For the first time, fetal deaths in the United States have outnumbered infant deaths, according to a new report from the Centers for Disease Control and Prevention. The new statistics signal progress in reducing infant mortality but a need for steps to reduce fetal mortality, particularly in women with multiple pregnancies, teenagers, women of late reproductive age, and those who are unmarried.
The data were drawn from 2 different National Center for Health Statistics vital statistics files: the 2013 fetal death data set and the 2013 period linked birth/infant death set. Fetal deaths included in the report were later than 20 weeks’ gestation because most states only report fetal deaths after that benchmark. Fetal death statistics did not include induced pregnancy termination.
In 2013, 23,595 fetal deaths at 20 weeks’ gestation or later were reported in the United States. Overall that year, the fetal mortality rate was 5.96 fetal deaths at 20 weeks’ gestation or later per 1000 live births, versus 6.05 in 2014. That lack of decline in fetal mortality means that more fetal deaths occurred than infant deaths between 2011 and 2013, even though the rates were essentially the same.
Non-Hispanic black women had a fetal mortality rate of 10.53, more than double that for non-Hispanic white women. Asian and Pacific Islanders had the lowest fetal mortality rate at 4.68. American Indian or Alaska Native women had a fetal mortality rate of 6.22 versus 5.22 for Hispanic women.
Rates of fetal mortality were slightly higher in male than in female fetuses: 6.12 compared with 5.80. Multiplicity was associated with significantly higher rates than for singletons: 30.53 for triplets and 14.07 for twins versus 5.65 for singletons. Looking at age, rates of fetal mortality were lowest in women aged 25 to 29 (5.34) versus teenagers younger than 15 (15.88) and women aged 45 and older (13.76). Half (51%) of fetal deaths were to unmarried women.
Public concern about reproductive loss, the authors said, primarily focuses on infant mortality, but interest in fetal mortality is increasing, with several organizations monitoring those losses and providing research opportunities.