When reality TV star Michelle Duggar announced last week that she’d learned at 19½ weeks that her baby-to-be no longer had a heartbeat, the very personal topic of miscarriage took a turn in the media spotlight.
Up to a quarter of pregnancies end in miscarriage, the majority of them in the first trimester. But even after a woman crosses the second trimester threshold, it’s not always smooth sailing. About 1 in 160 pregnancies ends in stillbirth — the term for pregnancy loss that occurs after 20 weeks — and it happens more than most people think, according to new research about stillbirth’s causes.
In the U.S., there are 26,000 stillbirths each year, roughly comparable to the number of babies who die in their first year of life, according to a study published Tuesday in the Journal of the American Medical Association. “The later in gestation it happens, the harder it is for parents and the more they tend to blame themselves,” says Dr. Bob Silver, a maternal-fetal medicine specialist and a professor of ob/gyn at the University of Utah School of Medicine. “It’s an emotionally devastating thing for families.”
While the underpinnings of prematurity have attracted a healthy share of research dollars, Silver says stillbirth hasn’t been studied much. As a result, efforts to decrease stillbirth have been pretty minimal. Stillbirth rates dropped in the first half of the 20th century but have plateaued over the last few decades. The U.S. rate is 6.2 stillbirths per 1,000 births, 59% higher than a public-health goal set for 2010. “Our rate is much higher than a lot of other developed countries,” says Silver.
Because the U.S. hasn’t had much success preventing stillbirth or evaluating women who’ve had one, the National Institutes of Health has established a network of five clinical sites — at Emory University, Brown University, University of Texas at Galveston, University of Texas San Antonio and University of Utah — to study stillbirths.
Some of the network’s first research results emphasize that in the majority of cases, a reason can be determined: tears in the placenta, ruptured membranes and preterm labor are the most common causes. In a significant number of cases, the placenta is not developing properly, meaning the growing baby does not get enough food and oxygen.
Between March 2006 and September 2008, researchers surveyed 59 U.S. hospitals where nearly 1,000 women had suffered stillbirths. Five hundred agreed to participate in the study, which found a distinct racial disparity in stillbirth occurrence. Black women have a stillbirth rate up to three times higher than whites, even once access to medical care is accounted for. Black women tend to suffer stillbirths earlier in gestation than white women; they are also more prone to stillbirths during labor and as a result of infection.
Race aside, the researchers concluded that a thorough medical evaluation — an autopsy, evaluation of the placenta and chromosomal analysis — after a stillbirth can usually determine why it happened.
It can be hard to explain to grieving women why such evaluations are important, but researchers discovered that finding a cause can improve emotional well-being, decrease self-blame and help with closure. “A lot of people feel it’s not going to bring my baby back so they’re often reluctant to do it,” says Silver. “But almost invariably, families want to think about having another baby, and they want to know if they can do something to prevent this from happening again. It’s important to think about this even when you’re emotionally distraught.”