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Maternal and fetal risk factors for stillbirth: population based study

BMJ 2013; 346 doi: (Published 24 January 2013) Cite this as: BMJ 2013;346:f108

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Re: Maternal and fetal risk factors for stillbirth: population based study

Increase of stillbirth rate in Greece

To the Editor

We read with great interest the article by J. Gardosi and colleagues1 on maternal and fetal risk factors for stillbirth and took the opportunity to draw attention to the recent increase in stillbirth rate in Greece.

We analyzed official data of stillbirths in Greece from Hellenic Statistic authority (EL.STAT). Stillbirth rates in Greece have been continuously decreasing during 42 years, from the historic high in 1966 (16.03) to the historic low in 2008 (3.31). The total 4.8 times decline follows an almost perfect exponential model (R2 = 0.9719, average annual rate of change: AARC = –3.8%) (figure 1).

The condition changed dramatically in the latest two years (2009-2010) when stillbirth rate increased by 32% (2010: 4.36) (p<0.0001). Gardosi et al1 conclude that the single largest stillbirth risk factor is fetal growth restriction, especially if not detected antenatally and suggest that the cornerstone of stillbirth prevention is an adequate antenatal care for early detection of fetal growth restriction and other obstetric complications. The dramatic increase of stillbirth rate is probably associated with the Greek economic crisis which started in 20092. We are concerned that stillbirth rate will further rise in Greece in the following years, since an increasing number of pregnant women are unemployed and without insurance, excluded from Hellenic national health system’s obstetric care.

Nikolaos Vlachadis M.D., D.M.D., M.P.H., M.Sc.
Eleni Kornarou Ph.D.
National School of Public Health, Athens, Greece

1 Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ 2013; 346: 1108
2Timeline-Greece's economic crisis. (accessed Feb 2, 2013).

Competing interests: No competing interests

04 February 2013
Nikolaos Vlachadis
Obstetrician Gynaecologist
Eleni Kornarou
National School of Public Health
196 Alexandras Avenue, 11521, Athens, Greece