Stillbirth rate trends across 25 European countries between 2010 and 2021: the contribution of maternal age and multiplicity

May 2, 2025

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Stillbirth rate trends across 25 European countries between 2010 and 2021: the contribution of maternal age and multiplicity

Publicated to: European Journal Of Public Health. 35 (2): 319-327 - 2025-04-01 35(2), DOI: 10.1093/eurpub/ckae214

Authors:

Kniffka MS; Schöley J; Lee S; Bertens LCM; Been JV; Gunnarsdóttir J; Farr A; Klimont J; Alexander S; Zhang WH; Vandervelpen G; Kolarova R; Yordanova E; Draušnik Ž; Kyprianou T; Scoutellas V; Velebil P; Mortensen LH; Sakkeus L; Abuladze L; Gissler M; Heino A; Blondel B; Deneux-Tharaux C; Durox M; Hocquette A; Philibert M; Zeitlin J; Fresson J; Heller G; Misselwitz B; Antsaklis A; Sziller I; Gunnarsdóttir J; Olafsdóttir HS; Kearns K; Sikora I; Cuttini M; Loghi M; Donati S; Boldrini R; Misins J; Zile I; Isakova J; Lecomte A; Billy A; Pastore J; Alvarez D; Gatt M; Nijhuis J; Broeders L; Achterberg P; Hindori-Mohangoo A; Klungsoyr K; Akerkar R; Engjom H; Szamotulska K; Mierzejewska E; Barros H; Horga M; Tica V; Puscasiu L; Budianu MA; Cucu A; Calomfirescu C; Cap J; Lučovnik M; Verdenik I; Zurriaga O; Alcaide AR; Elorriaga MF; Jané M; Vidal MJ; Källén K; Nyman A; Rihs T; Macfarlane A; Scott S; Monteath K; Smith L; Matthews R; Morgan S; Murphy J

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Affiliations

Agencia de Salut Publica de Barcelona - Author

Centre for Disease Prevention and Control of Latvia - Author

City, University of London - Author

College of Life Sciences - Author

CR2 - Author

Croatian National Institute of Public Health - Author

East European Institute for Reproductive Health - Author

Erasmus MC Sophia Children’s Hospital - Author

Erasmus MC Sophia Children’s Hospital; Erasmus MC Sophia Children’s Hospital - Author

Faculdade de Medicina da Universidade do Porto (FMUP) - Author

Federal Statistical Office - Author

Folkehelseinstituttet - Author

Folkehelseinstituttet; Universitetet i Bergen - Author

Foundation for Perinatal Interventions and Research in Suriname (Perisur) - Author

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures - Author

Health Directorate - Author

Health Service Executive Ireland - Author

Hospital Information Branch - Author

Institute for Quality Assurance and Transparency in Healthcare (IQTIG) - Author

Institute of Quality Assurance Hesse - Author

Instytut Matki I Dziecka - Author

IRCCS Eugenio Medea - Author

Istituto Nazionale Di Statistica, Rome - Author

Istituto Superiore di Sanita - Author

Karolinska Institutet - Author

Landspitali - The National University Hospital of Iceland - Author

Lithuanian Health Information Centre - Author

Luxembourg Institute of Health - Author

Læknadeild Háskóla Íslands; Landspitali - The National University Hospital of Iceland; Landspitali - The National University Hospital of Iceland - Author

Maastricht Universitair Medisch Centrum+ - Author

Max Planck Institute for Demographic Research - Author

Max Planck Institute for Demographic Research; Erasmus MC Sophia Children’s Hospital - Author

Medizinische Universität Wien Universitätsklinik für Frauenheilkunde - Author

Ministero della Salute - Author

Ministry of Health - Author

Ministry of Health Cyprus - Author

Ministry of Health Sofia - Author

National and Kapodistrian University of Athens - Author

National Directory for Hospital Management - Author

National Health Information Center - Author

National Institute of Public Health - Author

National Obstetric Information Systems (NOIS) Register - Author

NATIONAL STATISTICAL INSTITUTE BULGARIA - Author

National Statistics Institute - Author

Rijksinstituut voor Volksgezondheid en Milieu - Author

Socialstyrelsen National Board of Health and Welfare - Author

Statbel - Author

Statistics Austria - Author

Tallinna Ülikool - Author

Terveyden ja Hyvinvoinnin Laitos - Author

The National Perinatal Reporting System - Author

The Netherlands Perinatal Registry - Author

The ROCKWOOL Foundation; Københavns Universitet; Statistics Denmark - Author

The University of Edinburgh - Author

Universidad Autónoma de Madrid - Author

Universitat de València - Author

Université Paris Cité - Author

University ‘Ovidius’ Constant - Author

Univerzitetni Klinicni Center Ljubljana - Author

Ústav pro péči o matku a dítě - Author

Abstract

Stillbirth rates have stalled or increased in some European countries during the last decade. We investigate to what extent time-trends and between-country differences in stillbirth rates are explained by the changing prevalence of advanced maternal age and teenage pregnancies or multiple births. We analysed data on stillbirths and live births by maternal age and multiplicity from 2010 to 2021 in 25 European countries using Kitagawa decomposition to separate rate differences into compositional and rate components. Rates significantly decreased in six countries, but increased in two. Changes in maternal age structure reduced national stillbirth rates by a maximum of 0.04 per 1000 in the Netherlands and increased rates by up to 0.85 in Cyprus. Changes in the prevalence of multiple births decreased rates by up to 0.19 in the Netherlands and increased rates by up to 0.01 across multiple countries. Maternal age differences explained between 0.11 of the below-European average stillbirth rate in Belgium and 0.13 of the above-average rate in Ireland. Excluding Cyprus, differences in multiple births explained between 0.05 of the below-average rate in Malta and 0.03 of the above-average rate in Ireland. For most countries, the increase in advanced-age pregnancies contributed to rising stillbirth rates over time, while reductions in multiples led to decreases in rates. However, large parts of the trends remain unexplained by those factors. By 2021, neither factor explained the differences between countries, due to increased compositional uniformity and declining stillbirth risk for advanced maternal age.

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Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal European Journal Of Public Health due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 59/421, thus managing to position itself as a Q1 (Primer Cuartil), in the category Public, Environmental & Occupational Health.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2026-04-01:

Open Alex: 1
Scopus: 1

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Austria; Belgium; Bulgaria; Croatia; Cyprus; Czech Republic; Denmark; Estonia; Finland; France; Germany; Greece; Hungary; Iceland; Italy; Latvia; Lithuania; Luxembourg; Malt; Netherlands; Norway; Poland; Portugal; Slovakia; Slovenia; Surinam; Sweden; Switzerland; United Kingdom.

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Stillbirth rate trends across 25 European countries between 2010 and 2021: the contribution of maternal age and multiplicity

Affiliations

Abstract

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

Leadership analysis of institutional authors

Indexed in

APC

License and Use

Citations

Altmetrics

Analysis of institutional authors

Share

Stillbirth rate trends across 25 European countries between 2010 and 2021: the contribution of maternal age and multiplicity

Affiliations

Abstract

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

Impact and social visibility

Leadership analysis of institutional authors