Stillbirth reduction strategy remains unproven, study finds

September 27, 2018, University of Edinburgh
Credit: CC0 Public Domain

A care package aimed at reducing the risk of babies being stillborn may offer marginal benefit, research suggests.

Findings from a major study were inconclusive, but experts stress that advice for pregnant women remains the same.

Women who notice a change in their baby's movements in the womb should seek advice from their midwife or local maternity unit immediately.

Previous research had suggested that encouraging women to pay attention to their ' movements, combined with additional checks and early delivery of babies at risk, might help cut rates of stillbirth by 30 per cent.

Researchers led by the University of Edinburgh investigated whether a similar care package could help to reduce rates of stillbirths in a large randomised controlled trial.

The study—called AFFIRM—analysed outcomes from more than 400,000 pregnancies from 33 hospitals around the UK and Ireland.

It is the largest study of fetal movement awareness to date and the first in the world to investigate fetal movement combined with an intervention designed to reduce stillbirth.

Results indicated a marginal drop in the stillbirth rate, from 44 in 10,000 births after standard care to around 41 in 10,000 births with the intervention.

Further analysis suggested the intervention might prevent five stillbirths for every 10,000 babies born. The effects were too small to prove that the care package had been beneficial, however. The team say further research will be needed.

Study lead Professor Jane Norman, Director of the Edinburgh Tommy's Centre at the University of Edinburgh, said: "The study was designed to detect an effect of 30 per cent or greater. The results suggest that if there is a beneficial effect, it is much smaller than this. It is not possible to say with certainty that the intervention has any effect on reducing rates of stillbirth.

"The research adds further evidence to suggest that being aware of baby movements may help to marginally reduce risks of stillbirth, but it is unlikely that this strategy alone will be reliable for monitoring the wellbeing of babies in the womb. Other interventions will likely be needed to reduce stillbirth rates worldwide."

In the group that received the care package, more women were induced early and there were higher rates of caesarean section deliveries, the study found.

Researchers say an economic analysis of these data will help policy makers assess whether this approach might fit into a stillbirth reduction strategy.

Professor Alexander Heazell, co-investigator on the study and Director of the Tommy's Stillbirth Research Centre at the University of Manchester, said: "There are a number of other ongoing fetal awareness studies. Results from the AFFIRM trial should be analysed in conjunction with those studies before recommendations can be made on wider implementation of this approach."

An estimated 2.6 million babies are stillborn each year around the world. In the UK, around one in 200 pregnancies end in stillbirth, around nine babies every day.

Up to a half of women whose pregnancy ends in report reduced movements of their babies in the womb in the previous week.

Jane Brewin, Chief Executive of Tommy's, said: "We know that reduced baby movements is associated with the placenta not working so well and the baby's health being compromised. The advice for mums-to-be remains the same—if your baby's movements change please consult your midwife or local maternity unit immediately."

The study, published in The Lancet, was initiated and funded by the Scottish Government's Chief Scientist Office. It was also funded by Tommy's, the baby charity, and Sands, the Stillbirth and Neonatal Death Charity.

Dr. Clea Harmer, Chief Executive at Sands (the Stillbirth And Neonatal Death charity), said: "Women's awareness of their baby's movements remains a key part of public health information during pregnancy. At least one in three of the parents Sands supports tells us that their baby's movements had slowed down or changed in the womb before they died. Getting the message out that women need to report any concerns straightaway remains vital to routine antenatal care."

Explore further: Mum's sleep matters—the effect of sleep on an unborn baby

More information: The Lancet (2018). DOI: 10.1016/S0140-6736(18)31543-5

Related Stories

Mum's sleep matters—the effect of sleep on an unborn baby

July 19, 2018
How much sleep mothers get when they are pregnant can impact on the health of their growing baby, according to a new scoping study conducted by the University of South Australia.

Sleeping position linked to the risk of stillbirth

November 20, 2017
Pregnant women who go to sleep on their back during the later stages of pregnancy face an increased likelihood of suffering a stillbirth, according to new research.

The Obstetrician & Gynaecologist review examines strategies to prevent stillbirth

July 8, 2015
A review in The Obstetrician & Gynaecologist (TOG) finds that reducing the risk of stillbirth calls for better monitoring of women during their pregnancy to help find those whose babies' lives could be saved by early delivery.

Sleeping on your back increases the risk of stillbirth

June 14, 2017
New University of Auckland research has found that women who go to sleep on their back in the last three months of pregnancy are almost four times more likely to experience a stillbirth.

Stillbirth is not just stillbirth—more information is needed

December 4, 2017
Forty two babies are stillborn in Australia every week, and 60 per cent of them are recorded as "unexplained".

Women have up to a fourfold increase in risk of stillbirth following a previous stillbirth

June 24, 2015
Women who have experienced a stillbirth have up to a fourfold increased risk of stillbirth in a second pregnancy compared to those who had an initial live birth, finds a new meta-analysis published in The BMJ this week.

Recommended for you

Why mothers in mainland China, Hong Kong and Taiwan choose cesarean delivery

October 16, 2018
Pregnant women in mainland China, Hong Kong, and Taiwan are more likely to express preference for cesarean section (CS) as their mode of delivery later in pregnancy and postpartum, as compared to early in pregnancy, according ...

Importance of cell cycle and cellular senescence in the placenta discovered

October 15, 2018
Working with researchers from Stanford University and St. Anna Children's Cancer Research, researchers from Jürgen Pollheimer's laboratory at the Medical University of Vienna's Department of Obstetrics and Gynecology have ...

C-section rates have nearly doubled since 2000: study

October 12, 2018
(HealthDay)—The number of women delivering babies via cesarean section has nearly doubled worldwide since 2000, to about 21 percent, new research shows.

Study of nearly 41,000 women who almost died giving birth shows who's most at risk

October 10, 2018
Tens of thousands of American women each year need emergency treatment to save their lives while they deliver their babies, or immediately after. A new study shows how much their risk of a life-threatening birth depends on ...

In childbirth, when to begin pushing does not affect C-section rates

October 9, 2018
More than 3 million women in the United States give birth each year. But obstetricians have differing opinions about when women should begin pushing during labor and whether the timing of pushing increases the likelihood ...

Why single embryo transfer during IVF sometimes results in twins or triplets

October 8, 2018
It has been known for some time that it is better to transfer a single embryo to a woman's womb during assisted reproduction treatment (ART) rather than several embryos in order to avoid a multiple pregnancy and the risks ...

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

Parsec
not rated yet Sep 27, 2018
All of the stillbirth babies with intractable genetic or physical formation flaws are not going to be helped by detection or treatment.

The others who die because of some kind of incompatibility with the mother, or disorder (i.e. preeclampsia) would be far better assisted by monitoring the mothers heath instead of detecting movement issues which would happen only after damage to the baby has already occured.

We need a non-invasive way to weekly check a mothers blood levels for toxins.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.