Most of Europe has seen stillbirth rates decline or stabilize in the last decade. However, this is not the case for countries like Belgium, Cyprus, and Germany, where stillbirths rose between 2010 and 2021. Researchers from the Max Planck Institute for Demographic Research expected the usual suspects—older maternal age and fewer multiple births—to explain the shift. Their investigation further revealed that these factors do not provide the whole picture.
Europe is Experiencing an Uneven Progress in Stillbirths: Decline, Stagnation, and Increase
Background
The researchers referenced the German Federal Statistics Office to define stillbirths. This reference considers a birth to be a stillbirth if the birth weight is more than 500 grams or at least the 24th week of pregnancy has been reached. In this study, only stillbirths from the 24th week of pregnancy were included, regardless of the weight of the baby.
Data from the Euro-Peristat network, which collects standardized perinatal health indicators across Europe, were used. Stillbirth rates in 25 European countries over an 11-year period or from 2010 to 2021 were further analyzed to determine how changes in maternal age and multiple births have contributed to the observed variations in stillbirth rates.
The Kitagawa decomposition method was employed to separate the differences in stillbirth rates into compositional and rate components. The compositional component pertains to changes in the distribution of maternal age or multiple births. The rate component represents the changes in the risk of stillbirth based on age and multiple births.
Findings
The rate of stillbirths in Germany increased from 2.8 per 1000 births in 2010 to 3.7 per 1000 births in 2021. A similar increase was found in Belgium where stillbirths increased from 4.6 per 1000 births to 5.6 per 1000 births during the same period. Stillbirths in Cyprus also increased from 2.9 per 1000 births in 2010 to 3.9 per 1000 births in 2021.
Note that the upward trend in the three countries mentioned above contrasted with the trends in other countries. Other countries like Denmark, France, Spain, and The Netherlands saw declines, while Austria and Italy showed stagnation. The United Kingdom, which once had one of the highest stillbirth rates in Europe, also saw improvements.
Findings further showed that advanced maternal age increased in many countries. However, this contributed to either rising rates or dampening declines. The proportion of multiple births decreased in most countries and contributed to a decline in stillbirths. The slight decline in multiple births in Germany was insufficient to offset rising rates.
Limitations
Older pregnant women are at risk of complications due to conditions like gestational diabetes and hypertension. These can contribute to higher stillbirths. The rise in multiple births also plays a role. Assisted reproductive procedures have led to an increase in twins and triplets. These pregnancies are more complicated and require specialized care.
However, while maternal age and multiple births are likely contributing factors, they do not fully explain rising stillbirths in the three countries. These two explained only a small portion of the differences between countries. The convergence of these two across Europe further reduced their explanatory power by 2021. Other factors are at play.
Stillbirth rates reflect healthcare trends. For Belgium, the increase might partly reflect changes in the reporting of late abortions, which were included in stillbirth figures. In Germany, other factors, such as healthcare access, prenatal care quality, or socioeconomic disparities, may play a larger role but were not examined due to data limitations.
FURTHER READING AND REFERENCE
- Kniffka, M. S., Schöley, J., Lee, S., Bertens, L. C. M., Been, J. V., Gunnarsdóttir, J., Farr, A., Klimont, J., Alexander, S., Zhang, W.-H., Vandervelpen, G., Kolarova, R., Yordanova, E., Draušnik, Ž., Kyprianou, T., Scoutellas, V., Velebil, P., Mortensen, L. H., … Murphy, J. 2025. Stillbirth Rate Trends Across 25 European Countries Between 2010 and 2021: The Contribution of Maternal Age and Multiplicity. In European Journal of Public Health. Oxford University Press. DOI: 1093/eurpub/ckae214