Epidemiology of Antepartum Stillbirths in Austria-A Population-Based Study between 2008 and 2020

Abstract

(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22⁺⁰ gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20⁺⁰/40 was 3.10, ≥22⁺⁰/40 3.14, and ≥24⁺⁰/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33⁺⁰ (27⁺²-37⁺⁴) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58-8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83-3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020.

Keywords: epidemiology; fetal death; perinatal mortality; registration; stillbirth.

Figure 1

Flowchart on eligibility and selection of study population.

Figure 2

Interleaved contingency bar graph showing the stillbirth rate per 1000 births ≥20⁺⁰, ≥22⁺⁰, and ≥24⁺⁰ gestational weeks in Austria between 2008 and 2020.

Figure 3

Map chart illustrating the rate of antepartum stillbirths per 1000 births ≥22⁺⁰ weeks of gestation in the nine Austrian federal states between January 2008 and December 2020.

Figure 4

Trends in rates of antepartum stillbirth ≥22⁺⁰ gestational weeks in Austria between January 2008 and December 2020.

Figure 5

Map chart illustrating the median gestational age of antepartum stillbirths ≥22⁺⁰ gestational weeks across Austria between 2008 and 2020.

Figure 6

Bar graph illustrating the prevalence of antepartum stillbirth in Austria per gestational week (stillbirth rate per 1000 births in logarithmic scale to the base 2).

Figure 7

Time trend of stillbirth prevalence as per gestational age in Austria between January 2008 and December 2020: stillbirth rate per 1000 births in logarithmic scale to the base 2.