Despite advances in prenatal care, stillbirths in the United States remain far more common than previously reported, with a significant number of them striking without warning.
A sweeping analysis of nearly 2.8 million pregnancies finds that nearly 19,000 stillbirths occurred between 2016 and 2022, a rate higher than recorded in federal data.
The study published Monday shows that nearly 30 percent of stillbirths occur in pregnancies that did not appear linked to any previously identified health or clinical risks. The study also found that stillbirth continues to fall unevenly along racial and socioeconomic lines, with Black families and poorer communities being hit hardest.
Mark Clapp, an obstetrician and maternal-fetal medicine specialist at Massachusetts General Hospital and one of the study authors, said better screening and monitoring are urgently needed.
“Even when we know someone is at increased risk, our tools for prevention are still limited,” Clapp said. “Every stillbirth represents an unimaginable loss, not just for the mother but for the entire family, and is a reminder of how far we still have to go.”
Researchers from the Harvard T.H. Chan School of Public Health and Mass General Brigham said the study published Monday is “one of the largest, most data-rich studies of stillbirth burden to date.”
They found that between 2016 and 2022 stillbirths occurred in:
– 1 in every 147 births, a higher rate than the roughly one in every 175 births reported by the Centers for Disease Control and Prevention.
– 1 in every 112 births for-low income families.
– 1 in every 95 births in areas with higher proportions of Black families compared with White families.
Jessica Cohen, co-senior author and professor of health economics at the Harvard T.H. Chan School of Public Health, said the discrepancy in rates between the study and CDC data could be due to known inaccuracies in the recording of fetal death certificates, which don’t always accurately capture every stillbirth and varies in quality and definition across states.
The Harvard research reviewed pregnancy outcomes based on commercial health insurance claims, demographic data from the nonprofit Health Care Cost Institute, which tracks tens of millions of privately insured patients. It also relied on information from the U.S. Census Bureau’s American Community Survey and the March of Dimes, a nonprofit focused on maternal health and preventing infant deaths.
Stillbirths are defined as the death of a fetus after 20 weeks of pregnancy. Though federal data shows stillbirths have continued to trend downward over the past 30 years thanks to improvements in medical care, the overall rate of decline has slowed.
Stillbirth risks
More than 70 percent of stillbirths involved at least one clinical risk factor – such as obesity, substance use or diabetes – yet many occurred without warning or known complications, according to the study. Rates were especially high in pregnancies complicated by chronic hypertension, fetal anomalies or low amniotic fluid, and they climbed sharply after 41 weeks of gestation.
“It’s astonishing that in our day and age, so many stillbirths happen with no identified risk factors,” Cohen said. “We have watches that track our sleep and stress, but we can’t always tell when a pregnancy is in trouble.”
The study also found that structural inequities, including where a person lives and the resources available in their community is still a strong predictor of risk. Stillbirth rates were higher in areas with more low-income households and larger Black populations, even among those with private insurance.
The authors suggests that social disadvantage continues to determine pregnancy that stem beyond simple access to care. They add that even in cities with top hospitals, some women are still afraid to advocate for themselves or question medical decisions.
Harvey Kliman, director of the Reproductive and Placental Research Unit at Yale University who was not involved in the study, said systemic racism is one of the main culprits for the disparity.
“There is no biological reason for there to be almost triple the rate of stillbirths in American Blacks compared to Whites,” Kliman said. “And that has been shown over and over again, and that disparity has not really improved.”
‘I saw my baby’s heartbeat stop’
Jaye Wilson, a 41-year-old nurse from Prince George’s County, Maryland, was 22 weeks pregnant in 2007 when her pregnancy ended after a placental abruption.
On her commute home from her job at a pediatric community health center in New York City, she began bleeding on the train.
At the hospital, Wilson’s blood pressure was dangerously high, but she said staff questioned her. When she begged them to call her husband, a member of the medical team asked if he was her “husband or baby daddy.”
Soon after, doctors confirmed she was losing her baby.
“On the ultrasound, I saw my baby’s heartbeat stop,” she said. Wilson, who named her daughter Nyiiema Renay, said the loss was compounded by the degradation and disbelief she faced at every step.
She said her pregnancy loss underscored how deeply bias shapes Black women’s experiences in health care, and she started the organization Melinated Moms in 2017 to provide resources to women in all stages of motherhood.
In 2023, nearly 2 million stillborn pregnancies occurred worldwide, or about one in every 70 births, according to UNICEF, which defined stillbirth as babies born with no sign of life at 28 weeks of pregnancy or later. Compared with peer nations, the United States has one of the highest stillbirth rates.
For many families, those losses come suddenly and without explanation.
In October 2013, just two days before her due date, Samantha Banerjee, 40, from Katonah, New York, lost her daughter, Alana. Banerjee said that her baby’s movements had felt different in the days leading up to the tragedy, and instead of feeling the usual kicks, she noticed “a strange vibrating sensation.”
“I’ll never forget the look on my cat Gio’s face as I was walking out the door to the emergency room,” said Banerjee, who later founded PUSH for Empowered Pregnancy. “He had been with me throughout my entire pregnancy, and in that moment, I just knew something was wrong.”
This story was originally posted by Sabrina Malhi of The Washington Post. Sabrina Malhi is a national health-care reporter covering infant, maternal and public health. She was the author of the Coronavirus Updates newsletter and previously served as president of the South Asian Journalists Association.