US researchers have begun collecting tissue samples from thousands of pregnant women in an effort to learn what causes stillbirths – babies born dead – and preterm deliveries. This is the second of a three-part series on maternal and child health, and the seldom mentioned babies who are born after they have died.
Data is scarce on the more than 13 million babies born before 37 weeks of pregnancy every year – of which one million die – and an additional 3.2 million deaths that the World Health Organization (WHO) classifies as stillbirths, according to a recent report based on collaborative research led by the US-based Global Alliance to Prevent Prematurity and Stillbirth (GAPPS).
Lack of equipment and technicians to interpret ultrasound scans of the baby in the womb have made it difficult to gather information in sub-Saharan Africa and Asia, where most these deaths occur, GAPPS said. Stillbirths were "neither recorded nor discussed in health policies, making them effectively "invisible", the report commented.
"Stillbirth is largely ignored globally," Craig Reubens, executive director of GAPPS and a paediatrician, told IRIN. "Most stillbirths do not receive an autopsy and parents are left with more questions than answers."
Aminata Ndiaye, 24, from Senegal told IRIN it was God's will that her baby was born dead in November 2009. "We do not have control over these matters - He who gives can also take away, and we must accept the good Lord's will."
21 ways to life For preterm newborns Prophylactic steroids in preterm labour Antibiotics for preterm labour if premature membrane rupture Vitamin K at delivery Treat neonatal sepsis and pneumonia Delayed cord clamping Room air resuscitation Kangaroo mother care Early breastfeeding Thermal care Surfactant therapy Distending pressure to lungs for respiratory distress Preventing stillbirths Boosting protein Syphilis screening Presumptive malaria treatment Mosquito nets Birth preparedness Emergency obstetric care Cesarean section Elective induction for post-term delivery Preventing preterm births Quitting smoking Progesterone Source: GAPPS, 2010
Participants at an international conference on premature births and stillbirths, organized by GAPPS in May 2009, drafted an agenda to reduce stillbirths and preterm births by promoting low-cost proven interventions.
Based on a review of 2,000 studies of interventions conducted up to 31 December 2008, GAPPS looked at the success rate of 82 interventions and compiled a list of 21 that were proven to keep preterm newborns alive as well as prevent stillbirths and preterm births.
These measures include early breastfeeding, carrying a child against the mother's chest - "kangaroo" mother care - providing Vitamin K at delivery, and using ordinary air rather than oxygen to resuscitate babies not breathing at delivery.
Proven methods to prevent stillbirth include presumptive malaria treatments during pregnancy, syphilis screenings, boosting protein during pregnancy, and emergency obstetric care.
Unfortunately, these life-saving measures are not widely adopted due to lack of awareness about what causes preterm births and stillbirths, cultural barriers, poorly functioning health systems, lack of political will and resources, and corruption, according to GAPPS.
Lack of research
Researchers launched tissue-collection for the study in the US in November 2009, and plan to expand it to India and Africa. The goal is to collect samples of maternal blood, urine, vaginal and amniotic fluid, which surrounds the foetus during pregnancy, umbilical cord blood, and placental tissue from 6,000 pregnant women.
"The challenge with understanding preterm birth is that it has been looked at as an 'event' rather than a complex syndrome," Rubens told IRIN.
Unlike cancer researchers, who for years have had access to extensive tissue samples from patients with the illness, maternal and child health researchers have had little to consult.
There have been no standard operating procedures for collecting tissue specimens from pregnant women, which meant there was no tissue bank that researchers around the world could access, and therefore no large-scale scientific studies could be conducted.
High-quality specimens would speed up research into preventing newborn deaths and stillbirth rather than just reacting to it. "There is very little that can be done ... [without specimens], which is why most of the research focus for preterm birth has been on keeping the preterm neonate [baby] alive," Rubens told IRIN.
"The cost of prospective research is much more significant – you have to enrol a large cohort of pregnant women and follow them throughout their pregnancy," said Rubens.
A co-author of the study, Joy Lawn, of Save the Children, a UK-based NGO, noted that "Preterm births and stillbirths are ... a private loss to many families that should be on the public's priority list."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions