The burden of stillbirth has been underestimated by at least a third because of recommendations to report only stillbirths from 28 weeks' gestation in international comparisons, according to an observational study of 2.5 million babies in 19 European countries published in The Lancet.
The findings underscore the importance of accurate and consistent reporting of fetal deaths as early as 22 weeks so that the true burden of stillbirth can be understood and the impact on families acknowledged. At an international level, the World Health Organisation (WHO) sets a threshold of 28 weeks of pregnancy for identifying stillbirths.
The lead author of the study, Dr. Lucy Smith from the University of Leicester said:
"There are major and serious gaps in our knowledge of the burden of stillbirth which will have significant unforeseen impacts on families. To a mother or father, a second trimester stillbirth is no less tragic than a stillbirth at 28 weeks of pregnancy or later. These parents also deserve recognition of their loss and accurate reporting of their child's death to improve care and policy."
Alison Macfarlane, Professor of Perinatal Health at City has been a member of Euro-Peristat since it was founded and is a co-author of The Lancet paper.
The authors used data compiled by Euro-Peristat from 19 European countries on pregnancy outcomes from 22 weeks of gestation between 2004 and 2015, to calculate overall rates of stillbirth and changes in rates between 2004 and 2015 by gestational age and country.
The authors concluded that a threshold of 24 weeks should be used for international comparisons of stillbirths and that reporting at 22 and 23 weeks should be improved in the countries where it is incomplete.
To do these analyses, Dr. Smith was able to draw on data which the Euro-Peristat collaboration has been compiling since the beginning of the century. Her analysis is being published ahead of a new Euro-Peristat report on data for 2015 which is due to be published towards the end of November.
City's Professor Alison Macfarlane is UK representative on the Euro-Peristat Scientific Committee and a member of its Executive Board. She commented:
"This important article shows the value of the work done by the many members of the Euro-Peristat international collaboration over the years. It has provided the resource needed for this new analysis drawing on data compiled for a series of reports."
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Lucy K Smith et al. Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries, The Lancet (2018). DOI: 10.1016/S0140-6736(18)31651-9