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Global, Regional, and National Stillbirths at 20 Weeks' Gestation or Longer in 204 Countries and Territories, 1990–2021: Findings From the Global Burden of Disease Study 2021 Publisher Pubmed



Comfort H1 ; Mchugh TA1 ; Schumacher AE1 ; Harris A1 ; May EA1 ; Paulson KR1 ; Gardner WM1 ; Fuller JE1 ; Frisch ME1 ; Taylor HJ1 ; Leever AT1 ; Teply C1 ; Verghese NA1 ; Alam T1 Show All Authors
Authors
  1. Comfort H1
  2. Mchugh TA1
  3. Schumacher AE1
  4. Harris A1
  5. May EA1
  6. Paulson KR1
  7. Gardner WM1
  8. Fuller JE1
  9. Frisch ME1
  10. Taylor HJ1
  11. Leever AT1
  12. Teply C1
  13. Verghese NA1
  14. Alam T1
  15. Abate YH9
  16. Abbastabar H10
  17. Elhafeez SA30
  18. Abdelmasseh M32
  19. Abdelsalam S33
  20. Abdissa D34, 35
  21. Abdoun M36, 37
  22. Abdulkader RS38
  23. Abebe M39
  24. Abedi A42, 43
  25. Abidi H45
  26. Abiodun O46
  27. Aboagye RG48
  28. Abolhassani H11, 51
  29. Abrigo MRM53
  30. Abugharbieh E54, 60
  31. Aburmeileh NME61
  32. Adane MM62
  33. Addo IY65, 70
  34. Adema BG74
  35. Adesina MA75, 76
  36. Adetunji CO81
  37. Adeyinka DA82, 83
  38. Adnani QES84
  39. Afzal S86, 87
  40. Agampodi SB88
  41. Agodi A89
  42. Agyemangduah W90
  43. Ahinkorah BO91
  44. Ahmad A93
  45. Ahmad D95, 96
  46. Ahmadi A97, 101
  47. Ahmed A93, 109, 110
  48. Ahmed H111
  49. Ahmed LA112
  50. Ajami M102
  51. Akinosoglou K115, 116
  52. Al Hasan SM117
  53. Alaly Z118, 120
  54. Alam K121
  55. Alanezi FM124
  56. Alanzi TM122
  57. Albashtawy M125
  58. Alemi S126
  59. Algammal AM127
  60. Algheethi AAS128, 129
  61. Ali A130
  62. Ali L131
  63. Ali MU132, 133
  64. Alif SM134
  65. Aljunid SM137
  66. Almazan JU138
  67. Almekhlafi HM139, 140
  68. Almidani L141, 143
  69. Almustanyir S145, 146
  70. Altirkawi KA59
  71. Aly H147
  72. Aly S149, 151
  73. Amani R158, 159
  74. Ameyaw EK160
  75. Amhare AF161, 162
  76. Amin TT163
  77. Amiri S164
  78. Andrei CL165
  79. Andrei T169
  80. Anoushiravani A12
  81. Ansar A170, 173
  82. Anvari D174
  83. Anwer R175
  84. Appiah F176, 177
  85. Arabzozani M178
  86. Aravkin AY1, 2, 181
  87. Areda D184, 185
  88. Aregawi BB186
  89. Artamonov AA188
  90. Aryal UR190
  91. Asemi Z191
  92. Asemu MT192
  93. Asgedom AA194
  94. Ashraf T198
  95. Asresie MB63
  96. Atlaw D201
  97. Atout MMW202
  98. Atreya A203
  99. Atteraya MS204
  100. Aujayeb A205
  101. Quintanilla BPA171, 206
  102. Ayatollahi H207, 208
  103. Ayyoubzadeh SM13
  104. Azadnajafabad S119, 217
  105. Azevedo RMS218
  106. Azzam AY220, 221
  107. Darshan BB222
  108. Babaei M14, 226
  109. Badar M228
  110. Badiye AD229, 230
  111. Baghcheghi N231
  112. Baghdadi S144, 233
  113. Bagheri N234
  114. Bagherieh S235
  115. Asl FB238
  116. Bai R240
  117. Bakshi RK241
  118. Bam K243
  119. Banach M246, 247
  120. Bankethomas A248, 252
  121. Bansal H253
  122. Bantie BB193
  123. Barchitta M89
  124. Bardhan M254
  125. Bashiri A255
  126. Basiru A264
  127. Baskaran P265
  128. Batra K266
  129. Bayani M268
  130. Bayleyegn NS269
