Stillbirth is defined as the loss of a pregnancy at 20 weeks of gestation or later. While the causes are varied and not every stillbirth is preventable, a significant number of associated risk factors can be identified and managed through proactive medical care and behavioral changes. Understanding and addressing these factors can substantially improve the chances of a healthy outcome. Expectant parents can work closely with their healthcare providers on a strategy that combines diligent management of health conditions, necessary lifestyle modifications, and modern surveillance techniques.
Managing Maternal Health Conditions
Controlling pre-existing or pregnancy-related medical conditions is a fundamental step in minimizing stillbirth risk. Conditions like pre-existing or gestational diabetes require strict management, as poor blood sugar control can affect placental function and fetal growth. Timely screening, diet, exercise, and sometimes medication can reduce the associated risk.
Hypertensive disorders, including chronic hypertension and preeclampsia, also demand careful monitoring and treatment. These conditions restrict blood flow to the placenta, potentially leading to fetal growth restriction and distress. Regular blood pressure checks and appropriate medication adjustments are necessary. Prophylactic low-dose aspirin may be recommended early in pregnancy for high-risk individuals.
Thyroid function must also be carefully regulated, as both insufficient (hypothyroidism) and excessive (hyperthyroidism) hormone levels are linked to adverse outcomes. For those with hypothyroidism, the dose of levothyroxine medication typically needs to be increased during pregnancy to maintain the target thyroid-stimulating hormone (TSH) level. Hyperthyroidism is managed with antithyroid medications under close medical supervision.
Prompt identification and treatment of infections, such as urinary tract infections (UTIs) and certain viral illnesses, is important. Attending all prenatal appointments allows the healthcare team to screen for, diagnose, and treat these conditions before they progress.
Essential Lifestyle and Behavioral Adjustments
Daily lifestyle choices offer accessible ways for expectant parents to influence a healthy pregnancy outcome. A key recommendation for the third trimester is to adopt a side-sleeping position. After 28 weeks of gestation, sleeping flat on the back can nearly triple the risk of stillbirth compared to sleeping on one’s side.
This recommendation prevents aortocaval compression, where the weight of the uterus compresses major blood vessels, reducing blood flow to the placenta. The goal is simply to avoid lying supine when going to sleep or returning to sleep after waking.
Several behavioral changes are crucial for prevention. Absolute cessation of smoking, alcohol, and illicit drug use is a fundamental preventative measure, as smoking is directly associated with increased stillbirth risk. Maintaining a healthy weight gain is also important, since obesity independently increases stillbirth risk. Finally, all over-the-counter and prescription medications must be reviewed with a healthcare provider, as some drugs may pose risks during pregnancy.
Active Fetal Surveillance and Monitoring
Monitoring the baby’s well-being in the third trimester involves both parent-led and clinical assessment tools. Fetal movement counting, or “kick counts,” should begin around 28 weeks. The goal is to establish a pattern of normal activity and promptly report any significant change or reduction in movement to a healthcare provider.
A common counting method suggests noting the time it takes to feel 10 distinct movements, such as kicks, flutters, or rolls. Ideally, this should take less than two hours. A sudden, sustained decrease in movement can be an early indicator that the fetus is experiencing distress, prompting further medical evaluation.
When concerns arise, or for high-risk pregnancies, clinical tests assess fetal health. The Non-Stress Test (NST) is a non-invasive procedure that tracks the fetal heart rate’s response to movement. A “reactive” NST, showing heart rate accelerations, is highly reassuring of immediate fetal oxygenation.
The Biophysical Profile (BPP) provides a more comprehensive picture, combining the NST with an ultrasound to score five specific parameters. A high BPP score suggests the fetus is receiving adequate oxygen and blood flow. The parameters scored in the BPP are:
- Fetal breathing
- Body movement
- Muscle tone
- Heart rate
- Volume of amniotic fluid
Strategies for Mitigating Specific High-Risk Indicators
In pregnancies with identified risk factors, specialized medical strategies involve intensifying monitoring and planning the optimal timing for delivery. For individuals who have experienced a previous stillbirth, surveillance is heightened with more frequent appointments, ultrasounds, and antenatal testing. This close monitoring may lead to a planned early delivery, such as an induction, to prevent a recurrence of the complication.
Conditions affecting the placenta, such as placental insufficiency or fetal growth restriction (FGR), necessitate a proactive approach. FGR means the baby is smaller than expected and may not be receiving enough nutrients or oxygen, requiring specialized ultrasounds to monitor growth and blood flow. The decision to deliver is a careful balance between the risks of prematurity and the risks of remaining in a potentially hostile intrauterine environment.
Timing of delivery is a medical strategy for pregnancies progressing past term or having known risk factors. For an otherwise healthy pregnancy, stillbirth risk increases slightly after 40 weeks, and induction is routinely offered around 41 weeks. For high-risk pregnancies, like those involving twins or significant maternal disease, a scheduled induction or Cesarean section may be recommended between 37 and 39 weeks.