First Nations women at greater risk for stillbirths

Richard Oster is hopeful that a partnership between the University of Alberta and an unidentified First Nation will result in more women successfully carrying babies to full term.

“Our research group is … working in collaboration with a very large First Nations community here in Alberta to try and tackle, not just stillbirth, but healthy pregnancies in general,” said Oster, a senior research co-ordinator for the Believing we can Reduce Aboriginal Incidence of Diabetes Research group at the U of A faculty of medicine and dentistry. “Building relationships in communities, building friendships, building trust and talking and addressing issues together, because we (researchers) know … that if we try and use a program that might have worked in Edmonton or the inner city and we try and apply it to Aboriginal community it fails. We need to have collaboration for success.”

Data gathered from 2000 to 2009 shows a connection between First Nations women with pre-existing diabetes and the risk of stillbirths.

Oster and his research partner Dr. Ellen Toth, also with the department of medicine with the U of A, examined close to 470,000 births in that time period. Taking pre-existing diabetes and other factors into consideration, they determined that First Nations women were at a 70 per cent greater risk than their non-First Nations counterparts when it came to stillbirths. The study was published in the February edition of Journal of Obstetrics and Gynaecology Canada. Other risks included illicit drug dependence, alcohol use and smoking. Stillbirths were also more common for First Nations women over 35 years of age, those with more than three babies, and those with a history of abortion, previous stillbirth or neo-natal death.

Overall, statistics indicated that First Nations women had stillbirths at a rate of 1.7 per cent compared to non-First Nations women, who had stillbirths at a rate of 0.7 per cent. The statistic for First Nations women also includes Inuit women. Métis and non-Status Indian women fell under the non-First Nations category because of the way statistics were collected by Alberta Health. 

The rate at which First Nations women experienced stillbirths over those 10 years had not changed. While the steady rate could be seen in a positive light, it also has negative connotations, says Oster, who notes that in other developed countries, the rate for stillbirths has decreased.

“Rates in Alberta have stayed static over 10 years … and I can’t tell you why that is,” he said. “I don’t want to see any more stillbirths.”

While the study did not assess medical care received by First Nations women when pregnant, Oster says he has anecdotal information that indicates physician visits could be improved.

“We know that on average, First Nations women tend to come in less often for their prenatal care and perhaps come in later during their pregnancy,” said Oster. “We see that as an issue that could be playing a role.”

The upside with the role pre-existing diabetes plays in stillbirths is that it’s a risk factor that can be addressed.

By publishing their findings in a journal that deals with women and birth, Oster is hopeful that obstetricians and gynecologists will become aware of the role diabetes plays in stillbirths and use the information to help their patients.

The findings have also been presented at various conferences, which have been attended by federal government officials. Oster hopes that means the concern has come to the attention of Health Canada, which operates the First Nations and Inuit Health Branch and has responsibility for the health and well-being of First Nations and Inuit people.