Stillbirths: rates, risk factors, and acceleration towards 2030

Abstract

An estimated 2.6 million third trimester stillbirths occurred in 2015 (uncertainty range 2.4-3.0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas affected by conflict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1.3 million (uncertainty range 1.2-1.6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7.4% of stillbirths. Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8.0% and syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6.7%). Prolonged pregnancies contribute to 14.0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.

Predictors of stillbirths in Bangladesh: evidence from the 2004–2014 nation-wide household surveys

“…The Lancet Series [2,4,8] suggest a roadmap for ending preventable stillbirths. These include stronger independent accountability within countries, the establishment of stillbirth prevention strategic plans, empowerment of women and families, ensuring skilled birth attendance in health facilities, reduction in stigma associated with stillbirths and improvement in bereavement care.…”

“…The study outcome was stillbirth, defined as death of a fetus of more than or equal to 28 weeks’ gestation, consistent with previous studies [1,2,12]. The outcome was recorded as a binary variable in the datasets, coded as ‘1’ for stillbirth and ‘0’ for no stillbirth.…”

“…Despite this decline, recent studies have reported that global estimates of stillbirth ranged from 2.1 million [1] to 2.6 million [2] in 2015, and approximately 98% of those fetal deaths occurred in developing countries [1,2]. Variation in global estimates of the stillbirth rate may be due to access to data sources and modelling strategy, as both studies used the standard definition for stillbirth (fetal death after 28 weeks’ gestation).…”

“…Despite this achievement, Bangladesh remains a major contributor to stillbirth rates in South Asia [2] with a reported stillbirth rate of 20 per 1000 live births in 2015 [1]. Stillbirths have an enormous impact on mothers, families, health care professionals and the community [4].…”

Comparing performance of methods used to identify pregnant women, pregnancy outcomes, and child mortality in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda

“…The estimated number of worldwide stillbirths in the third trimester for 2015 was 2.6 million [3], yet the problem of stillbirth has remained an almost invisible global health issue [4]. Reliable estimates of numbers, causes and contributors to maternal and newborn deaths are critical for evidence-based priority setting and programming.…”