Stillbirth Rates in Singletons, Twins and Triplets in Sweden, 1869 to 2001

Fellman, Johan; Eriksson, Aldur W.

doi:10.1375/183242706776382356

Cited by 16 publications

(19 citation statements)

References 13 publications

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“…To go from a historic stillbirth rate typically seen in developing countries and regions such as South Asia and sub-Saharan Africa (currently 32/1,000) to today's rate in Sweden has taken over 100 years. (38) Even when we observe countries  fren, fretts, and flenady that experienced exceptional change, such as Lithuania in the 1990s after the fall of the "Iron Curtain," the improvements in stillbirth rates were slower than for other perinatal deaths. The perinatal mortality in the Kaunas region was 20.5 per 1,000 in 1992, and decreased to 10.3 in 1999, while stillbirths were only reduced from 8.2 per 1,000 to 7.6 per 1,000, respectively.…”

Section: General Trends and Lessons For Preventionmentioning

confidence: 99%

Definition and epidemiology of stillbirths

Frøen¹,

Fretts²,

Flenady³

2010

Stillbirth

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Stillbirths constitute over half the global perinatal mortality, but only a minority will be registered in any health information system.(1) According to the World Health Organization (WHO) estimates, 3 million stillbirths occurred in 2004 (2), apparently down from 3.3 million in 2000 (1) and 4.3 million in 1995.(3) There is little reason to believe that this trend reflects a decade of success in stillbirth prevention, and the authors of the WHO estimates acknowledge that the latest figures by all accounts are a significant underestimation--due to definitions used, methods of counting and estimation for missing data, and underreporting; issues we address in this chapter.Considering the prevalence and enormity of the emotional burden to families, stillbirths are a major public health problem. Understanding the epidemiology of stillbirths is essential for any maternity and infant health care policy development, surveillance and international comparisons, clinical services, and research. For this, we need not only to understand the basic numbers, but accessible data is needed on core indicators of quality and availability of care, as well as on the most prevalent causes of death and associated conditions. This need for information is a pressing issue in stillbirth prevention, as the knowledge gap is wide.(4-9)Despite the scale of the problem, stillbirths have largely been ill-prioritized and understudied by most standards. Stillbirths are not included in the WHO reports on the Global Burden of Disease (10) and, in contrast to infant and maternal deaths, they are not included in the Millennium Development Goals and Targets of the United Nations. For every 50 publications on unexplained infant death (SIDS) in PubMed, there is only one on the far more prevalent entity of unexplained stillbirths, and as we will show in this chapter, the proportion of medical research that directly addresses stillbirth has fallen continuously for over 40 years. The "10/90 gap" indicating that less than 10% of research resources address conditions affecting more than 90% of the world's population (11) is used to highlight important gaps in the global research agenda. However, the research gap for stillbirths goes beyond this "10/90 gap"; of all publications on stillbirth in PubMed, about 3% relates to developing countries where 99% of third trimester stillbirths occur.The ultimate goal in studying stillbirth epidemiology is prevention. The vast majority of stillbirths are not only preventable, but simple inexpensive interventions could lead to an increase in births of healthy infants with greater life expectancy.(9, 12) Mothers and families could be spared the chagrin accompanying pregnancy loss, and societies spared loss of healthy lives.This chapter aims to introduce some of the concepts in stillbirth epidemiology; some core numbers on the global epidemiology; and how definitions, data collections, and statistics affect our understanding and guide our preventive efforts for some of the main categories of stillbirths. The actual interven...

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Section: General Trends and Lessons For Preventionmentioning

confidence: 99%

Definition and epidemiology of stillbirths

Frøen¹,

Fretts²,

Flenady³

2010

Stillbirth

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“…Similar information published by Statistics Sweden was available for Sweden for the period 1901 to 1967. Swedish data have also been considered by Fellman and Eriksson (2006b) and Eriksson and Fellman (2006). In Fellman and Eriksson (2006c), the variation in the secondary sex ratio was considered among singletons and twins, and the frequencies of MZ and DZ twin maternities and the reliability of Weinberg's differential rule estimated.…”

Section: Methodsmentioning

confidence: 99%

“…In Fellman and Eriksson (2006c), the variation in the secondary sex ratio was considered among singletons and twins, and the frequencies of MZ and DZ twin maternities and the reliability of Weinberg's differential rule estimated. In Fellman and Eriksson (2006b), the temporal variations in the SBR were considered among singletons, twins and triplets. In that study and the log-likelihood function .…”

Section: Methodsmentioning

confidence: 99%

“…Preliminary studies of the effect of different SBRs for monozygotic (MZ) and dizygotic (DZ) twins were also performed, but the effect of zygosity will be discussed in more detail in a forthcoming paper (Fellman & Eriksson, 2006a). Analyses of the SBRs for different types of twin pairs confirm that the liability to stillbirth is almost constantly higher among males than among females (Fellman & Eriksson, 2006b;Eriksson & Fellman, 2006). Consequently, in the models introduced, we assumed different SBRs for males and females.…”

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Stillbirths in Multiple Births: Test of Independence

Fellman¹,

Eriksson

2006

Twin Res Hum Genet

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The stillbirth rate in twins is a more sensitive indicator of environmental hazards than the stillbirth rate in singletons. Medical care or other socioeconomic factors may be more influential for perinatal survival in twin than in single deliveries. Studies have indicated that stillbirths among children in a set of multiple maternities are not independent. Models were considered assuming independent outcomes within a set of multiple maternities. Analyses of the stillbirth rates confirm that the risk of stillbirth among males is almost constantly higher than among females. Any model introduced should assume different stillbirth rates for males and females. The models were tested with both maximum likelihood and minimum chi2 methods. Data was analyzed from Sweden, the Aland Islands, Saxony, England and Wales, and significant discrepancies obtained from the independence models. The same-sexed twin data contain both monozygotic and dizygotic twin sets with apparently different stillbirth rates. Consequently, for same-sexed twins the proposed model could be considered too simple. After improvement by splitting the same-sexed data into monozygotic and dizygotic twin sets, the dependence still remains. The proportion of both same-sexed and opposite-sexed twin pairs that contain two stillborn is greater than what the stillbirth rates and the independence should indicate. Consequently, stillbirth rate estimates based on the relative frequency of twin sets with two stillborn children have a positive bias. When the stillbirth rate decreases, the number of sets with two stillborn children decreases more slowly than would be indicated by independence.

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“…For Finland, a slight change in the definition took place in 1987. The gestation age was shifted from 28 weeks to at least 22 (Fellman and Eriksson, 2006a). Available SR and SBR data are presented in Table 1.…”

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Temporal Trends in the Secondary Sex Ratio in Nordic Countries

Fellman

Eriksson

2011

Biodemography and Social Biology

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Attempts have been made to identify factors influencing the number of males per 100 females at birth, also called the secondary sex ratio. It has been proposed to vary inversely with the frequency of prenatal losses, but available data lend at best only weak support for this hypothesis. Statistical analyses have shown that comparisons between secondary sex ratios demand large data sets. Variations in the secondary sex ratio that have been reliably identified in family data have mostly been slight and without a notable influence on national birth registers. For Sweden, 1751-1950, the secondary sex ratio among all births and live births revealed increasing trends. The Swedish results are compared with available findings for live births in Finland, Norway, Denmark, and the small Icelandic population. For Norway and Denmark, the secondary sex ratio increased during 1801-1950. A similar, but stronger pattern was observed for Finland (1751-1950) and Iceland (1838-1950). During the latter half of the twentieth century, marked decreases were observed in all countries. Attempts to identify reliable associations between secondary sex ratios and stillbirth rates have been made, but no consistent results have emerged.

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Stillbirth Rates in Singletons, Twins and Triplets in Sweden, 1869 to 2001

Cited by 16 publications

References 13 publications

Definition and epidemiology of stillbirths

Definition and epidemiology of stillbirths

Stillbirths in Multiple Births: Test of Independence

Temporal Trends in the Secondary Sex Ratio in Nordic Countries

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