Obesity linked to perinatal deaths

More than half of Irish mothers who lost an infant in the weeks before or after birth were either overweight or obese, it has emerged.

The National Perinatal Epidemiology Centre in University College Cork has called for a public education programme to reduce the rate of stillbirths in Ireland.

It found that almost 53% of mothers who experienced perinatal loss between 2011 and 2014 were either overweight or obese.

The centre’s 2014 national audit shows that almost one in five (18%) women who experienced a perinatal death were smoking when they first attended the maternity hospital.

The centre, based in UCC, conducts a national audit in collaboration with the medical and midwifery staff from maternity units around the country.

One of the authors of the report, Dr Paul Corcoran, said preparation for pregnancy is crucial in reducing stillbirths.

“Addressing levels of obesity and smoking in pregnancy is important because they are risk factors for a wide range of complications,” said Dr Corcoran.

Anonymised data were reported by 20 Irish maternity units on 504 perinatal deaths arising from 67,663 births that occurred in 2014.

There were 330 stillbirths (65%), 141 early neonatal (28%), and 33 (6.5%) late neonatal births. The perinatal mortality rate was seven deaths per 1,000 births.

Similar to 2013, a major congenital anomaly was the primary cause of death in one in four of the 330 stillbirths that occurred in 2014.

During 2014 an autopsy was undertaken following 52% of stillbirths and 39% of neonatal deaths.

Over two-thirds of the mothers who experienced perinatal loss in 2014 had at least one previous pregnancy; nearly a third had never been pregnant before.

There were 31 late neo-natal deaths reported to the centre in 2014, a number that is consistent with such deaths reported by the CSO in recent years.

The director of the National Perinatal Epidemiology Centre, Prof Richard A Green, said public perception and expectation is that stillbirth is a thing of the past, yet around one baby in every 250 is stillborn.

Prof Green said the public, and especially potential parents, must be made aware that stillbirth is a fact of life.

“Potential parents must be made aware of the lifestyle risks for stillbirth. This problem belongs to us all and is not just the responsibility of the maternity service,” he said.

Dr Corcoran said maternity units generally were experiencing similar rates of mortality. “There is a sense that there is a lot of inconsistency across the maternity units but in terms of perinatal mortality, it is in line with what would be expected,” he said.

He pointed out that Ireland’s actual stillbirth rate was below average when compared to other high-income countries.

“In recent years, the decrease may have levelled off. We have had a number of decades where things had improved but in the last number of years, the decrease is not evident anymore,” said Dr Corcoran

The National Perinatal Epidemiology Centre said a confidential inquiry for stillbirth and neonatal death which may improve care should be considered.

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