Abstract
ObjectivesTo determine the feasibility of combining routinely recorded perinatal data from several databases in high-income countries to assess the risk of recurrent stillbirth.MethodsWeb-based questionnaire survey with reminder emails and searching of relevant country websites.Results120 countries/regions in Canada, Europe and the USA were invited to participate and 83 (69%) responded. Of those one had no data, and two did not wish to take part. The remaining 80 were sent the questionnaire and 63 (53%) were completed. Twenty-seven countries/regions reported that they collect information on all perinatal events (including early pregnancy loss), 34 on live births and stillbirths and two only live births (stillbirths recorded in a separate database). Most countries (53/63) can link two or more pregnancies occurring in the same woman. Data and information extracted from the Australian and New Zealand Government websites showed that information on all perinatal events is collected nationally in New Zealand and in 5/8 regions in Australia. Both Australia and New Zealand can link two or more pregnancies occurring in the same woman. Maternal age and caffeine consumption were the most and least consistently collected demographic indicators respectively. Diabetes mellitus and mental health problems, birthweight and obstetric cholestasis the most and least consistently collected for medical conditions and pregnancy condition/complications. Procedures for gaining access to data vary between countries.ConclusionThis study demonstrates that it is possible to link pregnancies in the same woman to assess the risk of recurrent stillbirth using routinely collected perinatal data in all states/territories in Australia, 7/8 responding provinces/territories in Canada, 21/27 responding countries/regions in Europe, New Zealand and 26/28 responding states in the USA. The scope of the databases and quality and extent of data collected (thus their potential use) varied, as did procedures for accessing their data.
Highlights
Variation in stillbirth rates across high-income countries (HICs) shows that further reduction in stillbirths is possible [1]
Differentiation of termination of pregnancy (TOP) from stillbirth was possible in 23/28 states in the United States of America (USA), 3/8 provinces/territories in Canada and 13/27 countries/regions in Europe
Five states/territories collect information on previous miscarriage (Australian Capital Territory, Northern Territory, South Australia, Tasmania and Victoria). In this perinatal data survey we found that of 63 responding countries/regions across Canada, Europe and the US and 8 states/territories in Australia 63/71 (89%) have been collecting perinatal data for over 10 years and 57/71 (80%) have data that are ∼99% complete
Summary
Variation in stillbirth rates across high-income countries (HICs) shows that further reduction in stillbirths is possible [1]. Gestational cut-offs distinguish a miscarriage from a stillbirth and typically reflect gestational viability, which is linked to availability of neonatal care. Continued improvement in neonatal care means that definitions of stillbirth are still evolving, but at present, gestational age cut-offs range from 16 to 28 weeks’ gestation. A systematic review and meta-analysis identified 96 studies conducted in 13 HICs that used population-based data to investigate risk factors for stillbirth. The availability of good health care in HICs means that stillbirth is a relatively rare event occurring in
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