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Stillbirth risk twice as high for disadvantaged women

Stillbirth risk twice as high for disadvantaged women - Featured Image

Women from low socio-economic families have twice the risk of delivering a stillborn baby than those from wealthier backgrounds, an Australian-led international study has found.

The Lancet’s Ending Preventable Stillbirths series reports that over 200,000 stillbirths worldwide could have been prevented in 2015.

Although Australia ranks 15th lowest in the world, it has a stillborn rate that is 2.7/1000 total births, double the rate of Iceland which comes in at the lowest rate of 1.3 stillbirths/1000.

Experts in the field believe that more can be done to help prevent stillbirth and over 200 stillbirths each year could be prevented in Australia.

Related – MJA – Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years

Philippa Middleton from the University of Adelaide said migrants, Indigenous peoples, people on low income, those with low education and early teenagers all were found to have double the risk of stillbirth.

“During pregnancy it might be about how good your access to antenatal care is, whether you have to travel to get good care and whether your mental health is all that it might be,” she said.

The causes are varied, including the fact that some disadvantaged women aren’t as empowered to make choices.

Associate Professor Vicki Flenady from the Mater Research Institute at the University of Queensland said the lack of appropriate care is a big factor.

“The lack of provision of culturally sensitive care that results in women not attending for care and complications not being picked up. We know poor antenatal care is certainly a risk factor for stillbirth.”

Related: Anti-caesarean drive “misguided”

There are other major risk factors that are also at play, including smoking, being overweight or obese and fetal growth restriction which many care providers don’t know enough about.

Professor David Ellwood, a Professor of Obstetrics & Gynaecology at Griffith University, said an increased understanding of risk factors among care providers and the community could help the stillbirth rate.

He said surveys have demonstrated there is an underestimation of risk on certain risk factors including increased maternal age, multiple births and an increased risk of pregnancies attached to IVF.

A third of the population attributable risk comes from three risk factors which are maternal age, maternal overweight or obesity and smoking.

While smoking has become less of a burden, Dr Ellwood said it’s being replaced by overweight or obesity.

“It’s important to emphasise when we’re talking about risk factors, it doesn’t mean that everybody of a certain age is at high risk, it is characterising a group that collectively is at increased risk and require some additional surveillance or some other form of antenatal care,” he said.

The researchers also highlighted the role health care providers can play in helping a family who is dealing with stillbirth.

Associate Professor Fran Boyle from the School of Public Health at the University of Queensland said one thing that GPs can do is to acknowledge the loss.

“To understand that parents will be grieving their baby, to understand that recovery is a very long term process. It’s not something that happens in just 6 to 8 weeks.”

There are also issues in caring for women in subsequent pregnancies who may be anxious, and referring families to additional support services and parent organisations if needed

“It’s about recognising the loss and hearing from parents what they need,” she said.

Sands CEO, Andre Carvalho applauded the call to action on stillbirth prevention and said more needs to be done to support healthcare professionals.

“Sands will be developing new services to support this aim, including the development of new national care guidelines and training for front line staff,” he said.

Read the executive summary of the Lancet study or the full study.

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