Causes of Death Among Stillbirths

STILLBIRTH, DEFINED AS FETAL death at 20 weeks’ gestation or later, is one of the most common adverse pregnancy outcomes in the United States and affects approximately 1 in 160 pregnancies. These approximately 26 000 stillbirths per year are equivalent to the number of infant deaths. The stillbirth rate in the United States is higher than that of many other developed countries. From 1990-2003, the stillbirth rate declined slowly but steadily, by an average of 1.4% per year. In contrast, the infant mortality rate declined twice as fast by an average of 2.8% per year. Since 2003 the stillbirth rate in the United States has remained stagnant at 6.2 stillbirths per 1000 births, 59% higher than the Healthy People 2010 target goal of 4.1 fetal deaths per 1000 births. US stillbirth prevalence shows significant racial disparity. The stillbirth rate for non-Hispanic black women is 2.3-fold higher than that of nonHispanic white women (11.13 compared with 4.79 fetal deaths per 1000 live births and fetal deaths). The rate for Hispanic women is 14% higher than for non-Hispanic white women (5.44 per 1000 live births and fetal deaths). Much of the racial disparity in stillbirth remains unexplained. The Stillbirth Collaborative Research Network (SCRN) was initiated by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to address this major public health issue. A workshop of experts convened by NICHD in 2001 concluded that vital records were inadequate to address the See also pp 2469 and 2506.