University of Utah: The Road to Prevention of Stillbirth Clinical Research Center - PROJECT SUMMARY / ABSTRACT Globally, millions of pregnancies per year end in stillbirth, which occurs in 5.48/1000 U.S births, exceeding most high-resource countries and presenting major opportunities for improvement. Critical gaps in stillbirth risk stratification hamper efforts to accurately target interventions. Moreover, significant inequities persist; for example, American Indian/Alaska Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) people have 1.5- 2 times higher rates of stillbirth compared with White people. Further, stillbirth causes and experiences in AIAN and NHPI communities remain poorly elucidated. The University of Utah (UofU) is an ideal site for the NICHD “Road to Prevention of Stillbirth” Consortium, intended to reduce stillbirth in the U.S. For over 40 years, the UofU has led one of the most productive U.S. stillbirth research programs, with one of the few clinical programs dedicated to stillbirth prevention, staffed by leading experts with a history of national and global collaboration with clinicians, scientists, parents, and community groups. We recently launched the UofU Stillbirth Center of Excellence (USCoE), the first such center in the nation. With partners such as the University of Hawai’i, Tséhootsoí Medical Center (Navajo Nation), and Australia’s Stillbirth Centre of Research Excellence, we are poised to make innovative progress in preventing stillbirth and mitigating inequities. We also have a long history of effective participation in research (e.g. NICHD Maternal-Fetal Medicine Units (MFMU) Network, Stillbirth Collaborative Research Network, and Centers for Disease Control and Prevention), making UofU an ideal research network center. In addition to being an exceptional center for the Consortium, we propose to assess risk factors for adverse outcomes associated with decreased fetal movement (DFM). DFM is a major risk factor for stillbirth, occurring in up to 50% of cases. However, it also occurs frequently in normal pregnancies ending in live birth. Thus, risk stratification tools have great potential to improve stillbirth risk detection. We also aim to assess and address disproportionate stillbirth burdens in AIAN and NHPI communities. We will use audits to identify granular causes of and contributors to stillbirth through rigorous cause of death audits and qualitative approaches. Further, we will qualitatively assess parental experiences with stillbirth, related medical care, bereavement support, and evaluation for stillbirth. Disparities in these communities are unacceptable and have not been previously studied in a rigorous fashion. The UofU’s ability to support and complete Consortium research, in addition to our development of projects with high impact on stillbirth prevention and support, will ultimately reduce stillbirths and improve health equity.
