Socioeconomic Status, Maternal Age and the Risk of Stillbirth in the Netherlands

Alessandro Di Nallo , Universitat Pompeu Fabra
Selin Köksal, the London School of Hygiene and Tropical Medicine
Katya Ivanova, Tilburg University

Background. Stillbirths are a major public health concern in high-income countries. Most studies find that the risk is higher among socioeconomically disadvantaged women, though evidence is not always consistent. It remains unclear whether these inequalities vary across maternal age, especially as childbearing is increasingly postponed. Methods. We use linked Dutch administrative data (2014–2020) covering over 800,000 pregnancies to examine whether socioeconomic status—measured by education and personal income—is associated with stillbirth risk, and whether this association varies across the reproductive lifespan. We estimate logistic regression models with year fixed effects and age–SES interactions, adjusting for personal and area-level characteristics. Results. Women with low education face 1.38 to 1.47 times higher odds of stillbirth compared to those with tertiary education. This gradient persists after adjusting for confounders and in analyses limited to first pregnancies. However, SES disparities vary by maternal age: they are minimal under age 30, but widen from age 30 onward, peaking in the mid-to-late 30s. Educational gaps appear earlier, while income-related differences become more pronounced after age 35. Conclusion. Our findings confirm persistent socioeconomic disparities in stillbirth risk in the Netherlands and show that these widen with maternal age. These results highlight that, despite a universal healthcare system, the Netherlands displays SES gradients in stillbirth risk, suggesting structural inequities in maternal health persist even in high-income settings.

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 Presented in Session 89. Flash Session Medically Assisted Reproduction and Infertility