Report: Black Women More Prone To Stillbirths

According to the National Institutes of Health, African-American mothers are twice as likely to give birth to a child that's stillborn than white mothers. Host Michel Martin talks with Carol Hogue, an epidemiologist at Emory University about the risks.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News. Coming up, adoption advocates say a new film about a sociopathic orphan is sending unnerving messages to adopted kids and perspective adoptive parents. We'll talk more about that in our moms conversation, that in just a few minutes.

But first, we're going to return briefly to a conversation we began in yesterday's Behind Closed Doors segment about stillbirth. On Monday's program, we heard from two writers who experienced stillbirths and are working to raise awareness about it, especially about how painful it is when we don't acknowledge these losses.

Today, though, we want to speak with a medical expert to try to understand a bit more about why stillbirth happens and why women of color seem to be experiencing it in greater numbers than whites do.

Joining us now to talk about all this is Carol Hogue, an epidemiologist and director of the Women's and Children's Center at Emory University School of Public Health. She's involved in the National Institute of Health study examining the causes of stillbirth. Welcome. Thank you so much for speaking with us.

Dr. CAROL HOGUE (Epidemiologist; Director, Women's and Children's Center, School of Public Health, Emory University): Thank you, Michel.

MARTIN: Now, just to clarify for those who may have missed yesterday's program, what is stillbirth, and what factors contribute to stillbirth?

Dr. HOGUE: Stillbirth is the death of the baby in utero, and we define that at the point of - that the baby might be able to live outside of the womb, and that starts at 20 weeks of gestation, which is about five-and-a-half months.

MARTIN: Now, yesterday, we heard from parents who had suffered stillbirth, and they both talked about how surprised they were to find out how prevalent stillbirths are in this country. There are some 25,000 a year. And yet they said in contrast to other conditions, there seems to be relatively little research and relatively little known, and it's relatively little discussed. Do you agree with that, and why might that be?

Dr. HOGUE: I do agree with that, and I think it's shocking, actually. There are now more stillbirths in the U.S. than there are deaths of babies who die after birth and before their first year of life, and I don't know how many people are aware of that.

I think for many years, it was thought that miscarriage or death before birth was just sort of expected and that it was so common that people didn't consider it a problem. And then over time, as the death rates from other causes of death declined and deaths from stillbirths did not decline, people became aware that this is an ongoing problem that, if we don't pay attention to, it won't go away.

At the same time, I think parents began to be more forthcoming with the amount of grief and pain that loss incurs without a whole lot of cultural support for this, without ceremonies and rituals that would help them and help their community understand the extent of their grief.

Gradually, advocacy groups formed and are becoming very good at explaining that to the public at large. So I think this is an issue that we will learn more about over the next few years.

MARTIN: Well, hopefully, your study will fill in at least some of these gaps, and we do understand that the study has not yet been completed. But we understand from work that's already been done that African-American women are two to three times more likely to experience stillbirth than whites. Why might that be?

Dr. HOGUE: That's right, and we don't understand that. But there are some clues that we might be able to reduce that before we do understand it thoroughly.

One thing is that obesity is a known risk factor for stillbirth. And African-American women tend to be heavier, on average, than white women. And it's particularly surprising to me that if you compare a heavily obese group of women with stillbirth, black women who are obese tend to be - to have a higher risk of stillbirth than white women who are obese. So this really might be a major determinate of what we know now. It won't prevent the majority of stillbirths, but it could begin to drop the black-white gap.

MARTIN: What about Latinas?

Dr. HOGUE: Hispanic woman are not much more likely to have stillbirth than non-Hispanic white women, and we don't really understand why that is, but we do observe that there isn't much of an excess risk.

MARTIN: That's interesting. And what about Asian-American women, do we know?

Dr. HOGUE: A little less likely than white women.

MARTIN: That's interesting. So is there anything - and this is, of course, a very tricky question, because one does not want to lead people into the idea that you're blaming them for something that happens to them, particularly something so painful and tragic. But you do want to ask: Is there anything expectant parents can do to reduce their risk?

Dr. HOGUE: Exactly. And in addition to weight control, they are a couple of things. One is when people have a loss, oftentimes they're encouraged to try again right away, and that is not good advice. The better advice is to wait at least 18 months before trying to get pregnant again, because the risk of stillbirth or other pregnancy outcome - poor pregnancy outcome is greater with that shorter inter-pregnancy interval.

So that's one thing. And the second is to seek answers immediately. If you have a stillbirth, try to get the best medical attention possible to determine if there is an underlying medical problem that can be diagnosed and treated before the next pregnancy. Woman who have chronic medical conditions like diabetes or hypertension need to have that well under control before they get pregnant.

And finally - and this is really more research than knowledge here - vaginal infections can lie through the canal to the womb, and that happens before pregnancy and very early in pregnancy. So making sure that those are treated prior to pregnancy might reduce the risk. We really don't know that yet, but that's one of our working hypotheses.

MARTIN: Well, thank you for that, and we do hope you'll keep us posted as you learn more.

Carol Hogue is an epidemiologist and director of the Women's and Children's Center at Emory University. She was kind enough to join us by phone from Bryson City, North Carolina.

Carol Hogue, thank you so much for speaking with us.

Dr. HOGUE: Thank you.

MARTIN: You can hear our earlier conversation about stillbirth at the TELL ME MORE page of the new npr.org.

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