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Emory University Chosen by the National Institutes of Health to Establish
a Network to Study Scope and Causes of Stillbirths in United States
ATLANTA — In Georgia, there are nearly 100 fetal deaths reported for
every 10,000 deliveries each year. Still, the rates may be underestimated
in Georgia and nationwide because not all stillbirths are reported to
the states’ vital records system. Emory University has been granted
a federal award of $777,692 in core funding to establish a network to
study the scope and causes of stillbirths in the United States. It is
one of five sites chosen by the National Institute of Child Health and
Human Development (NICHD) of the National Institutes of Health (NIH).
Advances in the management of pregnancy and its complications have reduced
fetal deaths. Yet, stillbirths still account for a large proportion
of perinatal mortality in the United States and other countries.
"While death rates of newborns and infants have declined steadily in
recent years, the stillbirth rate has remained stagnant and high," says
the study’s principal investigator Barbara Stoll, MD, professor and
interim chair of the department of pediatrics, Emory University School
of Medicine. "Part of the problem is that for as many as half of all
fetal deaths, the cause of death is unknown. We want to change that.
The group of investigators for the Emory Stillbirth Network is committed
to working collaboratively with other clinical centers and scientific
groups to achieve the goals of the NICHD Stillbirth Network. It’s a
wonderful example of team science."
The Emory Stillbirth Network is a collaboration between the School of
Medicine and the Rollins School of Public Health. Together, they will
work with the Metropolitan Atlanta Stillbirth Study Coalition (MASSC),
a consortium of six Atlanta hospitals, to bring a breadth of experience
to the study. The expertise of the team ranges from neonatology, pathology,
and placental function, to epidemiology, genetics, birth defects and
infectious disease.
Participating universities must study a defined geographical area where
there are at least 8,000 deliveries to residents each year. The MASSC
represents the academic, private and public sector with almost 40,000
deliveries a year at the hospitals combined, out of which about 9,000
occur to residents in the defined study area. Residents of the study
area must deliver in a collaborating hospital so fetal deaths can be
identified as they occur.
The Emory Stillbirth Network study area is comprised of 100 census tracts
in central and northeast Fulton County, northwest Gwinnett County, and
north and central DeKalb County. The population in the area is also
racially, ethnically and economically diverse.
The participating hospitals are Emory Crawford Long Hospital, DeKalb
Medical Center, Grady Memorial Hospital, Gwinnett Medical Center, Northside
Hospital, and Piedmont Hospital.
Public health professor Carol Hogue, Ph.D. is co-principal investigator
of the study. She is an internationally recognized reproductive health
epidemiologist and immediate past president of the American College
of Epidemiology.
"Identifying a study area in Atlanta was a challenge because there are
numerous hospitals with obstetrics services whose service areas overlap,"
Dr. Hogue says. "We’re fortunate that Atlanta physicians, perinatal
loss counselors, and hospital administrators were eager to join us in
this consortium. All of them expressed a keen interest in increasing
their ability to counsel parents who have experienced the loss of a
stillborn infant."
According to Dr. Hogue, stillbirth rates in the study area are comparable
to rates in the rest of the state. In Georgia, more than 60 percent
of deliveries at the 20-23 weeks gestation period and 20 percent of
deliveries at the 24-27 weeks gestation period are stillbirths.
"However, even full term infants are not free from the risk of dying
before delivery," Dr. Hogue says. "More than ten percent of the stillbirths
occur after 37 weeks gestation."
Emory investigators are also collaborating with scientists at the Centers
for Disease Control and Prevention, who administer the Metropolitan
Atlanta Congenital Defects Program (MACDP), and at the Georgia Division
of Public Health, which is responsible for reproductive health surveillance
for the state as well as the city of Atlanta. The research team views
participation in the NIH Stillbirth Network as the first phase of a
proposed three-phase plan to expand active surveillance of stillbirths
throughout the five-county area covered by the MACDP, Dr. Stoll says.
The ultimate goal is to identify and autopsy all stillbirths in the
five-country area.
Drs. Stoll and Hogue and other stillbirth network principal investigators
will meet with the NIH staff in November to develop specific study plans.
"Once study plans are developed, the costs of data collection will be
added to the core funding," Dr. Stoll explained. "One topic to be investigated
is the extent to which access to prenatal care may be associated with
fetal loss because information on prenatal care is missing on about
one in five stillbirths in Georgia."
Other sites chosen for the NICHD Stillbirth Network include Brown University,
the University of Texas Health Sciences Center, the University of Texas
Medical Branch at Galveston, and the University of Utah Health Sciences
Center at San Antonio. The Research Triangle Institute will serve as
the data coordination center for the NICHD Stillbirth Network.
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