Since 2000, stillbirth and neonatal mortality rates in the United Kingdom have shown a downward trend, says the Perinatal Mortality 2009 report, published by the Centre for Maternal and Child Enquiries (CMACE) today.
In 2009 there were 790,781 live births in the UK. There were 4,125 stillbirths, 6,070 perinatal deaths and 2,511 neonatal deaths.
The stillbirth rate decreased from 5.4 per 1,000 total births in 2000, to 5.2 per 1,000 total births in 2009. The perinatal mortality rate showed a downward trend from 8.3 per 1,000 total births in 2000 to 7.6 per 1,000 total births in 2009 and the neonatal mortality rate decreased from 3.9 per 1,000 live births in 2000, to 3.2 per 1,000 live births in 2009.
In 2009, 10% of mothers who had a stillbirth or whose babies died in the neonatal period had a BMI of 35 or more. This is twice the UK prevalence rate (5%) of all deliveries to women with a BMI of 35 or more at any point in pregnancy, published in the CMACE Obesity in Pregnancy report.
The report also includes trends in mortality rates in the UK, and mortality rate comparisons between nations, Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs), Neonatal Networks, and maternity service providers.
The South East Coast had the lowest stillbirth rate of 3.8 per 1,000 total births and Yorkshire and the Humber had the highest stillbirth rate of 5.3 per 1,000 total births.
In addition, the report found links between stillbirths and neonatal deaths and age. Mothers who had stillbirths and neonatal deaths were more likely to be younger (less than 25 years old) and older (40+ years old).
The youngest (less than 20 years old) mothers were 1.4 times more likely to have a stillbirth and 1.2 times more likely to have a neonatal death than mothers of 25-29. The older (40+ years old) mothers were 1.7 and 1.3 times more likely to have a stillbirth or neonatal death respectively compared to mothers of 25-29.
Twenty eight percent of stillbirths in 2009 were unexplained. The biggest causes/associated factors for stillbirths were major congenital anomaly (9%), antepartum or intrapartum haemorrhage (11%) and specific placental conditions (12%).
Ethnicity was also a significant factor. Mothers from ethnic minority groups are more likely to have stillbirths and neonatal deaths. Mothers of black ethnic origin were 2.1 times more likely to have a stillbirth and 2.4 times more likely to have a neonatal death than mothers of White ethnic origin. Similarly, mothers of Asian ethnic origin were 1.6 times more likely to have a stillbirth or a neonatal death than mothers of White ethnic origin.
Dr Imogen Stephens, Clinical Director, CMACE said, “Perinatal deaths are difficult for women and their families to come to terms with and we do all we can to try to understand why they happen so that we can prevent them in the future. These reports help identify recurring problems which healthcare professionals and policy makers can look out for.
“The recommendations point to the need for fuller investigations into some intrapartum deaths and a more consistent system of registration (to include data such as gestational age and birth weight). Information collected will help doctors and commissioners to build a better picture of whether some of the factors were avoidable so that care can be improved.”
Dr Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists (RCOG) said, “Every stillbirth is a tragic event. This report highlights a promising downward trend of perinatal mortality over the last ten years. However, worryingly, the numbers of perinatal deaths linked to rising obesity is high.
“Maternal obesity is a key public health concern and pregnant women who are obese need to know about the possible risks to them and their baby. The ideal situation of course would be for women to maintain a healthy weight before they fall pregnant to ensure the best outcome for them and their babies. Therefore, it is vitally important for women to be encouraged to lead healthy lifestyles throughout their lives and they can get good information from their GPs on diet, nutrition and exercise.”
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The report provides key recommendations based on the results of the report. These include:
- CMACE recommends that all term intrapartum deaths with no sign of a major congenital anomaly be fully investigated locally with a view to identifying whether there were avoidable factors and to identify any areas where future care can be improved.
- CMACE recommends that guidelines be developed to ensure greater consistency in registration of the delivery of a pre-viable fetus as a neonatal death.
- CMACE recommends that further work is undertaken to determine whether the findings on twins remaining at a higher risk of stillbirth and neonatal death are due to prematurity and growth restriction or whether further twin specific neonatal factors need to be identified.
Centre for Maternal and Child Enquiries (CMACE) Perinatal Mortality 2009: United Kingdom. CMACE: London, 2011.