By Dr Ananya Mandal, MD
According to experts, excessive weight, smoking and late maternal age over 35 are contributing to thousands of stillbirths each year in high-income countries, including Australia, and the trend looks set to continue. These figures were published in the Lancet medical journal.
The report said that nearly 12 per cent or 8,000 stillbirths in high-income countries each year can be attributed to a mother's body mass index being more than 25 before conception. Mother’s age over 35 is also a major factor, causing about 11 per cent or 4,000 cases each year. Smoking was responsible for about six per cent or 3,000 stillbirths each year in high-income countries, the report said, with evidence mounting that passive smoking is also a risk factor for mothers. Among other risk factors are first-time birth and a previous caesarean, and many cases are caused by infections, umbilical cord abnormalities and accidents, medical disorders such as pre-eclampsia, high blood pressure and diabetes, and birth defects. The report reveals that suboptimal care was associated with up to 60 per cent of cases. This includes delayed recognition of problems and interventions that might have helped.
“It's a scandal there are so many stillbirths that can be prevented,” said Joy Lawn, director of global evidence and policy at Save the Children in South Africa, who led the Lancet series. She said the politics of public health has meant the stillbirths problem has been sidelined by maternal and child health programs, even though there are more stillbirths than children killed by AIDS and malaria combined. In developing countries, most stillbirths are caused by delivery complications, maternal infections in pregnancy, fetal growth problems and congenital abnormalities. In developed countries, the reasons are often unclear why stillbirths occur, and surveillance and autopsy data are patchy.
In the report on the high-income countries by Associate Professor Vicki Flenady from Brisbane's Mater Medical Research Institute among others, it appears that low socioeconomic status and ethnic origin also increased a woman's chance of stillbirth with indigenous Australians experiencing twice the risk of non-indigenous Australian women.
All in all about one-third of stillbirths are currently still unexplained, the report said. It urges more thorough investigations into individual cases to build an understanding of causes for preventive efforts. It says that since about 58 per cent of women of childbearing age are now overweight a combination of risk factors could lead to an increased rate of stillbirth in coming years despite 40 years of gradual decline across wealthy countries. “'The increasing prevalence of women with a combination of important risk factors such as primiparity (first-time pregnancy), maternal age of more than 35 years, and high BMI (body mass index) could potentially lead to an increase in stillbirth rates,” the authors write.
Professor of obstetrics and gynecology at Canberra Hospital David Ellwood said there were about 2.9 stillbirths for every 1000 births in Australia born after 28 weeks, amounting to about 2000 each year or seven every day. He added that Australia's stillbirth rate was ranked 15th in the world. Finland had the lowest rate of 2 per 1000 births. Of all high-income countries, Britain had the highest rate - 3.8 per 1000 births. Furthermore, Professor Ellwood said Australia had not reduced its rate as much as other countries in the past 15 years, meaning more work should be done to reduce women's risk factors, while also investigating causes when cases arise. “'Investigation of stillbirth needs to be as complete and as comprehensive as possible to ensure we know more about causes,”' he said.