Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?
Authors: Gissler Mika , Durox Mélanie , Smith Lucy , Blondel Béatrice , Broeders Lisa , Hindori-Mohangoo Ashna , Kearns Karen , Kolarova Rumyana , Loghi Marzia , Rodin Urelija , Szamotulska Katarzyna , Velebil Petr , Weber Guy , Zurriaga Oscar , Zeitlin Jennifer ,   the Euro-Peristat Research Network, Haidinger Gerald , Klimont Jeannette , Alexander Sophie , Vandervelpen Gisèle , Zhang Wei-Hong , Yordanova Evelin , Kolarova Rumyana , Filipovic-Grcic Boris , Drausnik Zeljka , Rodin Urelija , Kyprianou Theopisti , Scoutellas Vasos , Velebil Petr , Mortensen Laust , Sakkeus Luule , Gissler Mika , Heino Anna , Blondel Béatrice , Chantry Anne , Tharaux Catherine Deneux , Heller Guenther , Lack Nicholas , Antsaklis Aris , Berbik István , Ólafsdóttir Helga Sól , Kearns Karen , Sikora Izabela , Cuttini Marina , Loghi Marzia , Tamburini Cristina , Donati Serena , Misins Janis , Zile Irisa , Isakova Jelena , Billy Audrey , Couffignal Sophie , Lecomte Aline , Weber Guy , Gatt Miriam , Achterberg Peter , Broeders Lisa , Hindori-Mohangoo Ashna , Nijhuis Jan , Akerkar Rupali , Klungsøyr Kari , Mierzejewska Ewa , Szamotulska Katarzyna , Barros Henrique , Horga Mihai , Tica Vlad , Cap Jan , Tul Natasa , Verdenik Ivan , Bolumar Francisco , Jané Mireia , Alcaide Adela Recio , Vidal Maria José , Zurriaga Oscar , Källén Karin , Nyman Anastasia , Berrut Sylvan , Riggenbach Mélanie , Rihs Tonia A , Macfarlane Alison , Smith Lucy , Wood Rachael , Zeitlin Jennifer , Durox Mélanie , Delnord Marie , Hocquette Alice 
Published: January 2022

Abstract

Background
Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network.

Methods
We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks’ GA was analyzed separately.

Results
Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8–1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3–0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0–23%, average 1.8%).

Conclusions
Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.