The incidence of stillbirth is high in the United States and not improving, according to a new study published on Oct. 27.
According to the study, of the more than 2.7 million pregnancies from 2016 to 2022 that were examined, 18,893 resulted in stillbirths, defined as fetal death at 20 weeks of gestation or later.
“Both of these data sources—the data in our study and the CDC data—have potential flaws, but the main issue is that, regardless of data source, the rate of stillbirths is too high,” study co-leader Cohen said.
The study notes that more than 72 percent of stillbirths occurred in pregnancies in which there were one or more maternal or fetal risk factors, which are often modifiable with enhanced clinical oversight.
The highest rates of stillbirth occurred in the presence of certain medical conditions such as low amniotic fluid, fetal anomalies, and chronic hypertension.
Contributing factors include gestational or pre-pregnancy diabetes, obesity, substance use, decreased fetal movement, fetal growth restriction, history of adverse pregnancy outcomes, and excess amniotic fluid.
In these cases, medical guidelines call for proactive measures such as frequent ultrasounds, non-stress tests, or biophysical profiles to monitor the fetus.
Still, 27.7 percent of stillbirths entailed no identifiable clinical risk factors, with this proportion increasing with gestational age: 24.1 percent at 38 weeks, 34.2 percent at 39 weeks, and 40.7 percent at 40 weeks or beyond.
The study underscores issues in current risk assessment practices, especially for term pregnancies, suggesting that almost half of term stillbirths could be avoided with improved prediction and intervention strategies.
The study reveals considerable variation among sociodemographic groups, as stillbirth rates climb to one in 112 in low-income areas and to one in 95 in regions with higher proportions of black families.
At the same time, rural residence and access to obstetric care were not associated with increased risk, meaning that drivers could involve social factors, health system inequities, or unmeasured clinical elements, according to the study. The study did not include Medicaid data, making it possible that stillbirth rates could still be underestimated.
“The U.S. has among the highest rates of stillbirth among all high-income countries and there has been barely any improvement in stillbirth rates in recent years,” Cohen said.
In Europe, rates fell in several nations between 2010 and 2020.
“Many stillbirths are potentially preventable, and we can lower the stillbirth rate in the U.S., but not without attention, research, and resources,” Cohen said.
