Even with modern prenatal care, thousands of U.S. families annually experience the heartbreak of stillbirth, and a surprising number occur without warning.
A study published Monday in JAMA analyzed nearly 2.8 million pregnancies and found that approximately 30% of stillbirths occurred with no clear medical cause or risk factor.
Researchers from the Harvard T.H. Chan School of Public Health and Mass General Brigham said their findings highlight major disparities that continue affecting Black families and low-income communities.
Co-author Dr. Mark Clapp, an obstetrician at Massachusetts General Hospital, told The Washington Post: “Even when we know someone is at increased risk, our tools for prevention are still limited. Every stillbirth represents an unimaginable loss, not just for the mother but for the entire family, and is a reminder of how far we still have to go.”
Stillbirth Rates Higher Than Previously Reported
Between 2016 and 2022, the study found stillbirths occurred in about 1 in every 147 U.S. births—higher than the 1 in 175 reported by the U.S. Centers for Disease Control and Prevention (CDC).
Rates were significantly higher in disadvantaged groups:
- 1 in 112 births among low-income families
- 1 in 95 births in communities with higher proportions of Black residents
Researchers said part of the discrepancy may stem from inaccuracies in fetal death reporting.
Fetal death certificates vary in quality and definition across states, which can make national data inaccurate, according to Jessica Cohen, co-senior author and professor of health economics at Harvard.
Risk Factors
More than 70% of stillbirths in the study involved at least one risk factor such as obesity, diabetes, or substance use. However, nearly a third occurred without warning, researchers reported.
Cohen stated: “It’s astonishing that in our day and age, so many stillbirths happen with no identified risk factors. We have watches that track our sleep and stress, but we can’t always tell when a pregnancy is in trouble.”
Risks increased sharply in pregnancies complicated by chronic high blood pressure, low amniotic fluid, fetal anomalies, and after 41 weeks of gestation.
Structural Inequities
Stillbirth rates were highest in areas with limited resources, even among women with private insurance.
Researchers said this points to structural inequities and bias in maternal care, not merely gaps in access.
Dr. Harvey Kliman, a placental researcher at Yale University who wasn’t involved in the study, told The Post: “There is no biological reason for there to be almost triple the rate of stillbirths in American Blacks compared to whites. And that has been shown over and over again, and that disparity has not really improved.”
Personal Stories
Families affected by stillbirth describe the losses as often sudden and traumatic.
Jaye Wilson, a nurse from Maryland, lost her baby at 22 weeks after a placental abruption and said her experience of bias and disbelief from medical staff compounded the loss. She later founded Melinated Moms, a nonprofit supporting mothers of color.
Samantha Banerjee, who lives in an affluent New York City suburb, lost her daughter two days before her due date and went on to start PUSH for Empowered Pregnancy.
Banerjee told The Post: “I’ll never forget the look on my cat Gio’s face as I was walking out the door to the emergency room. He had been with me throughout my entire pregnancy, and in that moment, I just knew something was wrong.”
This research underscores both the limitations of current prenatal monitoring technologies and the persistent racial and socioeconomic disparities in maternal health outcomes, highlighting the urgent need for improved prevention strategies and more equitable care.