Tuesday 6 December 2016

Drinking and smoking raise the risk of stillbirth

Published 16/05/2011 | 05:00

Smoking during pregnancy raises the risk by 40pc, although the authors suggest that this is likely to be a conservative estimate - some high-quality data suggests a doubling of the risk. Photo: Getty Images
Smoking during pregnancy raises the risk by 40pc, although the authors suggest that this is likely to be a conservative estimate - some high-quality data suggests a doubling of the risk. Photo: Getty Images

Ireland ranks 27th in a global league table for stillbirths. Although the rate is declining, it is well behind countries like Denmark and Norway.

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A new report shows the rate of stillbirth here in 2009 was 3.3 per 1,000 births, which equates to 230 deaths.

Ireland's ranking has improved since 1995 when it was positioned 36th with a rate of five per 1,000 births, according to the report in 'The Lancet'.

But it is clear from the data that some high income countries are performing much better than others.

A stillbirth is defined as the death of a baby in the weeks before birth, or during labour and birth.

Cut-off points vary, with the World Health Organisation defining a stillbirth as the death of a baby at 28 weeks of pregnancy or later. In Ireland, a stillbirth is a death at 24 weeksr, and other high-income countries use a cut-off date of 22 weeks.

Finland and Singapore have the lowest stillbirth rate at 2.0 per 1,000 total births, followed closely by Denmark and Norway.

Australia and the USA have rates of 2.9 and 3.0 respectively per 1,000 births, and the UK rate is almost double Finland's at 3.5 per 1,000 births, putting it in 33rd place.

The high-income country with the highest rate of stillbirth is France (3.9 per 1,000), with Austria second worst (3.7) and the UK and New Zealand joint third worst (3.5).

Women of childbearing age in wealthy nations who are overweight or obese are at risk of a stillbirth.

About 8,000 stillbirths across 42 high-income nations are associated with these conditions.

A woman who is over 35 years is also at increased risk of stillbirth by 65pc, compared with women under 35.

Some 4,000 stillbirths in high-income countries are linked to "advanced maternal age".

Around half of all pregnant women consume alcohol during pregnancy, which raises the risk of stillbirth by 40pc.

Being pregnant for the first time (primiparity) also contributes to 15pc of stillbirths.

The authors note the increasing prevalence of women with a combination of risk factors, such as advanced age, obesity, and giving birth for the first time.

Smoking during pregnancy raises the risk by 40pc, although the authors suggest that this is likely to be a conservative estimate -- some high-quality data suggests a doubling of the risk.

Smoking cessation programmes are effective and should be implemented as part of routine antenatal care, the authors say.

In high-income countries, around 29pc of stillbirths are associated with placental problems or other causes including umbilical cord difficulties.

Other causes include infection, congenital abnormalities, birth complications, direct fetal problems, including blood disorders and incompatibilities.

The causes of 30pc of stillbirths remain unknown, even in high income settings. Poor care could be a contributing factor in a majority of cases.

Failure by medics to use best practice guidelines during birth and inadequate appointment attendance during pregnancy are examples of this.

The authors say strategies for tackling the stillbirth problem in high-income countries include improving the health of women before, during, and after pregnancy.

Better detection and management of women at risk during pregnancy and improving access to information and standards of maternity care would also improve rates.

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