Wednesday, April 13, 2011

Obesity, smoking lift stillbirth risk

STILL HURTING: Laura Hurley with son Mitchell and a mould of the feet of her stillborn daughter Tabitha-Rose. Ms Hurley said having another baby did not mean the hurt of losing her daughter had gone away.

Stillbirth rates in New Zealand will not drop unless more is done to tackle obesity and other avoidable pregnancy risk factors, new research says.

A comprehensive series of articles published in prestigious medical journal The Lancet has gathered data and research from throughout the world to paint a global picture of stillbirth.

The authors estimate 2.65 million babies are stillborn every year. They have called for action to halve that number by 2020.

The vast majority of stillbirths happen in developing countries, but rates in many high-income countries have nearly stalled in the past decade, the research says.

In 2007 and 2008, New Zealand's stillbirth rate was second-highest among developed countries, surpassed only by Britain.

There were 210 babies stillborn at 28 weeks or later in 2008, or 3.5 stillbirths per 1000 babies born - a rate that has remained mostly steady since 1996.

The risks increases for Maori and Pacific women and those in the lowest socio-economic groups.

David Ellwood, a professor of obstetrics and gynaecology at Canberra Hospital, said the rate of reduction in developed countries "has been nothing like what we'd like to see".

A third of stillbirths in high-income countries were probably avoidable, he said.

Obesity and smoking during pregnancy were two leading avoidable risks, The Lancet said.

Worldwide, being obese or overweight contributes to about 12 per cent of stillbirths.

"Implementation of preconception care for all women could reduce these risk factors. Smoking cessation programmes in pregnancy are effective and should be implemented as part of routine care," the authors said.

Women aged 35 or over were also more likely to have a stillborn baby.

Lesley McCowan, an associate professor of obstetrics and gynaecology at Auckland University, said increasing obesity rates and more women choosing to have babies later in life could be behind the stalled New Zealand rate.

"My colleagues and I speculate that's one of the reasons why Western countries are not seeing significant reductions in stillbirth risk. In New Zealand, [pregnant] women are older and we're all getting heavier."

Those factors could be counteracting improvements in other areas, she said. It was possible the stillbirth rate could even grow in tandem with New Zealand's increasing obesity rates.

However, McCowan took issue with The Lancet's ranking of New Zealand as second-worst among high-income countries.

"Those rates fluctuate from year to year."

New Zealand usually ranked somewhere in the middle. "I think New Zealanders should be really reassured that our rates ... are actually pretty good."


When Laura Hurley was told her baby daughter had died, the bottom dropped out of her world.

Just two weeks before her due date, the Trentham mother realised she had not felt any of the usual kicks and movements in her belly that day.

"As the day wore on I got more and more worried. We called the midwife, who did a heartbeat check, and were told our baby had passed away."

Hurley, 31, and her husband, Bryon Berry, found themselves planning for the arrival of a baby who would never grow up.

A few days later, on October 24, 2009, Ms Hurley was induced and gave birth to Tabitha-Rose.

They took her home for a week before the funeral.

Hurley felt lost. "All these thoughts - like, does that mean I'm not a mum?"

Tabitha-Rose was still part of the family, which now included three-month-old Mitchell.

Having another baby did not mean the hurt of losing her daughter had gone away.

"It just reminds us of what we missed out on."


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