Fetal, Neonatal, and Infant Mortality Surveillance in Nova Scotia: A Population-Based Cohort Study Examining Temporal...

To describe annual trends in the incidence of stillbirth and infant mortality in Nova Scotia over a 35-year period.

A population-based cohort study of deliveries between 1988 and 2022 was conducted using data from the provincial, clinically oriented Nova Scotia Atlee Perinatal Database. All pregnancies ≥20⁰ weeks gestation or ≥500 g were included. Rates of fetal death (per 1000 births) and neonatal and infant mortality (per 1000 live births) were calculated by birth year. Rates were reported for the entire cohort and stratified by birth parent age, birthweight for gestational age and sex, and number of fetuses.

A total of 334 776 deliveries were included, with 332 975 of these being live births; there were 1801 stillbirths, 1082 neonatal deaths, and 1579 infant deaths. Rates of fetal, neonatal, and infant death decreased between 1988-1992 and 2018-2022 (6.8-4.8, 4.0-2.5, and 6.3-4.0 per 1000 births, respectively). Rates increased somewhat in later 5-year epochs among those ≥35 years of age. Rates in the <10th percentile of birthweight for gestational age were highest in earlier epochs and showed a general downward trend with each epoch except the last. Marked temporal reductions in rates among multiple gestations were observed.

Increases in mortality in later epochs, and among select birth parents and infant factors, suggest that patient characteristics and clinical practice changes may play a role in these increases. The observed temporal changes are important in informing the evaluation of factors associated with stillbirth and infant mortality.