Seeking Stillbirth Solutions - The Auckland Stillbirth Study

Tomasina Stacey

PhD Student and AUT lecturer in midwifery

Obsetrics and Gynaecology/Paediatrics

University of Auckland

Background to Research

The death of a baby before birth is the loss of a lifetime opportunity for the unborn child and a tragedy for the family.  The number of stillbirths occurring in New Zealand is a growing cause of concern with over 400 a year, which is four times higher than the number of babies dying from SIDS.

Figures show that almost one in 100 births result in a stillbirth and one in 300 in a late stillbirth which occurs after 28 weeks of pregnancy.  There was a decline in the 1980s and 1990s in stillbirth numbers but current data suggests the rate is increasing again.  There is also evidence that the proportion of stillbirths which are unexplained is increasing.

What are your research objectives?

Ultimately we hope to reduce the number of stillbirths that occur in New Zealand by identifying and quantifying likely risks which cause late stillbirth.  We aim to isolate risks that can be modified to prevent late stillbirth and as part of this our study will examine the prevalence of risk factors in the major ethnic groups (Maori, Pacific Island and European).  There are a number of known risks associated with late stillbirth.  In particular babies of older mothers are at higher risk of perinatal death.  Obesity, smoking, diabetes and low socioeconomic status are also risk factors.

How will you conduct your research?

The study is a prospective case control study of late stillbirths at or after 28 weeks gestation.  It is being carried out over three years (from July 1 2006) in the three Auckland District Health Boards: Waitemata , Auckland and Counties Manukau. The study includes all women who are resident in Auckland and have a late stillbirth.  This does not include women with multiple pregnancies or stillbirths where the baby has a congenital abnormality.

Based on data from the last three years it is estimated there will be 150-200 late stillbirths included in the study.  Data are collected from clinical records and face to face interviews focusing on maternal medical and obstetric history and the health of the mother and the baby through the current pregnancy.

Issues considered will include:

Socio-economic factors: maternal and paternal job status

General health and access to alternative and complementary therapies.

Maternal dietary intake.

Sleep habits

Exercise, work habits and daily activities

Support

Stress and depression

Domestic violence

Random controls, which are matched to the cases by gestation are selected from the booking lists of the respective District Health Boards and invited to be part of the study.

Are there others in your field in NZ or globally conducting similar research?

There have been no prospective studies into risk factors for stillbirth conducted in New Zealand.  A retrospective study that explored the risk factors for late stillbirth in New Zealand indicates that there is an increased risk for Pacific Island, Maori and Indian women, women living in low socioeconomic areas and for women over the age of 35.  This retrospective study shed some light on the risk factors for late foetal death, but because of limited data was not able to investigate a wide number of variables.

The significance of stillbirth, and the need to gain a greater understanding of its causes, has recently been recognised internationally.  There are, therefore, a number of international studies that are being carried out into risk factors for unexplained stillbirth.  These include the Stillbirth Collaborative Research Network (SCRN) in the USA and in Australia a population based epidemiological study is being carried out.

What is innovative about the approach you are taking?

The Auckland Stillbirth Study is unique because the focus is on environmental and maternal lifestyle factors.  The nature of face to face interviews allows for greater depth in questioning women who have recently suffered a stillbirth.  By contrast the emphasis in other international studies is on medical and obstetric complications leading to stillbirth, and on standard epidemiological variables such as maternal age and education. 

If you achieve your objectives what will that mean to those suffering from the disease or to the knowledge advancement of this disease?

Once a greater understanding of the causes of late stillbirth has been developed, preventative strategies can be put in place to reduce the number of stillbirths that occur in New Zealand and reduce the tragedy for around  1000 parents a year.  Many of these deaths may be preventable and we hope to provide some positive answers through our study.

Is there national or international collaboration on your research project?

Our study is sharing research tools with the US Stillbirth Collaborative Research Network and we are in close communication, with visits to New Zealand planned by SCRN representatives to discuss the progress of our respective studies.