Stillbirth is the loss of a fetus at or after the 20th week of pregnancy. It affects approximately one in every 175 births in the United States annually. Although not every case is preventable, many stillbirths are linked to identifiable medical and lifestyle factors that can be managed or modified. Understanding these risks and actively participating in preventative care promotes a healthy pregnancy and birth.
Identifying Key Risk Factors
Understanding the conditions that elevate stillbirth risk allows for proactive management and increased medical surveillance. Several maternal health conditions increase risk, including poorly controlled pre-existing or gestational diabetes, chronic or pregnancy-induced hypertension, and preeclampsia. Obesity (Body Mass Index of 30 or higher) is also a factor associated with a higher likelihood of stillbirth.
A history of a previous stillbirth or other adverse pregnancy outcomes significantly increases the risk in subsequent pregnancies. Certain infections, such as cytomegalovirus (CMV) or parvovirus B19 (Fifth Disease), can also pose a threat to the developing fetus.
The health of the placenta is another factor, as it supplies oxygen and nutrients to the fetus. Issues like placental abruption (where the placenta separates from the uterine wall) or placental insufficiency leading to fetal growth restriction (FGR) are concerns. Undetected FGR is considered one of the strongest risk factors for stillbirth.
Essential Prenatal Care and Lifestyle Adjustments
Consistently attending all scheduled prenatal appointments is a direct preventative measure, as these visits allow healthcare providers to monitor for emerging risk factors like preeclampsia or FGR. Early and regular care ensures that potential complications are identified when intervention is most effective. Routine monitoring often includes measuring fundal height and checking blood pressure and urine.
Maintaining a healthy lifestyle throughout the pregnancy is another element of stillbirth prevention. This includes actively avoiding all forms of tobacco, including secondhand smoke, as smoking is linked to stillbirth risk. The safest choice is to abstain completely from alcohol and illicit drug use during pregnancy.
Managing weight is also important, as excessive weight gain or pre-existing obesity complicates pregnancy and elevates risk. For individuals with chronic conditions like diabetes or hypertension, strict adherence to a management plan, including blood sugar or blood pressure control, is necessary.
Maternal sleeping position is a modifiable practice that directly impacts late-term stillbirth risk. Beginning around 28 weeks of gestation, pregnant individuals should sleep on their side, rather than flat on their back. Lying on the back in the third trimester can cause the enlarged uterus to compress major blood vessels, reducing blood flow and oxygen supply to the fetus. Using pillows to maintain a side-sleeping position is advised, as the position one falls asleep in is typically held the longest.
Monitoring Fetal Well-being
A proactive step for expectant parents is to become familiar with their baby’s normal pattern of movement. Fetal movement (kicks, rolls, or swishes) indicates the baby’s health. A significant change in activity level, particularly a reduction, is the most common symptom preceding a stillbirth and requires immediate investigation.
Healthcare providers often recommend “kick counting,” or formal fetal movement counting, especially in the third trimester. A common method involves timing how long it takes to feel 10 separate movements within a two-hour period. This should be performed while resting, preferably lying on the side, at a time when the baby is usually active.
If a pregnant individual notices a decrease in the strength or frequency of movements, or fails to reach the target number during a counting session, they must contact their healthcare provider immediately. It is a misconception that a baby’s movements naturally slow down as the due date approaches; healthy babies remain active right up until birth.
When concerns about fetal movement arise, medical monitoring is initiated using specialized tools. A Non-Stress Test (NST) records the baby’s heart rate in response to movement. A Biophysical Profile (BPP) uses ultrasound to assess five markers of fetal health (heart rate, breathing, movement, muscle tone, and amniotic fluid volume), and Doppler ultrasounds measure blood flow through the umbilical cord to detect placental insufficiency or fetal stress.
Specialized Management and Delivery Timing
For pregnancies identified as high-risk, a tailored management plan involving increased surveillance is implemented. This often includes more frequent prenatal visits and serial growth ultrasounds to track the baby’s development and identify signs of growth restriction. The goal of this specialized care is to detect problems early enough to intervene before a stillbirth occurs.
In high-risk situations, the medical team may determine that the safest course of action is to deliver the baby early. This decision involves balancing the risk of stillbirth if the pregnancy continues against the potential risks of prematurity. For instance, in an uncomplicated multiple gestation pregnancy, delivery may be recommended around 37 weeks, as the risk of stillbirth begins to outweigh the risk of neonatal complications.
For all pregnancies, delivery timing is a consideration as the due date approaches. The risk of stillbirth increases with each week past term, leading to the practice of offering labor induction around 41 weeks of gestation. For individuals with underlying conditions, such as chronic hypertension, delivery is often scheduled earlier (typically around 39 weeks) to minimize stillbirth risk. Medical intervention through timely induction or scheduled Cesarean section, when warranted by risk factors, serves as a final preventative step.