Still a problem: Although infant deaths are down in the U.S., stillbirths have stayed fairly steady. New research looks for causes--and possible remedies
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Infant mortality has continued to drop in the U.S. during the past several decades. But stillbirths—when a fetus dies after 20 or more weeks of gestation—have remained relatively steady—and account for almost as many deaths as those of babies who die before their first birthday. About one in every 160 pregnancies in the U.S. ends in a stillbirth, which adds up to about 26,000 each year nationwide.
Two new studies, published online Tuesday in JAMA, The Journal of the American Medical Association, have analyzed data from large populations of still and healthy births in an effort to search for new causes—and to start to bring the mortality rate down.
Due to their emotional difficulty, stillbirths often go unexamined. Even for the health care provider, "it's really a very emotional event," says Jay Iams, a professor of maternal and fetal medicine at The Ohio State University Medical Center and author of an essay published in the same issue of JAMA. Previous studies of stillbirths had limited subject groups and generated smaller datasets. With the larger, population-based studies, the findings "should approximate better what we really expect to see in the U.S. population," remarks George Saade, chief of obstetrics and family medicine at the University of Texas Medical Branch at Galveston and co-author of one of the new studies.
What Saade's group and the authors of the second study found, Iams says, is "very powerful evidence" that the assumed risks behind—and the entire definition of—stillbirth should be reexamined.
Early risks
Compared with other developed countries, the U.S. has a relatively high rate of stillbirths. The new study by Robert Silver, a professor of obstetrics and gynecology at the University of Utah School of Medicine, and his colleagues helps to profile the most prevalent known causes of stillbirth. The researchers found that diabetes, smoking, drug addiction, being overweight, and being 40 or older all increased a woman’s chances of having a stillbirth.
Unmarried women who do not live with their partners were also more likely than married, cohabitating women to have a stillbirth, although that might be an indicator of larger socioeconomic factors, Saade notes.
The good news is that "many of these factors are modifiable," Saade remarks. So "women planning to get pregnant or women who might get pregnant should plan to be in the best possible condition before getting pregnant—and seek care early so that any of these factors [can] be identified," he says.
Troubling patterns
Not all risk factors can be modified, of course. And the stillbirth rate for black women is more than twice as high as it is for white women. This finding is not new, but with the new data, researchers have been able to dispel some of the previous assumptions about its causes. "The usual answer is it's access to health care, poverty and social risk," Iams says. But the data show that even after black women are in the hospital and are affluent and highly educated, they are still more likely to have a stillbirth. Why? Women of African descent living in the U.S. are nearly twice as likely as white women to give birth early, which increases the risk of complications and fetal death.
Previous research has shown that women who immigrate to the U.S. give birth at full gestation about as frequently as their white peers, but after two generations, their risk has increased. "Being raised in America is somehow associated with these adverse outcomes," Iams says. Whatever the causes, the disparity is "embarrassing," he concludes. But it is also "an opportunity because it explains some proportion of the premature births or stillbirths. It's a clue to figuring out what's happening."
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9 Comments
Add CommentMy mother had abortion when i was a kid.Reason was she had a troubling uterus.It could not hold.
Reply | Report Abuse | Link to thisWondering if abortion rates play a role here? For example, disproportionate abortion rates among african-americans highlight the fact that pregnancy following abortion is more likely to result in miscarriage or early-term delivery. Maybe this is just another symptom?
Reply | Report Abuse | Link to thisOr a symptom of a symptom: Early-term babies are more likely to have cerebral palsy, for example, which is also disproportionately high among african-americans.
The information about immigrants is interesting and could be pointing to diet as a possible influence. The main US diet is heavily weighted with macro nutrients like carbohydrates and proteins, with a lesser presence of micronutrients, driven by the processed food industry. These results for new immigrants could be because they ate a diet that was more balanced in the ratio of macro to micro nutrients, with higher consumption of more micronutrient rich foods like raw green vegetables and fruits, before arrival in the USA, indicating that researchers should look closely at diet overall as a possible major influence.
Reply | Report Abuse | Link to thisA second indicator that should be researched is the heavy mandatory vaccine load of the US versus other developed countries. The US requires its citizens to take many more vaccines than countries like Sweden which has a much the lower infant mortality rate than the USA. Since these differentials appear related in a directly proportional ratio (higher vaccine load, higher infant mortality rate)it could again indicate another area for research into causes.
Yes and according to the CDC's own data set one of those avoidable causes would be the bizarre new idea of telling pregnant women they should get vaccinated, see
Reply | Report Abuse | Link to thishttp://healthjournalclub.com/don%E2%80%99t-vaccinated-pregnant/
Good point, assaulting a fetal immune system with mercury, aluminum and other toxins has to be part of the problem.
Reply | Report Abuse | Link to thisOther disturbing trends - foreign women move to the US and their rate of miscarriage INCREASES?! So it's obviously an environmental issue, but could be anything from diet to stress to toxins to pathogens to allergens to medical care.
Abortion is unlikely to be a factor because many abortions are due to the fetus being non-viable, due to disease, defect, chemical or drug exposures. Those damaged fetuses are most likely to miscarry anyway, so they would INCREASE the stillbirth/miscarry rate.
Anyone who thinks racism is dead in the U.S. should explain the doubled stillbirth rate, shorter lifespan, lower pay and higher prison numbers of African-Americans. We could use the laughs.
It could be the fact the immigrants are NOW , since they have doctors , advised by their doctor to supplement iron during their pregnancy. It has been shown women restrict iron absorption during pregancy, in theory to protect the developing embryo from excess iron. This 'anemia' is recognised as an 'iron deficiency' and the doctor prescribes iron which injures the pregnancy.
Reply | Report Abuse | Link to this"First trimester curtailment of iron absorption: Innate suppression of a teratogen?"
"There might be an association of first trimester iron supplementation with miscarriage/fetal abnormalities"
As black women the problem why stillbirth is so high for us is lack of information + care given by the doctors.
Reply | Report Abuse | Link to thisWhite women get 2012 knowledge.. we get 1950's data on pregancy. My experience at the OBGYN was unbelieveable. They speak to you like your freaking five years old!
KNOWLEDGE THAT GIVES YOU A FIGHTING CHANCE AT REDUCING STILLBIRTH IS RARELY SPOKEN. The word stillbirth is never utter, the only risk factor they pound into you is AIDS,sickle cell, sickle cell amenia.. do you have sickle cell? wtf!
Caregiver - "You should eat more steak."
Me - tell me my iron is low. Give me ALL the options available, then allow me to make a choice with you.
Me - should I use only glass containers now? - Im worried about BPA.
Caregiver - ....now lets me measure your stomach.
Looking back.. me, mother nature, and google would have done a better job. $200 per visit. 30 mins wait, 4 mins care that is healthcare in America.
...I guess Mercedes dont grow on trees.
JP Prichard
Reply | Report Abuse | Link to thiswhere are you getting your abortion stats from? According to all scientific statistics: white people dont have sex PERIOD
that abortion rate/cerebral palsy stats on black women is B S.
I think the increase is due to the GMO's used to produce so much of our foods. Genetically Modified foods will be our downfall in the US.
Reply | Report Abuse | Link to thishttp://geneticroulettemovie.com/