Stillbirths in the U.S. More Common Than Reported: New Study Reveals Stark Disparities

A study published on Monday revealed that stillbirths in the United States are more common than previously reported, occurring in about one out of every 150 pregnancies, with higher rates in low-income areas.

According to the U.S. Centers for Disease Control and Prevention (CDC), the national rate of stillbirths is reported as 1 in every 175 pregnancies.

However, researchers told Reuters that the CDC’s primary data source — fetal death certificates collected by individual states — is less reliable than the commercial insurance claims data used in the new study.

“Both data sources — ours and the CDC’s — have potential flaws,” said Jessica Cohen, co-author of the study from Harvard T.H. Chan School of Public Health. “But regardless of data source, the stillbirth rate is alarmingly high.”

Cohen added, “The United States has the highest stillbirth rates among all high-income countries, and there has been little improvement in recent years.”

Published in the Journal of the American Medical Association (JAMA), the study excluded pregnancies covered by Medicaid, the government health insurance program for low-income Americans.

Cohen noted that “pregnancy outcomes among Medicaid-covered patients are worse, so we expect the actual stillbirth rate to be even higher in that population.”

Risk Factors:

Analyzing more than 2.7 million pregnancies across the U.S. between 2016 and 2022, researchers identified 18,893 stillbirths, defined as fetal death at or after 20 weeks of pregnancy.

More than 70% of these pregnancies involved at least one maternal risk factor, suggesting that many stillbirths might have been preventable.

The highest rates occurred among pregnancies involving low amniotic fluid levels, fetal abnormalities, and chronic high blood pressure. Other risk factors included maternal diabetes, obesity, and substance abuse.

Medical guidelines call for intensive pregnancy monitoring when such risks are present — including more frequent ultrasounds and fetal heart rate tests, said Dr. Mark Clapp of Massachusetts General Hospital in Boston, a co-leader of the study.

Social and Demographic Characteristics:

There was no significant link between living in rural or urban areas and stillbirth risk.

However, the stillbirth rate rose to 1 in every 112 births in low-income regions, and to 1 in every 95 births in areas with higher proportions of Black households compared to white households.

Dr. Clapp noted that social and demographic factors in local communities are not included in current clinical guidelines for pregnancy monitoring.

He emphasized that the reasons behind this socioeconomic and racial disparity — whether social, healthcare-related, or clinical — must be investigated further.

Researchers also found that a large number of stillbirths occurred with no known risk factors, especially late in pregnancy.

“Many stillbirths are preventable,” Cohen concluded. “We can reduce the stillbirth rate in the U.S., but not without attention, research, and resources.”