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.
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).
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.
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.
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."
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.
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.
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
health Professor Carol Hogue, an internationally recognized reproductive
health epidemiologist and immediate past president of the American
College of Epidemiology, is co-principal investigator.
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."
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.
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."
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.
and Hogue, along with other stillbirth network principal investigators,
will meet with the NIH staff in November to develop specific study
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."
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.