A new comprehensive investigation led by researchers from Harvard T.H. Chan School of Public Health and Mass General Brigham has unveiled a more alarming reality about stillbirth rates in the United States. This large-scale study, analyzing over 2.7 million pregnancies across a six-year period, reveals that stillbirths occur more frequently than formerly reported, with profound disparities linked to socioeconomic factors. The findings, published in the Journal of the American Medical Association (JAMA) on October 27, 2025, challenge previous national estimates and underscore pressing imperatives for research and preventive healthcare interventions.
The analysis examined data collated from commercial health insurance claims coupled with demographic information sourced from the Health Care Cost Institute, the American Community Survey, and March of Dimes. An aggregate of 18,893 stillbirth cases were identified among the pregnancies studied between 2016 and 2022. This extensive dataset enabled researchers to scrutinize the interplay between stillbirth incidence and a range of clinical, fetal, obstetric, and socioeconomic factors, providing an unprecedented granularity in risk assessment unmatched in prior studies.
Contrary to earlier understanding, the researchers determined that more than one in every 150 births in the United States culminate in stillbirth, a rate substantially exceeding the approximately one in 175 figure propagated by the Centers for Disease Control and Prevention (CDC). Alarmingly, in economically disadvantaged regions, the incidence rises sharply to one in 112 births. Moreover, geographic areas with higher proportions of Black families showed a stillbirth occurrence of one per 95 births, highlighting persistent racial disparities exacerbated by social determinants of health.
In assessing clinical factors, the study found compelling evidence that while a majority of stillbirths — roughly 72.3% — were associated with at least one identifiable clinical risk factor, a significant minority occurred without any diagnosed risk prior to delivery. This absence of known risk markers escalates with gestational age, with nearly 41% of stillbirths at 40 weeks or beyond lacking recognizable clinical indicators. These results present a considerable challenge for current prediction and prevention paradigms, which often rely heavily on early risk identification.
The array of clinical risk factors scrutinized includes chronic hypertension, pregnancy-related hypertension, gestational and pre-pregnancy diabetes, obesity, and substance use. Fetal factors such as growth restriction, decreased fetal movement, and congenital anomalies were also accounted for, alongside obstetric history elements including previous adverse pregnancy outcomes and abnormal amniotic fluid levels. These complexities illustrate the multifactorial nature of stillbirth etiology and suggest the need for integrative approaches that transcend conventional clinical surveillance.
Surprisingly, area-level access to obstetric care and rurality were not strongly correlated with stillbirth rates in this analysis. Instead, socioeconomic parameters such as income levels and racial demographics played a more decisive role, pointing to the influence of structural inequities and social determinants in perinatal outcomes. These insights demand a reevaluation of healthcare delivery models, advocating for targeted interventions tailored to mitigate disparities rooted in socioeconomic disadvantage.
The implications of these findings resonate deeply within the obstetric and public health communities, generating a call to action around enhancing stillbirth risk prediction methodologies. Current tools may inadequately capture the nuances of late-term stillbirth risks, particularly when no overt clinical warnings exist. Innovative screening strategies, perhaps incorporating advanced biomarker discovery and real-time monitoring technologies, could offer breakthroughs in identifying vulnerable pregnancies closer to term.
Jessica Cohen, co-senior author and professor of health economics, emphasizes the urgent gap in research and clinical practice addressing stillbirths. The burden is enormous—approximately 21,000 families are affected annually in the United States alone. Nearly half of stillbirths occurring after 37 weeks gestation are deemed preventable, yet lack of robust predictive capacity hinders effective intervention and resource allocation. Cohen advocates for amplified research endeavors that marry epidemiological data with molecular and physiological insights to revolutionize prevention.
Mark Clapp, co-senior author and maternal-fetal medicine specialist at Massachusetts General Hospital, stresses that despite growing momentum in stillbirth prevention, U.S. rates remain dramatically elevated compared to peer nations. He underscores the necessity of policy reforms and practice innovations informed by this study’s data, aiming to reduce the emotional and societal toll suffered by affected families. Clapp’s perspective reflects a broader commitment within academic medicine to confront persistent disparities head-on.
This investigation also spotlights an urgent need for further inquiry into the mechanisms behind socioeconomic disparities driving differential stillbirth rates. It remains unresolved whether these disparities stem principally from social determinants such as housing instability and food insecurity, health system inequities including insurance coverage and provider access, or intrinsic clinical risk distributions. Future research is tasked with disentangling these complex drivers to better inform multifaceted interventions.
Another notable aspect is the heightened risk associated with specific pregnancy conditions observed in the dataset. Low amniotic fluid volumes, fetal anomalies, and chronic hypertension emerged as the strongest predictors of stillbirth, suggesting these conditions should command heightened vigilance in clinical management protocols. The optimization of monitoring and timely intervention in such high-risk pregnancies could constitute pivotal steps toward mitigating stillbirth incidence.
Overall, this seminal study represents one of the most data-rich explorations of stillbirth burden in the United States to date. Its findings hold transformative potential for obstetric care standards, health policy formulation, and scientific exploration. By illuminating both the magnitude and complexity of stillbirths, the research invites a multidisciplinary coalition of experts—from epidemiologists to clinicians and policymakers—to join forces in designing and implementing comprehensive prevention frameworks that address clinical, social, and systemic determinants.
In conclusion, the enhanced stillbirth rates unveiled by this investigation serve as both a wake-up call and an opportunity. The compelling evidence linking disparities to socioeconomic factors and the prevalence of risk-free yet fatal outcomes demand innovative approaches to prediction, prevention, and equity restoration in prenatal care. As researchers further decode the underpinnings of stillbirth, the ultimate goal remains clear: to ensure every pregnancy results in a healthy birth, and no family endures the profound loss stillbirth inflicts.
Subject of Research:
Not applicable
Article Title:
Stillbirths in the United States
News Publication Date:
October 27, 2025
Web References:
http://dx.doi.org/10.1001/jama.2025.17392
Keywords:
Pregnancy complications, Obstetrics, Childbirth, Pregnancy, Gestational age
