Producing valid statistics when legislation, culture and medical practices differ for births at or before the threshold of survival: report of a European workshop

Smith, Lucy; Blondel, Béatrice; Zeitlin, Jennifer

doi:10.1111/1471-0528.15971

Cited by 24 publications

(17 citation statements)

References 14 publications

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“…These differences make it difficult to compare stillbirth rates and trends across countries and to calculate the global burden, as highlighted previously. 7 , 13 , 14 , 15 We estimated stillbirth rate using a 28 weeks’ gestation or more definition of stillbirth ( panel 1 ). If information for the 28 weeks’ gestation definition was not available, adjustments and additional uncertainty associated with alternative definitions were accounted for in the model fitting.…”

Section: Methodsmentioning

confidence: 99%

Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment

et al. 2021

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Summary Background Stillbirths are a major public health issue and a sensitive marker of the quality of care around pregnancy and birth. The UN Global Strategy for Women's, Children's and Adolescents’ Health (2016–30) and the Every Newborn Action Plan (led by UNICEF and WHO) call for an end to preventable stillbirths. A first step to prevent stillbirths is obtaining standardised measurement of stillbirth rates across countries. We estimated stillbirth rates and their trends for 195 countries from 2000 to 2019 and assessed progress over time. Methods For a systematic assessment, we created a dataset of 2833 country-year datapoints from 171 countries relevant to stillbirth rates, including data from registration and health information systems, household-based surveys, and population-based studies. After data quality assessment and exclusions, we used 1531 datapoints to estimate country-specific stillbirth rates for 195 countries from 2000 to 2019 using a Bayesian hierarchical temporal sparse regression model, according to a definition of stillbirth of at least 28 weeks’ gestational age. Our model combined covariates with a temporal smoothing process such that estimates were informed by data for country-periods with high quality data, while being based on covariates for country-periods with little or no data on stillbirth rates. Bias and additional uncertainty associated with observations based on alternative stillbirth definitions and source types, and observations that were subject to non-sampling errors, were included in the model. We compared the estimated stillbirth rates and trends to previously reported mortality estimates in children younger than 5 years. Findings Globally in 2019, an estimated 2·0 million babies (90% uncertainty interval [UI] 1·9–2·2) were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13·9 stillbirths (90% UI 13·5–15·4) per 1000 total births. Stillbirth rates in 2019 varied widely across regions, from 22·8 stillbirths (19·8–27·7) per 1000 total births in west and central Africa to 2·9 (2·7–3·0) in western Europe. After west and central Africa, eastern and southern Africa and south Asia had the second and third highest stillbirth rates in 2019. The global annual rate of reduction in stillbirth rate was estimated at 2·3% (90% UI 1·7–2·7) from 2000 to 2019, which was lower than the 2·9% (2·5–3·2) annual rate of reduction in neonatal mortality rate (for neonates aged <28 days) and the 4·3% (3·8–4·7) annual rate of reduction in mortality rate among children aged 1–59 months during the same period. Based on the lower bound of the 90% UIs, 114 countries had an estimated decrease in stillbirth rate since 2000, with four countries having a decrease of at least 50·0%, 28 having a decrease of 25·0–49·9%, 50 having a decrease of 10·0–24·9%, and 32 having a decrease of less than 10·0%. For the remaining 81 countries, we found no decrease in stillbirth rate since 2000. Of these countries...

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Section: Methodsmentioning

confidence: 99%

Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment

et al. 2021

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“…A recent workshop panel from European countries encourages vital statistics agencies to routinely collect clinical data that could classify stillbirths as occurring either before the initiation of labor (i.e., antepartum) or during labor (i.e., intrapartum) [ 48 ]. Such information may assist with identifying a subset of stillbirths whose selection in utero affects the risk of early neonatal death [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Stillbirth as left truncation for early neonatal death in California, 1989–2015: a time-series study

Bruckner

Gailey

Das

et al. 2021

BMC Pregnancy Childbirth

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Background Some scholars posit that attempts to avert stillbirth among extremely preterm gestations may result in a live birth but an early neonatal death. The literature, however, reports no empirical test of this potential form of left truncation. We examine whether annual cohorts delivered at extremely preterm gestational ages show an inverse correlation between their incidence of stillbirth and early neonatal death. Methods We retrieved live birth and infant death information from the California Linked Birth and Infant Death Cohort Files for years 1989 to 2015. We defined the extremely preterm period as delivery from 22 to < 28 weeks of gestation and early neonatal death as infant death at less than 7 days of life. We calculated proportions of stillbirth and early neonatal death separately by cohort year, race/ethnicity, and sex. Our correlational analysis controlled for well-documented declines in neonatal mortality over time. Results California reported 89,276 extremely preterm deliveries (live births and stillbirths) to Hispanic, non-Hispanic (NH) Black, and NH white mothers from 1989 to 2015. Findings indicate an inverse correlation between stillbirth and early neonatal death in the same cohort year (coefficient: -0.27, 95% CI of − 0.11; − 0.42). Results remain robust to alternative specifications and falsification tests. Conclusions Findings support the notion that cohorts with an elevated risk of stillbirth also show a reduced risk of early neonatal death among extremely preterm deliveries. Results add to the evidence base that selection in utero may influence the survival characteristics of live-born cohorts.

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“…10 Using these data for international comparisons of perinatal indicators also supports efforts to improve maternal and neonatal care. 11 A recognized barrier to high-quality data collection is the variability in how perinatal outcomes are defined across countries, in particular the lower gestational age threshold. 1 The lower threshold is often affected by the level of care available for extremely preterm newborns as well as sociocultural values around life at early gestations.…”

Section: Introductionmentioning

confidence: 99%

“…10 Using these data for international comparisons of perinatal indicators also supports efforts to improve maternal and neonatal care. 11…”

Section: Introductionmentioning

confidence: 99%

Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review

Connolly

Phung

Farrington

et al. 2021

Asia Pac J Public Health

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Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.

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Producing valid statistics when legislation, culture and medical practices differ for births at or before the threshold of survival: report of a European workshop

Cited by 24 publications

References 14 publications

Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment

Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment

Stillbirth as left truncation for early neonatal death in California, 1989–2015: a time-series study

Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review

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