US stillbirths and newborn deaths down 11.5%, study says
CNN/Stylemagazine.com Newswire | 5/14/2018, 11:40 a.m.
These changes are probably due in part to a 2013 recommendation from the American College of Obstetrics and Gynecologists that obstetricians postpone elective deliveries until 39 weeks in order to avoid some of the complications of preterm delivery such as breathing problems, heart problems and gastrointestinal problems, according to the Mayo Clinic.
"It became clear that early elective delivery prior to 39 weeks was associated with higher neonatal morbidity and mortality. As such, quality initiatives around early elective delivery were discouraged and hospitals adapted guidelines that discouraged elective delivery prior to 39 weeks," Brown said.
Preterm births account for approximately 70% of all newborn deaths and 36% of all infant deaths, according to the American College of Obstetricians and Gynecologists.
Risk factors for preterm delivery include a mother's history of preterm birth; problems of the uterus, cervix or placenta; smoking or use of illicit drugs during pregnancy; chronic conditions such as high blood pressure and diabetes; some infections; stressful life events; and physical injury or trauma, according to the Mayo Clinic.
"Other risk factors include older age and obesity," Brown added. "Clearly, the increase in obesity rates in pregnant women poses a greater risk for stillbirth."
For women at high risk of preterm delivery, a number of practices can help postpone delivery until 39 weeks, such as the use of a cervical cerclage or progesterone therapy, Ananth said.
For those women who may need to deliver earlier than 39 weeks for their own health and safety, there are also a number of ways to promote the maturity of the fetus during pregnancy. These include taking steroids such as betamethasone between 34 and 37 weeks of gestation to accelerate lung development, according to the American College of Obstetricians and Gynecologists.
Some racial and ethnic groups are at higher risk for stillbirths and newborn deaths. African American women, for instance, have a 2.2-fold increased risk of stillbirth compared with Caucasian women, according to a 2009 study.
"African American women are known to have a higher risk for stillbirth at or near term, especially if comorbidities such as obesity, diabetes and hypertension are present," Brown said.
But the new study did not look at differences in stillbirths or neonatal mortality between different racial or ethnic groups -- one of the study's main limitations, according to Ananth.
"We did not look at race-specific trends in this paper, although we did recognize race and ethnicity as a potential confounder," Ananth said. "That would be a topic worthy of investigation in the next set of studies."
But the results still suggest that -- assuming that the mother and fetus are in good health -- pregnancies should not be delivered earlier than 39 completed weeks, and doing so would lead to a decrease in overall perinatal mortality rates, according to Ananth.
"Preterm delivery rates have declined between 2005 and 2014 in the US and in several European countries," Ananth said. "So reducing the burden of early deliveries, and in turn improving perinatal survival, will be of tremendous benefit to society."