Stillbirth Risks and Prevention for Developed Countries
Though this would not be true for all developed countries, it was reported that the highest ranking modifiable risk factors for developed countries are maternal overweight/obesity and smoking.
Major risk factors for developed countries were cited as follows:
- Mothers who are obese prior to getting pregnant (BMI ≥ 30)
- First pregnancy (primiparity) and pregnancy after four previous pregnancies
- Mothers over 35 years of age and mothers under 20 years of age
- Multiple pregnancies and/or babies conceived by in vitro fertilization (IVF) techniques
- Alcohol/drug abuse
- Disadvantaged communities*
- A previous baby with low birth weight, SIDS, growth restriction or a previous stillbirth
- Highly stressful lives such as homelessness or other extreme lifestyles
Medical disorders previously associated with stillbirth in developed countries include:
- Infections of the mother, baby or placenta including CMV and Group B Strep, malaria, syphilis
- Fetal growth restriction (babies who are very small or not growing normally)
- Diabetes or hypertension
- Thyroid disorders, renal disease, and systemic lupus
- Placental pathologies: including development of the placenta and maternal adaptation to pregnancy, insufficient blood flow or placental abruption (see FAQs for more information)
- Cord abnormalities including hypercoiled or undercoiled cord, excessively long or short cords, velamentous cord insertion (see FAQs for more information)
- Congenital abnormalities
- Multiple genetic abnormalities
Strategies for prevention of stillbirth in developed countries would include:
- Weight management strategies before and during pregnancy
- Smoking, alcohol and drug cessation programs
- Management of hypertensive disorders and diabetes
- Education on maternal age affecting outcome and "lifetime" pregnancy planning
- Women's health outreach to disadvantaged communities
- Detecting risk and managing it. (This could take the form of more vigilance during pregnancy by more extensive use of ultrasound and kick count)
These and other prevention strategies are of utmost importance and most will require diligent effort including further research policy change and funding and persistence. Many of these strategies will take many years to make an impact. It is important to note that the last strategy on this list is one that could be used starting TODAY. Preliminary studies show that more vigilance during pregnancy can reduce the stillbirth rate. (See Fetal Movement for more information.) Kick count is a low-cost and harmless method to track baby's health and is one that any pregnant woman can do herself. Kick charts are available for download on the internet as well as kick counter applications such as "Sprout" used on iPhones, iPads or computers.
More frequent ultrasounds during pregnancy, as are already done in Japan, are not proven to reduce stillbirth, but may be useful to ensure more vigilance but would incur some expense. Asking mothers to sleep on their left side when possible may be one other preventive method that is as simple and effective as kick count, or putting baby to bed on its back for SIDS prevention.
Mother's sleep position
A new study presented at the conference showed intriguing results. This is the first study to report maternal sleep related practices as risk factors for stillbirth. The risks were: getting up infrequently during sleep, too little or too much sleep and sleeping on the right side.
Fetal oxygen saturation studies have shown that mothers turning onto the left side will cause the best cardiac output. In this study, women who slept on their back or on their right side on the previous night before stillbirth were more likely to experience a late stillbirth compared with women who slept on their left side. These findings require confirmation studies but this is a potentially modifiable risk factor that in the future may help to reduce the risk of stillbirth.
*) In some places certain ethnic groups are at higher risk of stillbirth. For example in the U.S., African-American, Hispanic, American Indian, and Alaskan Natives are at higher risk than white women. Researchers attribute some of this risk to greater risk of preterm birth in these populations. However, more research is needed to understand other contributing factors to disparities including differences in preconception health, infection, income, and access to quality health care.