Stillbirth Causes and Risk Factors: New Studies Shed Light

Stillbirth can be caused by complications with the placenta or umbilical cord. Image courtesy of Gray’s Anatomy

A new article, published recently in the Journal of the American Medical Association, provides insight into the risk factors and underlying causes of stillbirth.

A stillbirth occurs when a baby over the age of 20 weeks gestation dies in utero. According to the March of Dimes, stillbirths occur in approximately one in 160 pregnancies, and usually before labor begins. The stillbirth rate in the United States is much higher than in other developed countries, according to Robert M. Silver, M.D., of the University of Utah School of Medicine. Dr. Silver, and Dr. Saade of the University of Texas Medical Branch, each conducted a study about stillbirths in the United States. Dr. Silver’s study focuses on the causes of stillbirths, and Dr. Saade’s study focuses on the risk factors associated with stillbirths. The two studies were published together in the article Association Between Stillbirths and Risk Factors Known at Pregnancy Confirmation.

Stillbirth Causes

Dr. Silver, and his colleagues with the Stillbirth Collaborative Research Network Writing Group, conducted a study to focus on the causes of stillbirth in a racially and geographically-diverse population in the United States. This study was conducted from March 2006 to September 2008, and examined all stillbirths at 20 weeks or later in 59 tertiary care and community hospitals. During this time-frame, 663 women were enrolled in the study, and 500 of these women agreed to a postmortem examination of 512 neonates.

The most common cause of stillbirth was obstetric complications, which occurred in 29.3 percent of cases. Placental abnormalities occurred in 23.6 percent of cases, fetal genetic/structural abnormalities in 13.7 percent, infection in 12.9 percent, umbilical cord abnormalities in 10.4 percent hypertensive disorders in 9.2 percent and maternal complications in 7.8 percent.

The study also concluded that non-Hispanic black women had more stillbirths associated with obstetric complications (43.5 percent vs. 23.7 percent) and infections (25.2 percent vs. 7.8 percent) compared with non-Hispanic white women and Hispanic women combined. Cord abnormalities were associated with more stillbirths in non-Hispanic white and Hispanic women compared with non-Hispanic black and other women.

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Stillbirth: Risk Factors

Smoking is a risk factor for stillbirths. Photo by: AIGA

Dr. Saade, and his colleagues at the Stillbirth Collaborative Research Network Writing Group, studied the relationship between stillbirths and risk factors at the beginning of pregnancy. This study also took place between March 2006 and September 2008 at 59 United States tertiary care and community hospitals. The study included women with deliveries of one or more stillborn fetuses and a sample of deliveries of only live-born babies. The study examined 614 cases and 1,1816 deliveries.

The researchers examined risk factors, that before the start of a pregnancy would put a woman at a greater risk for having a stillbirth.  These risk factors were found to be: having a history of prior stillbirths or miscarriages, being a non-Hispanic black woman, never having had a child, expecting multiples, having diabetes or being obese, unusual maternal age, differences in marital status, and use of cigarettes or illicit drugs. The strongest risk factor for stillbirth was prior pregnancy history, such as prior stillbirths and/or miscarriages.

Reduce Chances of Stillbirth: Recommendations

Decoded Science asked Dr. Saade for his recommendations to women who wish to reduce their chances of having a stillbirth. His response:

“Our study found that stillbirth is associated with risk factors that are present before pregnancy or very early in pregnancy. Many of these risk factors are modifiable such as obesity, smoking, drug use, and diabetes. Some recommendations include improving health status before getting pregnant, and starting prenatal care early in order to improve pregnancy outcomes. These factors may also lead the clinician to increase surveillance during pregnancy. Despite this, women should remember that most pregnancies with these risk factors will result in a live birth.”

When a stillbirth occurs, a postmortem examination, placental histology, and genetic testing are recommended to help understand the cause, and potentially prevent reocurrance. Further research is needed to completely prevent stillbirths from occurring; however researchers have identified certain risk factors that women can modify to decrease their chances of having a stillbirth.  Receiving early prenatal care, maintaining a healthy weight, and not smoking or taking illicit drugs are all ways women can decrease their chances of experiencing a stillbirth.


March of Dimes. Stillbirth. February 2010. Accessed March 16, 2013.

The Stillbirth Collaborative Research Network Writing Group. 2011. Causes of Death Among Stillbirths. JAMA: The Journal of the American Medical Association 306 (22) (December 14): 2459 -2468. doi:10.1001/jama.2011.1823. Accessed March 16, 2013.

*Originally published on Decoded Science*

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