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Gestational Age-Specific Stillbirth Rates: Are We Using the Right Denominator?
Jessica Sexton1, Aleena M Wojcieszek1, Georgina M Chambers2
1NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland, Brisbane, Queensland, Australia.
Paediatric and Perinatal Epidemiology
|December 5, 2024
Summary
Globally, nearly 2 million babies are stillborn annually. This study shows that foetus-at-risk (FAR) or continuity corrected foetus-at-risk (ccFAR) rates, not the standard stillbirth rate, accurately reflect stillbirth risk throughout pregnancy.
Area of Science:
- Perinatal epidemiology
- Reproductive health
- Biostatistics
Background:
- Stillbirth remains a significant global concern, with nearly 2 million cases annually.
- The standard stillbirth rate, while useful, obscures critical gestational age-specific trends.
- Understanding precise risk at different gestational ages is crucial for intervention.
Purpose of the Study:
- To analyze and critique stillbirth trends in Australia from 1998-2018.
- To calculate and compare gestational age-specific stillbirth rates using three distinct methodologies.
- To evaluate the accuracy of gestational age-specific stillbirth rate (GS-SBR), foetus-at-risk (FAR), and continuity corrected foetus-at-risk (ccFAR) calculations.
Main Methods:
- Cross-sectional analysis of Australian National Perinatal Data Collection (1998-2018).
- Stillbirth defined as birth from 20 weeks gestation or 400g.
- Applied GS-SBR (births denominator), FAR (fetuses at start of week denominator), and ccFAR (fetuses at midpoint of week denominator).
Main Results:
- 39,576 stillbirths occurred among 5.9 million births (6.7 per 1000).
- GS-SBR varied widely (1.0-790.0/1000 births).
- FAR and ccFAR demonstrated increasing stillbirth risk with advancing gestation, unlike GS-SBR.
Conclusions:
- Foetus-at-risk (FAR) and continuity corrected foetus-at-risk (ccFAR) methods provide a more accurate probability of stillbirth throughout pregnancy.
- These advanced methods better inform clinicians about evolving risks.
- Accurate gestational age-specific risk assessment is vital for timely clinical action.
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