notes and signed by the midwife.We also considered all two factor interactions between the explanatory variables and used empirical probability plots to check the final model to assess whether the modelling assumptions were met.We carried out sensitivity analyses to assess the influence of factors excluded because of P0.05, potential clustering by maternity unit, and the effect of repeat pregnancies from the same mother.

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