Stillbirth is rarely talked about.
Perhaps that’s why many people are shocked to hear of just how frequently it still occurs.
Every day in Australia six babies are stillborn. That is one stillborn baby for every 135 live births.
The rate is not declining and the causes are still not well understood.
It is a tragedy no one wants to contemplate – especially when they are expecting a baby. For some the thought of losing a child can become an overwhelming fear. But it is important to arm yourself with a few of the facts about stillbirth while you are pregnant. If you are aware of the risk factors then you may be able to take preventative measures.
So what exactly is stillbirth? What causes it? Who is at risk? And what preventative measures can you take to lower the risk?
What is stillbirth?
Stillbirth is when a baby dies before or during birth after a pregnancy of at least 20 weeks. In about 40 per cent of cases the cause of stillbirth is unknown. Six babies are stillborn each day in Australia and the rate has not changed in 20 years.
What causes stillbirth?
It isn’t always known why a baby dies. But there is a range of issues known to increase the risk of stillbirth or cause stillbirth. The following is a list of commonly reported risk factors and causes of stillbirth in Australia.
This is when there’s a problem with the baby’s development, starting from conception or early pregnancy. Congenital abnormalities include chromosomal problems and issues with the development of major organs such as the heart, brain, spinal cord or kidneys.
These days many of the 7 per cent of babies born prematurely do well thanks to modern developments in neonatal care. If a baby is born too early however it may be too immature and not developed enough to survive.
Placenta or cord problems
If the placenta isn’t functioning properly the baby will not be nourished and stillbirth can occur. A number of issues can lead to placenta problems including diabetes and high blood pressure. Placental abruption is when there’s bleeding between the placenta and the uterine wall. This can reduce blood supply to the fetus and is a common cause of stillbirth. Cord ‘accidents’ are commonly attributed to stillbirth also, but this diagnosis should only be made with evidence of true obstruction and the absence of other issues, as cord issues are seen in many healthy, liveborn babies also.
Fetal growth restriction
Almost half of all babies who are stillborn are smaller than expected. This means that babies who do not reach their full growth potential are at a higher risk of being stillborn. It is difficult to diagnose these at-risk babies during normal antenatal care and their small size could be secondary to other risk factors such as impaired placenta function, maternal smoking or high blood pressure.
Maternal medical conditions
There are a number of commonly reported maternal health conditions that have been associated with stillbirth. These include diabetes, renal disease, thyroid disorders, cardiac disease systemic lupus erythematosus and obstetric cholestasis.
Hypertensive disease or preeclampsia
High blood pressure is associated with stillbirth, whether it is an existing condition or associated with the pregnancy. High blood pressure is linked to poor placenta function and fetal growth restriction. Blood pressure is frequently monitored during pregnancy.
Congenitally acquired infections
Infections associated with stillbirth include parvovirus, rubella, listeria monocytogenes, toxoplasmosis and group B streptococcus. However in developing countries, such as Australia, infections associated with stillbirth are more commonly seen in premature babies.
The stillbirth rate is 4 times higher with multiples than singleton pregnancies. This is due to complications specific to multiples (eg. twin-to-twin transfusion) as well as increased risks of common complications such as advanced maternal age, congenital abnormalities and fetal growth restriction.
Smoking creates an increased risk for stillbirth mostly due to reduced placenta function, placental abruption and reduced fetal growth.
Potential risk factors for stillbirth may be:
- Advanced maternal age (considered to be more than 35 years)
- Pre-pregnancy obesity
- Smoking, drug-taking, and alcohol consumption
- Gestational diabetes
- High blood pressure (hypertension)
- Congenital anomalies
- Premature birth (babies that are too immature may be stillborn)
- Placenta or cord problems
- First pregnancy
- Fetal growth restriction
- Maternal medical conditions
- Congenitally acquired infections
- Multiple gestation
Stillbirth preventative measures
In some cases, unfortunately, we don’t always know the reasons a baby is stillborn in an otherwise healthy pregnancy. But there are ways to reduce the risk factors and avoid possible complications in pregnancy:
- Before you fall pregnant have a preconception health check – maintain a healthy lifestyle, take folate, quit smoking and work towards a healthy weight range.
- Maintain good health during pregnancy including managing your weight and avoid smoking, alcohol and drug-taking.
- Woman in the first pregnancy and older than 35 years in particular should ensure they are receiving good maternity care during pregnancy.
- Make sure you attend all your antenatal appointments, take the necessary antenatal screening tests and receive good maternity care.
- Have an ultrasound in early pregnancy
- Folate, iron, calcium and vitamin supplementation
- Fetal monitoring, including fetal movement counting
- Early detection and treatment for gestational diabetes and high blood pressure
- Consideration of induction of post-term pregnancies
- Consideration of elective caesarean for babies in breech presentation.
Hopefully with increased awareness of the risk factors and preventative measures plus increased funding for research into stillbirth, we will soon see the rate of stillbirth decline.
– written with information from the Stillbirth Foundation Australia.
Image credit: yuran-78/123RF Stock Photo