December 14, 2011 — Stillbirth steadily occurs in 1 in 160 pregnancies in the United States, most often as a result of obstetric complications and placental abnormalities, researchers report in 2 studies published in the December 14 issue of JAMA. Defined as fetal death at 20 weeks of gestation or later, stillbirth also shows significant, but unexplained, racial disparity, the researchers note.

The rate of stillbirths in the United States has remained consistent since 2003, and is higher than in many other developed countries, whereas the rate of infant deaths has declined, the researchers say.

Members of the Stillbirth Collaborative Research Network (SCRN), started by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), conducted a population-based study involving pregnancies at 59 hospitals in 5 states (Rhode Island, Massachusetts, Georgia, Texas, and Utah) between March 2006 and September 2008. Collectively, the hospitals had more than 80,000 deliveries per year.

Of a total of 953 women who had 972 stillbirths during this period, 663 women who had 676 stillbirths were enrolled in the study. The JAMA reports focus on 500 women who had 512 stillbirths and who consented to complete postmortem examinations.

In the first report, Robert M. Silver, MD, chief of the Division of Maternal-Fetal Medicine at the University of Utah School of Medicine in Salt Lake City, and colleagues concluded that obstetric complications caused the most (29.3%) fetal deaths in the study, and placental abnormalities caused 23.6% of deaths. Fetal genetic/structural abnormalities, infection, umbilical cord abnormalities, hypertensive disorders, and maternal medical complications constituted other causes of death. The researchers determined probable or possible causes of death in 76.2% of the stillbirths.

The authors also discovered a "consistent and persistent racial disparity in stillbirth." Non-Hispanic black women showed more than a 2-fold risk for stillbirth compared with non-Hispanic white women. Although the disparity is often attributed to poor access to prenatal care, this study included women who did have access to prenatal care, the researchers write.

In the second study, George R. Saade, MD, from the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, and colleagues reported that risk factors for stillbirths, in addition to race, were strongly related to the reproductive history of the women. Risk factors included previous stillbirth, no previous birth, diabetes, age 40 years or older, AB blood type, drug use history, tobacco use before pregnancy, overweight or obesity, and not living with a partner.

The researchers note in the second report that their study was, to their knowledge, the largest population-based study so far of stillbirth that also included the study of control patients.

"In the United States, fetal mortality is almost as common as infant mortality," Jay D. Iams, MD, from the Division of Maternal/Fetal Medicine, Department of Obstetrics and Gynecology, and Courtney D. Lynch, PhD, MPH, from the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Ohio State University Medical Center, Columbus, write in an accompanying editorial. "[T]he reports from the SCRN will not only further the understanding of stillbirth but should also encourage the need to reframe thinking about how to address the problem of spontaneous preterm birth and the associated racial/ethnic disparities."

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health Human Development, National Institutes of Health. The authors of the 2 studies have disclosed no relevant financial relationships. For the editorial, 1 author reported employment compensation for Elsevier and current research contracts with NICHD, and 1 author reported institutional support from a current or pending NICHD grant.

Cigarette smoking is one of the leading causes of death in the United States, and it is also the most preventable. Fifty percent of smokers who do not quit will die from smokingrelated diseases or illnesses. One out of every five deaths in the United States is caused by smoking. It is the cause of 90% of deaths from chronic obstructive pulmonary disorder (COPD), 80% of lung cancer deaths in women, and 90% of lung cancer deaths in men. Smoking is also implicated in the development of many other cancers that target major organs, because it negatively affects the entire body. It also increases the risk of cardiovascular disease such as coronary heart disease, which is the number one cause of death in the United States.

Damage from smoking cannot be reversed, but quitting will keep further damage from occurring. Quitting this habit will also reduce the risk of developing a smoking-related disease or illness. Soon after smoking cessation occurs, the individual should experience an increase in circulation and normalization of blood pressure. Breathing will also become easier, and the individual will experience an increase in smell and taste. Each year an individual remains tobacco-free, the risk of cancer declines as well.

There are many different ways smokers can quit. Some choose to seek professional help from a therapist on an individual or group basis, while others use the help of medications to aid the quitting process. Some smokers decide to gradually reduce the amount of cigarettes they smoke daily until they are tobacco free. Others swear the only way to truly quit is by “cold turkey”-- giving the habit up all at once. However the individual decides to quit, it is important to pick a “quit day” and to be fully prepared with prescriptions or anything else necessary to make quitting cigarettes successful. Tips to Deal with Nicotine Cravings:

• Drink plenty of fluids, especially water. This will help flush the toxins from your body. Keep coffee, soda, and alcohol to a minimum as they can increase tobacco cravings.

• Eat more fruits and vegetables, but do not diet while quitting as this will decrease the chance for success.

• Relieve stress: read a book; exercise; get a massage; practice yoga; take a bath; etc…

• Get more sleep.

• Distract yourself when you feel cravings: chew a piece of gum; go for a walk; listen to music; watch television; play a game; or call a friend or family member to catch up on life’s events.

• Change your daily habits that would normally trigger a smoking habit.

• Clean your home of anything that smells of smoke.

Weight gain, anxiety, and agitation are all normal side effects experienced during the process of smoking cessation. With time, these should subside. It is not uncommon to have to try several times before being able to quit smoking permanently. It is important to remember not to become discouraged. Perseverance is the key and quitting and improved health is possible.

 

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