  131. Bedi N271, 274
  132. Begum T275, 279
  133. Behnoush AH15, 281
  134. Belgaumi UI282
  135. Bermudez ANC283, 284
  136. Beyene KA285, 286
  137. Bhandari B287
  138. Bhandari D244, 288
  139. Bhardwaj N289
  140. Bhardwaj P290, 291
  141. Bhaskar S294, 295
  142. Bhattarai S249, 296
  143. Bodolica V297
  144. Braithwaite D298, 299
  145. Brenner H300
  146. Bustanji Y55, 301
  147. Butt NS302
  148. Butt ZA304, 305
  149. Cadri A306, 307
  150. Camposnonato I308
  151. Cattaruzza MS310
  152. Cembranel F311
  153. Cerin E312, 313
  154. Chaconuscamaita PR316
  155. Charan J292
  156. Chattu VK317, 318
  157. Chauhan D319, 320
  158. Chavula MP321, 322
  159. Chen S323
  160. Chi G152
  161. Chitheer A324
  162. Cho WCS325
  163. Choudhari SG326
  164. Chu DT327, 328
  165. Cruzmartins N329, 331
  166. Dadras O16, 333
  167. Dagnew GW64
  168. Dalaba MA49
  169. Dandona L1, 242, 335
  170. Darwesh AM337
  171. Das JK338
  172. Das S339
  173. Dash NR56
  174. Davilacervantes CA340
  175. Davletov K341
  176. Debela BG40
  177. Debele AT343
  178. Derese M345
  179. Deribe K346, 347
  180. Dervisevic E348
  181. Dessie AM192, 397
  182. Dhali A349
  183. Dhulipala VR350
  184. Dirac MA1, 3, 182
  185. Dong W351
  186. Dora BT352
  187. Dsouza HL225, 354
  188. Duraes AR355, 357
  189. Dutta S359
  190. Dziedzic AM360
  191. Eddra A361
  192. Edvardsson K362
  193. Eini E363
  194. Ekholuenetale M364
  195. El Sayedzaki M365
  196. Elgendy IY153, 368
  197. Elhadi M369, 370
  198. Elshaer M365
  199. Elsohaby I372
  200. Emeto TI374
  201. Bain LE376
  202. Esayas HL352
  203. Eshrati B209
  204. Esposito F377
  205. Fagbamigbe AF77, 380
  206. Fakhradiyev IR342
  207. Faramarzi A256, 257
  208. Faro A382
  209. Fatehizadeh A383
  210. Fekadu G371, 384
  211. Fischer F385
  212. Fomenkov AA386
  213. Fukumoto T387
  214. Gaal PA388, 389
  215. Gaidhane AM390
  216. Gajdacs M391
  217. Galali Y392, 393
  218. Gallus S394
  219. Ganesan B395
  220. Gazzelloni F396
  221. Gebrehiwot M397
  222. Gebremedhin AT398, 399
  223. Gebremeskel TG400, 401
  224. Geda YF403
  225. Gezae KE195
  226. Ghasemi MR105, 106
  227. Ghazy RM31, 404
  228. Gheno G405
  229. Gialluisi A406
  230. Gissler M407, 408
  231. Glasbey JC409
  232. Glasstetter LM411
  233. Golechha M412
  234. Goleij P413, 414
  235. Golinelli D415, 416
  236. Grivna M112, 417
  237. Guha A418, 422
  238. Guicciardi S378, 423
  239. Guo H4
  240. Gupta S424
  241. Gupta VB425
  242. Gupta VK426
  243. Haller S428, 429
  244. Halwani R56, 57
  245. Hamidi S430
  246. Handal AJ431
  247. Haro JM432, 433
  248. Hartman NN435, 436
  249. Hasan T438
  250. Hasanpourdehkordi A439
  251. Hasnain MS440
  252. Hassanipour S441, 442
  253. He WQ66
  254. Heidari M98
  255. Herreraserna BY444
  256. Herteliu C179, 446
  257. Hessami K154, 258
  258. Hezam K447, 449
  259. Hiraike Y450
  260. Holla R222
  261. Hossain MM452, 453
  262. Hosseinzadeh H454
  263. Hosseinzadeh M455, 458
  264. Hostiuc M166
  265. Hostiuc S167, 459
  266. Hu C460
  267. Huang J461
