According to a study led by Rutgers, a decades-long effort to reduce the stillbirth rate in the United States has stalled, as has progress in closing a persistent gap between excessive stillbirths suffered by black women compared to women. white.
“Over the past 40 years, we have reduced some risk factors for stillbirth, such as smoking and alcohol consumption before and during pregnancy, but these gains have been countered by substantial increases in other risk factors. , such as obesity and structural racism,” Cande said. Ananth, chief of epidemiology and biostatistics in the department of obstetrics, gynecology and reproductive sciences at Rutgers Robert Wood Johnson Medical School and senior author of the study published in The Lancet Regional Health – Americas.
“Our results illustrate that past progress has now been offset by these newly identified risks,” Ananth said.
To determine the impact of cultural and environmental factors on stillbirths among black and white women in the United States, Ananth and a team of obstetricians from Rutgers looked at changes in stillbirth rates between 1980 and 2020.
Using data compiled by the Centers for Disease Control and Prevention’s National Center for Health Statistics and covering all 50 states and the District of Columbia, the researchers measured maternal age, year of death (indicating changes in antenatal and intrapartum care and other factors) and maternal birth cohorts (indicating social and environmental elements, such as socioeconomic status, education, nutrition and substance use at the time of birth of women ) have shaped stillbirth trends.
More than 157 million live births and nearly 711,000 stillbirths at 24 weeks or older over the past four decades in the United States were included in the study.
Consistent with previous studies, researchers found that total stillbirth rates in the United States declined steadily between 1980 and 2005, supported by advances in prenatal care and maternal health. For every 1,000 women who gave birth in 1980, 10 of those pregnancies ended in stillbirth. By 2005, that figure had dropped to around 5 per 1,000.
But since then, researchers have found that the improvements have leveled off and the rate today is about the same as it was more than a decade ago.
Additionally, despite efforts to reduce structural racism and increase access to health care for women of color, the disparity in stillbirth rates among black women compared to white women has remained unchanged over the past decade. 40 year period. The rate for black women was about double the rate for white women in 1980 (17.4 versus 9.2 per 1,000 births) and remained double in 2020 (10.1 versus 5.0 per 1,000 births).
Unlike most previous work, which focused primarily on risks such as age at childbirth and social and environmental conditions, Ananth’s study added a third element: the birth cohort – the year of birth of the mother herself.
Ananth said the data demonstrates a strong link between birth cohort and stillbirth risk.
The cohort is a new dimension to understand these unfavorable results. To understand the meaning of paper, you need to see it from a three-dimensional perspective. We have the age of the mother, the year of birth and the birth cohort. The three factors are time-bound and interdependent.”
Cande Ananth, chief of epidemiology and biostatistics in the department of obstetrics, gynecology, and reproductive sciences at Rutgers Robert Wood Johnson Medical School
Several factors could explain the stagnant decline in the reduction in stillbirth rates. One possible cause, the researchers wrote, is a nationwide effort in 2009 to reduce elective deliveries before 39 weeks. There may also have been a slowdown in medical advances and obstetrical interventions to predict or prevent stillbirth.
The persistent gap in stillbirth disparities is more complicated and includes structural racism and prejudice, social inequalities and a greater burden of chronic illness and disease, Ananth said.
Taken together, Ananth said that data paints a dire picture of health care that needs urgent attention at local, state and national levels.
“I firmly believe that even one death is one death too many,” he said. “Delivering a stillbirth brings so much social and emotional trauma – for the parents and for society as a whole.”
Ananth, Resume, et al. (2022) Trends in stillbirth rates among black and white women in the United States, 1980-2020: a population-based study. The Lancet Regional Health – Americas. doi.org/10.1016/j.lana.2022.100380.
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