The research, published Tuesday in the Canadian Medical Association Journal, aims to shed light on reasons behind the striking frequency of stillbirth rates in First Nations and Inuit populations.
The study offers new evidence that health problems linked to obesity and smoking may be behind the gap. It also suggests that better access to obstetric care could help address the discrepancy."Stillbirth is a problem that's kind of hidden, and there's silence around it," said the study's lead author, Dr. Nathalie Auger, of the Institut national de sante publique du Quebec, the provincial public-health institute.
"People don't talk about it very much. Because of that there's still relatively little research."
Earlier studies have also found the rate among Canada's First Nations and Inuit is two to three times higher than in non-aboriginal populations — and among the highest in the Western world.The researchers, who analyzed records in Quebec over nearly two decades, found that health problems linked to smoking, such as poor fetal growth, placental disorders and birth defects, were important contributing causes of stillbirth among the Inuit. Among First Nations, diabetic and hypertensive complications, which may be connected to obesity, may be also be contributing factors.
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The study looked at nearly 2.1 million stillbirths and live births between 1981 and 2009.Over the entire study period, rates of stillbirth were 6.8 per 1,000 total births for the Inuit women, 5.7 per 1,000 births for the First Nations women, and 3.6 per 1,000 for the non-aboriginal women. Stillbirth rates actually declined during that period by nearly half for non-aboriginals and even more than half for Inuit people — but not for First Nations. Unlike the other study subjects, First Nations actually experienced a small increase in stillbirths over that 28-year period.
For all aboriginal groups, the risk was higher for late stillbirths, after 28 weeks, and peaked at 37 weeks and beyond, compared with non-aboriginal groups.
The gap in stillbirth rates was largest at term — "a period when most stillbirths are potentially preventable," the authors wrote.
That means the rate can be reduced with improved access to care, Auger said.
"The simplest (thing) would be to revisit obstetric care, especially in late pregnancy," she said.
"But there's also aspects like smoking prevention, and controlling weight."
Auger pointed to systemic problems behind those issues as well, such as poverty, access to education, and social conditions.A study published in the respected science journal Lancet in 2011 found that twenty-five countries had lower stillbirth rates than Canada.
Finland and Singapore had the lowest rate, at 2.0 per 1,000 births.
The journal found that Inuit-inhabited areas of Canada had stillbirth rates in 2009 that are nearly three times higher than the rest of the country.