Twice as many babies stillborn in most deprived 10% of England, finds research into ‘intractable problem’
Nine hundred babies’ lives could be saved every year if the rate of stillbirths in the poorest areas of England was as low as is in the most affluent, research suggests.
Twice as many babies are stillborn in the most deprived 10% of the country as in the wealthiest, researchers write in the online journal BMJ Open. The more affluent the area, the less likely babies are to be stillborn, whether the cause is a congenital abnormality, the mother’s high blood pressure, sudden bleeding during pregnancy or even unknown causes. The only area in which there is no difference between rich and poor is once labour has started and the mother is under the care of midwife or consultant.
Dr Lucy Smith, of the department of health sciences at Leicester University, who is one of the authors, said the reasons for the inequality were not clear. “We need to look into this in more detail,” she said. Detailed data collection on stillbirths was halted nearly two years ago, but the government has agreed it should start again from January.
Smoking and obesity, both more common in deprived areas, are factors, but there are also issues around access to healthcare. Regular antenatal check-ups can detect some problems in pregnancy, such as pre-eclampsia (high blood pressure), and ensure a woman at risk is monitored and cared for to give her every chance of successfully giving birth. But in some deprived areas and among some ethnic groups, women are less likely to attend.
From 2000 to 2007, the period of the study, there were more than 20,000 stillbirths – defined as the death of the baby in the womb at more than 24 weeks. The rate was 44 deaths for every 10,000 births, which did not change over the eight years.
The UK had the highest stillbirth rate among 13 countries, including the US, Canada, Australia and European nations, in a separate recent study. The problem, say Smith and colleagues in their paper, “remains apparently intractable” and is now “a major public health burden that is frequently overlooked since stillbirths are generally not included in international comparisons of maternal and infant health”.
More than half the stillbirths have unexplained causes. “These are women who apparently have a normal pregnancy,” said Smith. “There is no distinction about them from what we know so far and their pregnancy sadly ends in a stillbirth. We need more data so we can predict which ones may end in a stillbirth.”
Deaths during labour have come down over the years, she said. “We know what should be happening during and after labour, but those during the pregnancy are really difficult to understand.”
There are about 11 stillbirths every day. “Some will be women who have been monitored but the vast majority of women won’t have known [there was a risk] and the shock to those women is terrible.”
• This article was amended on 26 June 2012 to clarify that it was detailed data collection on stillbirths that was halted nearly two years ago.
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