Temporal Trends of Stillbirth in Brazil Disaggregated by Maternal and Gestational Age

Maria Isabel do  Nascimento; Lara Miranda  Marchesi; Wender Emiliano  Soares; Jenaine Rosa Godinho  Emiliano; Maria Auxiliadora  Nogueira Saad; Glaucimara Gonzaga  Nunes Hacar; Gabriel Eijiro  Chiracava

doi:10.18502/jfrh.v18i4.17426

Maria Isabel do Nascimento Department of General and Specialized Surgery, Professional Master's Program in Maternal and Child Health, Faculty of Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
Lara Miranda Marchesi Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil
Wender Emiliano Soares Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil
Jenaine Rosa Godinho Emiliano Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil
Maria Auxiliadora Nogueira Saad Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil
Glaucimara Gonzaga Nunes Hacar Maternity Ward, Rede D’Or São Luiz, Oeste D’Or Hospital, Rio de Janeiro (RJ)- Brazil
Gabriel Eijiro Chiracava Faculty of Medicine, Department of Clinical Medicine, Universidade Federal Fluminense – UFF, Niterói, RJ, Brazil

DOI: https://doi.org/10.18502/jfrh.v18i4.17426

Keywords: Stillbirth; Fetal Mortality; Gestational Age; Maternal Age; Time Series Studies

Abstract

Objective: Stillbirth is a neglected problem that needs to be given a greater visibility, especially in developing countries. This study aimed to describe temporal trends of stillbirth rates disaggregated by maternal and gestational age.

Materials and methods: This is an ecological study conducted in Brazil. Stillbirth rates and temporal trends were calculated using data from 2011-2021, considering variables such as gestational age (≥ 22 weeks) and maternal age (10-19, 20-34, and ≥ 35 years old). Stillbirth rates were presented per 1,000 births, and trends were assessed via autoregressive models.

Results: There were 228,386 stillbirths in Brazil, corresponding to 1 event per 133 live births at
≥ 22 gestational weeks in singleton pregnancies. At ≥28 weeks, the average stillbirth rates were
139.46 per 1,000 births (28-31 weeks), 36.59 per 1,000 births (28-36 weeks), 6.07 per 1,000 births (28-41 weeks), and 5.94 per 1,000 births (28-42 weeks and more). Data disaggregation by maternal age showed that average stillbirth rates were 7.69 per 1,000 births (mothers aged 10-19 years),
6.90 per 1,000 births (mothers aged 20-34 years), and 10.34 per 1,000 births (mothers aged
≥ 35 years). The temporal trends showed statistically significant increase in stillbirth rates in almost all gestational age strata among adolescent mothers, but not among older women.

Conclusion: Older women experienced the highest stillbirth rates in Brazil but with a clear declining trend. The upward stillbirth trends revealed among adolescent mothers suggest that the fetal death prevention must be prioritized in the Brazilian adolescent health policy agenda.