With the United States being one of the wealthiest, most technologically-advanced countries in the world — not to mentioned heralded as the "greatest country" by a good portion of its citizens — you'd think we'd be among the best pregnancy and newborn outcomes. Unfortunately, the U.S. ranks relatively low on the list when it comes to stillbirth and newborn mortality. And to me, this just doesn't made sense. Do we not care enough for our new moms and babies to fix this devastating reality? Is there something we're missing? Well it finally seems we have some good news: According to a new study, stillbirths and newborn deaths are down in the U.S., and here's why.
But first, let's back it up a bit and establish just how poorly the U.S. compares when it comes to infant mortality. A 2014 report from the Centers for Disease Control and Prevention found the U.S. ranked dead last when it came to infant mortality for all gestational ages — out of 26 developed countries. That's kind of a bid deal. Which is why this new study published Monday in the journal JAMA Pediatrics seems so promising. Using data from the National Center for Health Statistics of the CDC, the study looked at more than 99 percent of live births and still births in the U.S. between 2007 and 2015, CNN reported. What researchers found was the overall number of stillbirths and neonatal deaths dropped from 37,813 in 2007 to 33,457 in 2015 — translating to an 11.5-percent decrease.
This is undeniably great news, right? But why did it happen? For the study, women were grouped into eight different categories based on when they delivered: Extremely preterm (20-27 weeks), very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), full term (39-40 weeks), late term (41 weeks), and post-term (42-44 weeks). As the study's abstract pointed out, the likely reason for the decrease in stillbirth and newborn death during this time period is that births at all gestational ages except 39-40 weeks decreased from 2007 to 2015. The percentage of women who delivered between 39 and 40 weeks rose from 54.5 percent in 2007 to 60.2 percent in 2015. This means a greater percentage of infants were born during the ideal gestational period.
"In the past decade, there have been some obstetrical interventions, as well as physician education, resulting in a decline in births at preterm or early term gestations," said Cande Ananth, one of the study's lead authors, CNN reported. "Indeed, what we found is that the decline in perinatal mortality was largely attributable to changes in the gestational age distribution." Ananth continued:
These data are really encouraging ... But we still need to continue to work in order to reduce the overall burden of infant deaths and morbidity associated with preterm births in the US.
Something else to take into consideration is how infant mortality is counted in other countries compared to the U.S. As Science Daily reported. a 2016 Texas A&M study pointed out, the definition of "infant mortality" — the death of babies under age 1 — and the subtle differences between countries in how they're counted, has something to do with the disparity. For example: A baby born at only 21 weeks gestation and weighing less than 1 pound would be counted as a stillbirth in some countries. In the U.S., however, the baby is considered born, and therefore counting toward the nation's infant mortality rate. But this is only one small piece of the puzzle.
The top contributing factor for stillbirth/newborn death is preterm birth, according to the American College of Obstetricians and Gynecologists. Although many times this is out of parents and doctors' control, cutting back on scheduled deliveries prior to 39 weeks gestation can make a big difference, PBS reported back in 2013. Making sure that mothers are getting prenatal and even pre-conception care can potentially help prevent preterm births, as well, according to the National Institutes of Health (NIH). Likewise, newborn screenings and educating parents/caregivers about creating safe sleep environments can help combat newborn deaths.
So yes, the fact that stillbirths and newborn deaths declined 11.5 percent from 2007 to 2015 is fantastic news. But as Ananth pointed out, there's still more we can do. And I have a feeling neither she nor the rest of the medical community will until until the U.S. infant mortality rates are on equal footing with other developed countries.