  268. Huda MM71, 276, 463, 464
  269. Huda MN71, 276, 463, 464
  270. Huynh HH465
  271. Hwang BF469, 470
  272. Iftikhar PM471
  273. Ilesanmi OS472, 473
  274. Ilic IM475
  275. Ilic MD476
  276. Immurana M50
  277. Iranmehr A17
  278. Iravanpour F259
  279. Iwagami M250, 477
  280. Iwu CD5
  281. Iyasu AN478
  282. Jaafari J443
  283. Jafarzadeh A479, 482
  284. Jahrami H484, 485
  285. Janodia MD486
  286. Javadi N235, 236
  287. Javaheri T487
  288. Jayapal SK489
  289. Jema AT490
  290. Jokar M491, 493
  291. Joseph N494
  292. Joshua CE497
  293. Jurisson M498
  294. Kabir A210
  295. Kabir Z499
  296. Karaye IM500, 501
  297. Karimi H15
  298. Kasraei H211, 260
  299. Kauppila JH52, 502
  300. Kendal ES503
  301. Keykhaei M18, 19
  302. Khalid N504
  303. Khamesipour F212, 505
  304. Khan MN67, 272, 506
  305. Khan M67, 272, 506
  306. Khan YH507
  307. Khatab K508, 509
  308. Khatatbeh H510
  309. Khatatbeh MM511
  310. Khateri S512
  311. Kashani HRK103
  312. Khormali M20
  313. Kim MS513, 516
  314. Kim TV517, 518
  315. Kim YJ519
  316. Kimokoti RW520
  317. Kisa A521, 522
  318. Kisa S523
  319. Kochhar S6, 524
  320. Kolahi AA104
  321. Kompani F21
  322. Koohestani HR232
  323. Kosen S525
  324. Koyanagi A526
  325. Krishan K527
  326. Krishnamoorthy V7, 437
  327. Defo BK528, 529
  328. Kuchay RAH530
  329. Kuddus M531
  330. Kumar GA335
  331. Kurmi OP381, 532
  332. Vecchia CL534
  333. Lacey B535, 536
  334. Lahariya C537, 538
  335. Laksono T539, 540
  336. Lal DK242
  337. Lasrado S541
  338. Latief K466, 542
  339. Latifinaibin K213
  340. Le TTT543
  341. Lee M544
  342. Lee SW545
  343. Lee WC546
  344. Lee YH547
  345. Lenzi J377
  346. Li MC548
  347. Li S135
  348. Ligade VS223
  349. Lim SS1, 3
  350. Liu G92
  351. Liu J549
  352. Liu X148, 419
  353. Lorenzovici L552, 553
  354. Lotfizadeh M99, 100
  355. Afifi AM554
  356. Madureiracarvalho AM555, 557
  357. Magee LA559, 561
  358. Majeed A563
  359. Rad EM22
  360. Malhotra K410, 564
  361. Malik AA303
  362. Malik I565
  363. Mallhi TH507
  364. Maravilla JC277, 567
  365. Martini S568, 570
  366. Martinsmelo FRR571
  367. Martorell M572, 573
  368. Marzan MB172
  369. Mathangasinghe Y245, 574
  370. Mattiello R575
  371. Maugeri A89
  372. Mayeli M15
  373. Mazaheri M576
  374. Mediratta RP227
  375. Mehrabanizeinabad K237
  376. Meles GG196
  377. Meles HN187
  378. Mendezlopez MA577
  379. Mendoza W578
  380. Menezes RG123
  381. Meretoja A579, 581
  382. Meretoja TJ580, 582
  383. Michalek IM583, 584
  384. Minh LHN467, 468
  385. Mirfakhraie R106
  386. Mirghafourvand M585
  387. Mirica A169
  388. Mirrakhimov EM588, 589
  389. Mirza M590
  390. Bawa EM593
  391. Misra S293
  392. Mizana BA270
  393. Mohamed NS594, 595
  394. Mohammadalizadehcharandabi S586, 587
  395. Mohammed G56, 596
  396. Mohammed S353, 597, 598, 599
  397. Mohammed S353, 597, 598, 599
  398. Mokdad AH1, 3
  399. Molinaro S600
  400. Momtazmanesh S15, 18
  401. Monasta L601
  402. Moni MA278, 602
  403. Ghalibaf AM179
  404. Moraga P603
  405. Morovatdar N604
  406. Mosapour A606, 608
