TY - JOUR
T1 - Stillbirth rate trends across 25 European countries between 2010 and 2021
T2 - the contribution of maternal age and multiplicity
AU - Kniffka, Maxi S.
AU - Schöley, Jonas
AU - Lee, Susie
AU - Bertens, Loes C.M.
AU - Been, Jasper V.
AU - Gunnarsdóttir, Jóhanna
AU - Farr, Alex
AU - Klimont, Jeannette
AU - Alexander, Sophie
AU - Zhang, Wei Hong
AU - Vandervelpen, Gisèle
AU - Kolarova, Rumyana
AU - Yordanova, Evelin
AU - Draušnik, Željka
AU - Kyprianou, Theopisti
AU - Scoutellas, Vasos
AU - Velebil, Petr
AU - Mortensen, Laust Hvas
AU - Sakkeus, Luule
AU - Abuladze, Liili
AU - Gissler, Mika
AU - Heino, Anna
AU - Blondel, Béatrice
AU - Deneux-Tharaux, Catherine
AU - Durox, Mélanie
AU - Hocquette, Alice
AU - Philibert, Marianne
AU - Zeitlin, Jennifer
AU - Fresson, Jeanne
AU - Heller, Guenther
AU - Misselwitz, Bjoern
AU - Antsaklis, Aris
AU - Sziller, István
AU - Gunnarsdottir, Johanna
AU - Olafsdóttir, Helga Sól
AU - Kearns, Karen
AU - Sikora, Izabela
AU - Cuttini, Marina
AU - Loghi, Marzia
AU - Donati, Serena
AU - Boldrini, Rosalia
AU - Misins, Janis
AU - Zile, Irisa
AU - Isakova, Jelena
AU - Lecomte, Aline
AU - Billy, Audrey
AU - Pastore, Jessica
AU - Alvarez, Daniel
AU - Gatt, Miriam
AU - Nijhuis, Jan
AU - the Euro-Peristat Network
N1 - Funding:
Susie Lee was funded/co-funded by the European Union (ERC, BIOSFER, 101071773). Views and opinions by Susie Lee expressed in this paper are, however, those of the author only and do not necessarily reflect those of the European Union or the European Research Council. Neither the European Union nor the granting
authority can be held responsible for them.
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Public Health Association.
PY - 2025/4/1
Y1 - 2025/4/1
N2 - Stillbirth rates have stalled or increased in some European countries during the last decade. We investigate to what extent time-trends and between-country differences in stillbirth rates are explained by the changing prevalence of advanced maternal age and teenage pregnancies or multiple births. We analysed data on stillbirths and live births by maternal age and multiplicity from 2010 to 2021 in 25 European countries using Kitagawa decomposition to separate rate differences into compositional and rate components. Rates significantly decreased in six countries, but increased in two. Changes in maternal age structure reduced national stillbirth rates by a maximum of 0.04 per 1000 in the Netherlands and increased rates by up to 0.85 in Cyprus. Changes in the prevalence of multiple births decreased rates by up to 0.19 in the Netherlands and increased rates by up to 0.01 across multiple countries. Maternal age differences explained between 0.11 of the below-European average stillbirth rate in Belgium and 0.13 of the above-average rate in Ireland. Excluding Cyprus, differences in multiple births explained between 0.05 of the below-average rate in Malta and 0.03 of the above-average rate in Ireland. For most countries, the increase in advanced-age pregnancies contributed to rising stillbirth rates over time, while reductions in multiples led to decreases in rates. However, large parts of the trends remain unexplained by those factors. By 2021, neither factor explained the differences between countries, due to increased compositional uniformity and declining stillbirth risk for advanced maternal age.
AB - Stillbirth rates have stalled or increased in some European countries during the last decade. We investigate to what extent time-trends and between-country differences in stillbirth rates are explained by the changing prevalence of advanced maternal age and teenage pregnancies or multiple births. We analysed data on stillbirths and live births by maternal age and multiplicity from 2010 to 2021 in 25 European countries using Kitagawa decomposition to separate rate differences into compositional and rate components. Rates significantly decreased in six countries, but increased in two. Changes in maternal age structure reduced national stillbirth rates by a maximum of 0.04 per 1000 in the Netherlands and increased rates by up to 0.85 in Cyprus. Changes in the prevalence of multiple births decreased rates by up to 0.19 in the Netherlands and increased rates by up to 0.01 across multiple countries. Maternal age differences explained between 0.11 of the below-European average stillbirth rate in Belgium and 0.13 of the above-average rate in Ireland. Excluding Cyprus, differences in multiple births explained between 0.05 of the below-average rate in Malta and 0.03 of the above-average rate in Ireland. For most countries, the increase in advanced-age pregnancies contributed to rising stillbirth rates over time, while reductions in multiples led to decreases in rates. However, large parts of the trends remain unexplained by those factors. By 2021, neither factor explained the differences between countries, due to increased compositional uniformity and declining stillbirth risk for advanced maternal age.
KW - Humans
KW - Stillbirth/epidemiology
KW - Maternal Age
KW - Female
KW - Europe/epidemiology
KW - Pregnancy
KW - Adult
KW - Adolescent
KW - Young Adult
KW - Middle Aged
UR - http://www.scopus.com/inward/record.url?scp=105003004574&partnerID=8YFLogxK
UR - https://pubmed.ncbi.nlm.nih.gov/39836899/
U2 - 10.1093/eurpub/ckae214
DO - 10.1093/eurpub/ckae214
M3 - Article
C2 - 39836899
AN - SCOPUS:105003004574
SN - 1101-1262
VL - 35
SP - 319
EP - 327
JO - European Journal of Public Health
JF - European Journal of Public Health
IS - 2
ER -