In developed countries stillbirth is one of the few potentially avoidable maternal and child health complications that have not declined in recent decades.1 Stillbirth rates vary between and within countries, suggesting that it might be possible to reduce this devastating problem.2 A linked study by Gardosi and colleagues (doi:10.1136/bmj.f108) adds important new insights into risk factors for non-anomalous singleton stillbirths after 24 weeks.3 The findings highlight the important contribution of the modifiable risk factors of fetal growth restriction (FGR) (especially when it is unrecognised before birth), smoking, and obesity.

In this English retrospective population based study, FGR is defined using a customised standard that correlates better with stillbirth than population birthweight references.4 5 FGR was recognised antenatally in 31% of women in the general population but in only 18% of women who went on to have a stillborn infant. Among pregnancies that ended in stillbirth, unrecognised FGR was associated with 32% of all deaths (relative risk for stillbirth 8.0, 95% confidence interval …