  407. Mouodi S607
  408. Mousavi P18
  409. Mueller UO609, 610
  410. Mughal F611, 612
  411. Mulita A613
  412. Mulita F614, 615
  413. Muriithi MK616
  414. Nair TS617
  415. Najmuldeen HHR618
  416. Nambi G566
  417. Nangia V619
  418. Nascimento GG620
  419. Nauman J113, 621
  420. Nejadghaderi SA280, 480
  421. Nematollahi MH481
  422. Nguefacktsague G622
  423. Ngunjiri JW623
  424. Nguyen DH514, 624
  425. Nguyen HTH456, 457
  426. Nguyen HQ625
  427. Nguyen PT626
  428. Niazi RK627
  429. Nikoobar A104
  430. Nnyanzi LA628
  431. Noman EA68, 448
  432. Nomura S451, 629
  433. Noreen M630
  434. Nurrika D631, 632
  435. Nzoputam CI633
  436. Nzoputam OJ634, 635
  437. Oancea B636
  438. Obamiro KO375
  439. Ogunsakin RE637
  440. Okeke SR69, 70
  441. Okekunle AP78, 638
  442. Okonji OC639
  443. Okwute PG47, 640
  444. Olagunju AT533, 641
  445. Olakunde BO642
  446. Olatubi MI643
  447. Olufadewa II75, 79
  448. Olusanya BO644
  449. Ordak M645
  450. Ortegaaltamirano DV309
  451. Osman WMS647
  452. Osuagwu UL648, 649
  453. Otoiu A169
  454. Otstavnov N650
  455. Otstavnov SS651
  456. Ouyahia A653, 654
  457. Owolabi MO80, 474
  458. Padronmonedero A655
  459. Padubidri JR495
  460. Pana A656, 657
  461. Parija PP658
  462. Parikh RR659
  463. Pashaei A562
  464. Patel SK660
  465. Patil S661, 662
  466. Pawar S665
  467. Pedersini P666
  468. Pepito VCF667
  469. Peprah P427
  470. Pereira G668, 669
  471. Pereira J670
  472. Pereira M356
  473. Pereira MO671
  474. Perianayagam A672
  475. Perico N673
  476. Pesudovs K72
  477. Petcu IR169
  478. Petermannrocha FE674, 676
  479. Pezeshki PS23, 24
  480. Pham T1
  481. Phan MK677
  482. Philip AK678
  483. Pigeolet M150, 155
  484. Piracha ZZ679
  485. Podder V680, 681
  486. Poddighe D682, 683
  487. Pradhan PMS156, 684
  488. Shahraki HR261
  489. Raghav P290
  490. Rahman M685
  491. Rahmanian V686
  492. Raimondo I687, 688
  493. Ramasamy SK689
  494. Ranabhat CL690, 691
  495. Rancic N692, 693
  496. Rao CR224
  497. Rao SJ694
  498. Rasella D356, 695
  499. Rashid AM696, 697
  500. Rawassizadeh R488
  501. Redwan EMM698, 699
  502. Remuzzi G673
  503. Rengasamy KRR700
  504. Renzaho AMN701, 702
  505. Rezaei N18, 25
  506. Rezaei N18, 25
  507. Rezaeian M483
  508. Robinsonoden HE1
  509. Roever L703, 704
  510. Rohloff P157, 705
  511. Ronfani L601
  512. Rwegerera GM706
  513. Saad AMA373
  514. Saadatian Z707, 708
  515. Sabour S101
  516. Saddik BA57, 73
  517. Sadeghi M709
  518. Saeb MR710
  519. Saeed U711, 712
  520. Saghazadeh A11
  521. Sagoe D334
  522. Saheb Sharifaskari F58
  523. Saheb Sharifaskari N56
  524. Sahebkar A605, 664
  525. Sahoo H713
  526. Sahoo SS591
  527. Saleh MA57, 366
  528. Salehi S44
  529. Salem MR714
  530. Samy AM715, 716
  531. Sanjeev RK717
  532. Sarikhani Y260, 718
  533. Sarode SC719
  534. Satpathy M720, 721
  535. Sawhney M722
  536. Saya GK723
  537. Saylan M724
  538. Schlaich MP725, 726
  539. Schneider IJC727
  540. Schuermans A515, 728
  541. Sengupta P729
  542. Senthilkumaran S730
  543. Sepanlou SG12, 262
