Foetal growth checks 'could save hundreds of lives'
25th January 2013 - More care should be taken checking pregnant women for signs their unborn baby has growth problems, according to experts. They say restricted foetal growth is the biggest cause of stillbirths and call for better monitoring to save hundreds of lives.
A study led by West Midlands Perinatal Institute in Birmingham found major shortcomings in detecting restricted foetal growth, ranging in maternity units between 12.5% and 50% - with an average of 31%.
'Failing' NHS care
A prominent charity which supports parents affected by the death of a baby says the research shows that routine NHS care is failing hundreds of families.
Stillbirth rates in the United Kingdom are among the highest in developed countries. Deaths are often described as unexplained and unavoidable, and their rates have changed little over the last two decades.
The authors say spotting restricted foetal growth at an early stage could substantially reduce the risk of a child being stillborn, and argue that this needs to become a cornerstone of safety and effectiveness in antenatal care in the NHS.
"Screening and surveillance is not well standardised," says Professor Jason Gardosi, director of the West Midlands Perinatal Institute, adding that "many maternity units are still not using customised growth charts and referral protocols".
He explains further to us: "There is also often a shortage of scans, and high risk pregnancies do not get the serial scans which they should have."
Researchers at the Institute set out to explain the main risk factors associated with stillbirth.
Using NHS records, they identified 92,218 normally formed singleton babies, including 389 stillbirths, from the 24th week of pregnancy, delivered during 2009-11 in a single health service region. They then assessed several maternal and foetal risk factors for stillbirth and calculated the proportion of deaths that could be potentially avoided if these risks were removed.
Factors which increased the risk of stillbirth included:
- An obese mother with a body mass index (BMI) of 30 or more
- Being from African, African-Caribbean, Indian or Pakistani ethnic groups
- Having diabetes
- A history of mental health problems
- Social deprivation
Fourfold higher risk
However, the single largest risk factor for stillbirths applied to women when growth problems in their unborn baby had not been diagnosed. The authors say foetal growth restriction carried a fourfold higher risk of stillbirth compared with normal growth pregnancies. This increased to an eightfold risk if it was not detected during pregnancy, accounting for 32% of all stillbirths in the study.
They conclude that 71 stillbirths in their study population could have been avoided if foetal growth problems had been detected. "Extrapolated to the UK population, this would represent 600 fewer stillbirths per year," they write.
In an accompanying editorial, two experts from the University of Auckland say this study adds "important new insights" about modifiable risk factors for stillbirth, but that efforts to improve detection of foetal growth restriction must be intensified. In particular they say more evidence is needed about whether older mothers increase stillbirth rates.