Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?
Mika Gissler, Mélanie Durox, Lucy Smith, Béatrice Blondel, Lisa Broeders, Ashna D. Hindori‐Mohangoo, Karen Kearns, Rumyana Kolarova, Marzia Loghi, Urelija Rodin, Katarzyna Szamotulska, P Velebil, Guy Weber, Óscar Zurriaga, Jennifer Zeitlin, Gerald Haidinger, Jeannette Klimont, Sophie Alexander, Gisèle Vandervelpen, Wei‐Hong Zhang, Evelin Yordanova, Rumyana Kolarova, Boris Filipović‐Grčić, Željka Draušnik, Urelija Rodin, Theopisti Kyprianou, Vasos Scoutellas, P Velebil, Laust Hvas Mortensen, Luule Sakkeus, Mika Gissler, Anna Heino, Béatrice Blondel, Anne Alice Chantry, Catherine Deneux‐Tharaux, Guenther Heller, Nicholas Lack, Aris Antsaklis, István Berbik, Helga Sól Ólafsdóttir, Karen Kearns, Izabela Sikora, Marina Cuttini, Marzia Loghi, Cristina Tamburini, Serena Donati, Jānis Misiņš, Irisa Zīle, Jelena Isakova, Audrey Billy, Sophie Couffignal, Aline Lecomte, Guy Weber, Miriam Gatt, Peter Achterberg, Lisa Broeders, Ashna D. Hindori‐Mohangoo, Jan G. Nijhuis, Rupali Akerkar, Kari Klungsøyr, Ewa Mierzejewska, Katarzyna Szamotulska, Henrique Barros, Mihai Horga, Vlad Tica, Ján Cáp, Nataša Tul, Ivan Verdenik, Francisco Bolúmar, Mireia Jané, Adela Recio Alcaide, M.J. Méndez Vidal, Óscar Zurriaga, Karin Källén, Anastasia Nyman, Sylvan Berrut, Mélanie Riggenbach, Tonia Rihs, Alison Macfarlane, Lucy Smith, Rachael Wood, Jennifer Zeitlin, Mélanie Durox, Marie Delnord, Alice Hocquette
Abstract
BACKGROUND: Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. METHODS: We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks' GA was analyzed separately. RESULTS: Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8-1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3-0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0-23%, average 1.8%). CONCLUSIONS: Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.