Abstract
BackgroundThe stillbirth rate in most high income countries reduced in the early part of the 20th century but has apparently been static over the past 2½ decades. However, there has not been any account taken of pregnancy terminations and birth defects on these trends. The current study sought to quantify these relationships using linked Western Australian administrative data for the years 1986–2010.MethodsWe analysed a retrospective, population-based cohort of Western Australia births from 1986 to 2010, with de-identified linked data from core population health datasets.ResultsThe study revealed a significant decrease in the neonatal death rate from 1986 to 2010 (6.1 to 2.1 neonatal deaths per 1000 births; p < .01), while the overall stillbirth rate remained static. The stillbirth trend was driven by deaths in the extremely preterm period (20–27 weeks; which account for about half of all recorded stillbirths and neonatal deaths), masking significant decreases in the rate of stillbirth at very preterm (28–31 weeks), moderate to late preterm (32–36 weeks), and term (37+ weeks). For singletons, birth defects made up an increasing proportion of stillbirths and decreasing proportion of neonatal deaths over the study period—a shift that appears to have been largely driven by the increase in late pregnancy terminations (20 weeks or more gestation). After accounting for pregnancy terminations, we observed a significant downward trend in stillbirth and neonatal death rates at every gestational age.ConclusionsChanges in clinical practice related to pregnancy terminations have played a substantial role in shaping stillbirth and neonatal death rates in Western Australia over the 2½ decades to 2010. The study underscores the need to disaggregate perinatal mortality data in order to support a fuller consideration of the influence of pregnancy terminations and birth defects when assessing change over time in the rates of stillbirth and neonatal death.
Highlights
The stillbirth rate in most high income countries reduced in the early part of the 20th century but has apparently been static over the past 21⁄2 decades
The purpose of the current study was to use linked Western Australian administrative data for the years 1986–2010 to investigate whether the overall stillbirth and neonatal death rates follow the trends observed in other high-income jurisdictions, to explore differences between singleton and multiple births, and to assess the influence of pregnancy terminations and birth defects on these trends
Our findings show that pregnancy terminations: (1) at least partially account for the discrepant trends in the stillbirth rate at different gestational ages; and (2) explain over a third of the variation in the neonatal death rate over time for extremely preterm singletons
Summary
The stillbirth rate in most high income countries reduced in the early part of the 20th century but has apparently been static over the past 21⁄2 decades. The available data highlight that these advancements extend to the perinatal period, the scale and pattern of mortality rate trends have differed between the prenatal and neonatal periods. Marked reductions in the stillbirth rate occurred in high-income countries during the 20th. Since the middle of last century, stillbirths and neonatal deaths have typically been reported together as perinatal deaths [9,10]. More recently it has been argued that the divergence in the causes of stillbirths and neonatal deaths means that, in high-income countries, they should be reported separately [9]. Continued overlap in some of the causes indicates that there is still some benefit in assessing stillbirths and neonatal death rates together [10]
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