Fetal Deaths Outnumber Infant Deaths for First Time in US

Beth Skwarecki

July 27, 2015

Fetal deaths after 20 weeks' gestation have not declined in recent years, and starting in 2011, there were more fetal deaths than infant deaths in the United States, according to data from 2011 to 2013 published by the Centers for Disease Control and Prevention in a National Vital Statistics Report.

"Much of the public concern surrounding reproductive loss has focused on infant mortality, due in part to a lesser knowledge of the incidence, etiology, and prevention strategies for fetal mortality," the authors write, calling for more research on the occurrence and causes of fetal death.

There were 23,595 fetal deaths in 2013, for a rate of 5.96 per 1000 live births plus fetal deaths, which is close to the 2012 rate of 6.05. (Induced terminations were not included.) Overall, this puts the rate of fetal deaths for 2011 to 2013 higher than the rate of infant mortality for the first time, although the rates were "essentially the same," study authors Marian F. MacDorman, PhD, and Elizabeth C.W. Gregory, MPH, from the Centers for Disease Control and Prevention's Division of Vital Statistics, write.

The rate was highest in non-Hispanic black women, with a rate of 10.53 deaths vs 4.88 for non-Hispanic white women. Although much of the disparity is still unexplained, part of the difference is a result of the higher rate of preterm delivery in black women because of previously documented factors including differences in prenatal health and access to quality healthcare, according to the researchers.

The rate for Asian and Pacific Islander women was 4.68 per 1000; it was 6.22 for Native American women and 5.22 for Hispanic women of any race.

Geographically, the rates of fetal deaths per 1000 live births plus fetal deaths were above 5.0 in Alabama, Georgia, Mississippi, South Carolina, Tennessee, Puerto Rico, and Guam and were below 3.2 in New Hampshire, New Mexico, and Vermont.

Age, Sex, and Marital Status

The age of the mother was also linked to the rate of fetal deaths. Teenagers aged 15 to 17 years had 32% more fetal deaths, and those aged 18 to 19 years 22% more, than women aged 25 to 29 years. Those younger than 15 years had a fetal death rate nearly three times as high. The differences are probably a result of biological immaturity, the authors write, but are likely also partly a result of socioeconomic and behavioral factors.

Women aged 35 years and older also had higher rates of fetal death even after adjusting for multiple pregnancies and medical conditions such as hypertension and diabetes that are more common in older women.

Unmarried women had more fetal deaths than married women, likely because of different social, emotional, and financial resources, the authors write. The difference varied by race, at 44% higher among non-Hispanic white women, 14% among non-Hispanic black women, and 11% among Hispanic women.

Multiple gestations also had a higher mortality rate, with twins having a rate of 14.07 compared with 5.65 for singletons. The rate was 30.53 for triplets or more. (Each fetus was counted separately.) Multiples are at higher risk for preterm labor, growth restriction, and placental and cord problems.

Previous research has found differences in fetal death by sex, with male fetuses at greater risk. In the recent data, the rate was overall 6% higher for male fetuses, also varying by race: 12% for non-Hispanic black women and no difference in Hispanic women.

The authors did not report any conflicts of interest.

"Fetal and Perinatal Mortality: United States, 2013." Centers for Disease Control and Prevention. Full text

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