The association between the provision of recommendations for stillbirth prevention and the stillbirth reduction: A regional population-based study in Japan

Abstract Shiga Prefecture in Japan still had higher stillbirth rates than the national average before 2010. To improve stillbirth rates in Shiga, we have informed both obstetricians and pregnant women in our region of recommendations for stillbirth prevention after peer-reviewing all stillbirth cases in Shiga since 2013. We therefore evaluated the reduction in the stillbirth rate and preventable stillbirths in Shiga after the intervention. We assessed outcomes over 15 years divided into three 5-year periods: before- (2008-12), early- (2013-17), and late-intervention (2018-22) period. The primary outcome was the rate of stillbirth in Shiga, and the secondary outcome was the rate of preventable stillbirth in each period. The stillbirth rate in Shiga significantly decreased by 40% in the late-intervention period compared to that in the before-intervention period (95% CI: -52%, -24%), and it also significantly decreased compared to the national average between those periods (rate ratio: 0.76, 95% CI: 0.61, 0.96). It improved to the second lowest level in Japan during the late-intervention period. The rate of possibly preventable stillbirths in the late-intervention was significantly lower than that in the before-intervention period. Informing healthcare providers and pregnant women of the recommendations for stillbirth prevention was associated with a reduction in stillbirths.