  544. Serban D731
  545. Seyedalinaghi S26
  546. Seylani A732
  547. Shafie M27
  548. Shah J733
  549. Shah PA734
  550. Shahid S199, 200
  551. Shaikh MA735
  552. Sham S736
  553. Shanawaz M273
  554. Shannawaz M737
  555. Sharew MM738
  556. Sharma M267
  557. Shetty A496
  558. Shetty BSK495
  559. Shetty PH495
  560. Shiri R739
  561. Shirkoohi R28, 29
  562. Shivalli S251
  563. Shool S20, 214
  564. Shorofi SA402, 740
  565. Shuja KH741
  566. Shuval K742
  567. Sibhat MM41
  568. Sidamo NB353
  569. Silva JP332
  570. Simpson CR743, 744
  571. Singh JA746, 747
  572. Singh P592
  573. Singh S292
  574. Skhvitaridze N748, 749
  575. Socea B168, 750
  576. Sohag AAM751
  577. Soleimani H280
  578. Solomon Y752
  579. Song S754
  580. Song Y550
  581. Spartalis M755
  582. Sreeramareddy CT136
  583. Stergachis A3, 8
  584. Suleman M756, 757
  585. Sultana S758
  586. Sun HZ759
  587. Sun J463, 760
  588. Szeto MD761
  589. Tabaresseisdedos R434, 762
  590. Tabatabai S107
  591. Tabish M94
  592. Taheri M108, 215
  593. Soodejani MT763
  594. Tamuzi JL764, 766
  595. Tan KK767
  596. Tarigan IU769
  597. Oliaee RT263
  598. Taye BT770
  599. Tefera YM753
  600. Temsah MH772
  601. Teramoto M773
  602. Tesfamariam WB197
  603. Teyekwadjo E765, 775
  604. Tharwat S367
  605. Thavamani A420, 421
  606. Thomas N776
  607. Titova MV189, 777
  608. Tiyuri A180, 216
  609. Topormadry R778, 779
  610. Tovanipalone MR663
  611. Tripathy JP780
  612. Tromans SJ781, 782
  613. Ubah CS783, 784
  614. Umair M785, 786
  615. Umakanthan S787
  616. Unim B788
  617. Vaithinathan AG789
  618. Tahbaz SV790, 791
  619. Valenti M792, 793
  620. Valizadeh R239
  621. Van Den Eynde J728
  622. Varthya SB292
  623. Veroux M89
  624. Verras GI745, 794
  625. Villani L795
  626. Violante FS379, 797
  627. Vlassov V652
  628. Walde MT344
  629. Wang F798
  630. Wang S799, 800
  631. Wang Y560
  632. Wang Y560
  633. Wassie EG803
  634. Weerakoon KG804
  635. Wolde AA1, 805
  636. Xu X73, 806
  637. Yadav V807
  638. Yang L492, 808
  639. Yano Y796
  640. Yehualashet SS771
  641. Yi S569, 768
  642. Yigit A558
  643. Yigit V558
  644. Yip P314, 315
  645. Yonemoto N556, 675
  646. Zaki N114
  647. Zamagni G601
  648. Zaman BA445
  649. Zastrozhin M358, 774
  650. Zhang H142, 551
  651. Zhang Y330
  652. Zhang ZJ219
  653. Zhao H85
  654. Zhong CC462
  655. Zielinska M646
  656. Zuhriyah L336
  657. Hay SI1, 3
  658. Naghavi M1, 3
  659. Murray CJL1, 3
  660. Dandona R1, 181
  661. Kassebaum NJ1, 7, 181

Source: The Lancet Published:2024


Abstract

Background: Stillbirth is a devastating and often avoidable adverse pregnancy outcome. Monitoring stillbirth levels and trends—in a comprehensive manner that leaves no one uncounted—is imperative for continuing progress in pregnancy loss reduction. This analysis, completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, methodically accounted for different stillbirth definitions with the aim of comprehensively estimating all stillbirths at 20 weeks or longer for 204 countries and