Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?

Abstract

Background Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks’ GA was analyzed separately. Results Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8–1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3–0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0–23%, average 1.8%). Conclusions Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.

Risk Measurement of Perinatal and Neonatal Morbidity Characteristics and Applicability of GAIA Case Definitions: Results and Lessons Learnt of a Hospital-Based Prospective Cohort Study in the Valencia Region (2019–2020)

“…The data analysis performed in the present study yielded incidence rates of the outcomes of interest for the Valencia region ( Figure 2 ) that are in line with the previously reported rates in Spain and Europe for the LBW, PTB, SB, and ND outcomes ([ 13 , 14 , 17 , 18 , 19 ], Figure 5 ). The rates for SGA are also resembling the rates reported for Europe [ 15 ], but we could not find any literature reporting the specific rates for Spain.…”

“…Only one stillbirth and three neonatal deaths were recorded in the Valencian study for the defined study period (all at Castellon GUH), being the overall incidence rates 0.4 and 1.2 per 1000 live births, respectively ( Table 3 , Figure 2 ). The previously reported SB rate for Spain was 2.2 in 2019 [ 17 ] and 2.4 per 1000 live births in 2015 [ 18 ]. Similarly, the SB incidence rate in Europe, North America, Australia, and New Zealand overall (in 2019) was 3.1 per 1000 live births in 2019 [ 17 ], and for Europe only (in 2015) was 2.9 per 1000 live births [ 18 ].…”

“…The previously reported SB rate for Spain was 2.2 in 2019 [ 17 ] and 2.4 per 1000 live births in 2015 [ 18 ]. Similarly, the SB incidence rate in Europe, North America, Australia, and New Zealand overall (in 2019) was 3.1 per 1000 live births in 2019 [ 17 ], and for Europe only (in 2015) was 2.9 per 1000 live births [ 18 ]. On the other hand, the ND incidence rate reported in 2019 in Spain was 2 per 1000 live births, whereas in Europe overall, 3 per 1000 live births [ 19 ].…”

Ending Preventable Stillbirths and Improving Bereavement Care: A Scorecard for High- and Upper-Middle Income Countries

“…Another well-known issue highlighted by the Scorecard is the lack of comparability of data, due to differences in de nitions of stillbirth and related perinatal outcomes between HIC as well as the lack of a single classi cation system for cause of death and contributing factors [41,42]. This reduces our ability to understand where progress is being made and to identify roadblocks.…”

Temporal Trends in Stillbirth in Greece: A Longitudinal Population-Based Study

“…Stillbirth or fetal death is defined as the loss of the fetus at gestational age beyond the limit of viability, which is generally considered to be 24 weeks of gestation in the developed world and 28 gestational weeks in less developed countries. The fetal viability limit has been significantly reduced due to advances in perinatal medicine, and there is no international agreement on gestational age, so the World Health Organization has recommended a cut-off at 28 weeks to facilitate comparisons between countries, whereas in recent years there has been a tendency for fetal losses in the first half of gestation (<20 weeks) to be considered miscarriages, whereas stillbirths are considered those occurring in the second half (≥20 weeks) with a birth weight of at least 350 gr which is the 50th percentile for weight at 20 weeks of gestation [1][2][3].…”