Inequalities in Late Stillbirths: A Population-Based Study in Northern Italy

Objective: Inequalities contribute substantially to adverse perinatal outcomes; however, data on stillbirth risk and its etiologic diversity across maternal migrant status remain limited in Italy. Understanding these patterns is essential for developing targeted prevention strategies. The aim of the present study was to assess stillbirth risk and evaluate differences in underlying causes between Italian and migrant women in a large population-based cohort. Study design: We conducted a retrospective cohort study including 323,635 births in Emilia-Romagna, Italy (2014–2023). Late Stillbirth (L-SB) was defined as fetal death ≥28 weeks. Maternal origin was categorized as Italian vs. migrant according to the citizenship. Risk factors were assessed using multivariable logistic and Cox regression models, and causes of fetal death were classified by Re.Co.De. Results: L-SB incidence was significantly higher in migrants (0.32%) than Italians (0.21%) (OR 1.52; HR 1.55, p<0.001). Low birthweight, advanced maternal age, obesity, and low number of antenatal visits emerged as significant risk factors for L-SB irrespective of maternal citizenship. Importantly, fetal deaths related to placental pathologies were significantly more frequent in migrants (n=150/328, 45.7% in migrants vs n=159/464, 34.3% in Italians, p = 0.001), as well as infection/inflammation (n=33/328, 10.1% in migrants vs 25/464, 5.4% in Italians, p= 0.019), Conclusions: Substantial diversity in L-SB etiology exists across mothers of different origin, underscoring the need for tailored prevention strategies. Accordingly, ultrasounds and infection screening (i.e., antenatal care) should be implemented, especially in migrants. Such measures, combined with culturally sensitive counseling could reduce preventable stillbirths in the multicultural Italian population.