territories from 1990 to 2021. Methods: We extracted data on stillbirths from 11 412 sources across 185 of 204 countries and territories, including 234 surveys, 231 published studies, 1633 vital statistics reports, and 10 585 unique location-year combinations from vital registration systems. Our final dataset comprised 11 different definitions, which were adjusted to match two gestational age thresholds: 20 weeks or longer (reference) and 28 weeks or longer (for comparisons). We modelled the ratio of stillbirth rate to neonatal mortality rate with spatiotemporal Gaussian process regression for each location and year, and then used final GBD 2021 assessments of fertility and all-cause neonatal mortality to calculate total stillbirths. Secondary analyses evaluated the number of stillbirths missed with the more restrictive gestational age definition, trends in stillbirths as a function of Socio-demographic Index, and progress in reducing stillbirths relative to neonatal deaths. Findings: In 2021, the global stillbirth rate was 23·0 (95% uncertainty interval [UI] 19·7–27·2) per 1000 births (stillbirths plus livebirths) at 20 weeks' gestation or longer, compared to 16·1 (13·9–19·0) per 1000 births at 28 weeks' gestation or longer. The global neonatal mortality rate in 2021 was 17·1 (14·8–19·9) per 1000 livebirths, corresponding to 2·19 million (1·90–2·55) neonatal deaths. The estimated number of stillbirths occurring at 20 weeks' gestation or longer decreased from 5·08 million (95% UI 4·07–6·35) in 1990 to 3·04 million (2·61–3·62) in 2021, corresponding to a 39·8% (31·8–48·0) reduction, which lagged behind a global improvement in neonatal deaths of 45·6% (36·3–53·1) for the same period (down from 4·03 million [3·86–4·22] neonatal deaths in 1990). Stillbirths in south Asia and sub-Saharan Africa comprised 77·4% (2·35 million of 3·04 million) of the global total, an increase from 60·3% (3·07 million of 5·08 million) in 1990. In 2021, 0·926 million (0·792–1·10) stillbirths, corresponding to 30·5% of the global total (3·04 million), occurred between 20 weeks' gestation and 28 weeks' gestation, with substantial variation at the country level. Interpretation: Despite the gradual global decline in stillbirths between 1990 and 2021, the overall number of stillbirths remains substantially high. Counting all stillbirths is paramount to progress, as nearly a third—close to 1 million in total—are left uncounted at the 28 weeks or longer threshold. Our findings draw attention to the differential progress in reducing stillbirths, with a high burden concentrated in countries with low development status. Scarce data availability and poor data quality constrain our capacity to precisely account for stillbirths in many locations. Addressing inequities in universal maternal health coverage, strengthening the quality of maternal health care, and improving the robustness of data systems are urgently needed to reduce the global burden of stillbirths. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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