November 17, 2003

$778K grant to fund Atlanta stillbirth network

By Tia Webster

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 systems.

Emory has been granted a federal award of $777,692 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 Develop-ment (NICHD) of the National Institutes of Health (NIH).

Advances in the management of pregnancy and its complications have reduced fetal deaths. Yet stillbirths continue to 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," said principal investigator Barbara Stoll, professor and interim chair of pediatrics in the 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 Net-work," she continued. "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 participating hospitals, 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 made up of 100 census tracts in central and northeast Fulton County, northwest Gwinnett County and north and central DeKalb County. The area's population also is racially, ethnically and economically diverse. Partici-pating hospitals are Crawford Long Hospital, DeKalb Medical Center, Grady Hospital, Gwinnett Medical Center, Northside Hospital and Piedmont Hospital.

Public health Professor Carol Hogue, an internationally recognized reproductive health epidemiologist and immediate past president of the American College of Epidemiology, is co-principal investigator.

"Identifying a study area in Atlanta was a challenge because there are numerous hospitals with obstetrics services whose service areas overlap," Hogue said. "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 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-week gestation period and 20 percent of deliveries at the 24-27-week period are stillbirths.

"However, even full-term infants are not free from the risk of dying before delivery," Hogue said. "More than 10 percent of stillbirths occur after 37 weeks gestation."

Emory investigators also are collaborating with CDC scientists who administer the Metropolitan Atlanta Congenital Defects Program (MACDP) and with 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 of a proposed three-phase plan to expand active surveillance of stillbirths throughout the five-county area covered by the MACDP, Stoll said. The ultimate goal is to identify and autopsy all stillbirths in the five-country area.

Stoll and Hogue, along with 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," Stoll said. "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 at San Antonio, the University of Texas Medical Branch at Galveston and the University of Utah Health Sciences Center. The Research Triangle Institute will serve as the data coordination center for the network.