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Stillbirths in Ontario

The loss of a baby after 20 weeks gestation and before birth (called stillbirth) is a devastating pregnancy outcome. Stillbirth can be due to illness, infection, trauma or exposure to toxic substances, abnormalities in the baby, problems with the placenta that supplies the baby with blood flow and nutrition, or problems in the umbilical cord. However, in many cases there is no clear reason found at the time the baby dies.

Stillbirth is an uncommon occurrence; In Ontario, for the last few years anywhere between 560 and 840 babies are stillborn each year, out of about 140,000 total births (the rate typically ranges between approximately 0.4% to 0.6%).

Does COVID-19 Infection affect Stillbirth rates?

There have been questions about how the COVID-19 virus and COVID-19 vaccinations might affect stillbirth rates.

Related to the virus, a Canada-wide study team found that the rate of stillbirth among pregnant individuals with COVID-19 infection was about twice as high as in the general population (1.06% following infection, as compared to 0.54% in the general Canadian population). [1] 

Higher rates of stillbirth following COVID-19 infection have also been found in other countries around the world. [2-4]  

Related to COVID-19 vaccination, evidence about the safety and effectiveness of mRNA COVID-19 vaccination during pregnancy is growing rapidly. To-date, there have been no pregnancy-related safety concerns identified and all the major obstetrical organizations in Canada, the US, the UK and many other countries have recommended the vaccine for pregnant and breastfeeding individuals to protect them from COVID-19, which is now considered a vaccine-preventable disease. 

Does Vaccination Status affect Stillbirth Rates?

The table below shows the number of live births and stillbirths in vaccinated and unvaccinated individuals in the province of Ontario from January 1, 2021 until October 31, 2021 - the most recent month of birth data at the time of this posting (a time lag is normal as it takes time for hospitals and midwifery practice groups to enter their births into the BORN Information System and these then have to be linked with the Ministry of Health vaccination data that come to BORN each month).

As can be seen in the table below, the rates of stillbirth in vaccinated and unvaccinated individuals were similar to background rates in Ontario, and there is no indication of higher rates of stillbirth in individuals who received one or more doses of COVID-19 vaccine before or during pregnancy.

Number of live births and stillbirths among infants born in Ontario, by COVID-19 vaccination status.  Ontario, January 1, 2021 - October 31, 2021.
Vaccination StatusLive Births                             (# & row %)Stillbirths                               (# & row %)Total                                     (# & row %)
Unvaccinated or vaccinated after pregnancy 80,566 (99.52%) 391 (0.48%) 80,957 (100%)
1 or more vaccine doses received before or during pregnancy 36,442 (99.62%) 140 (0.38%) 36,582 (100%)
Vaccine status missing  77 (100%)  0 (0%)  77 (100%)
Total 117,085 (99.55%) 531 (0.45%) 117,616 (100%)

BORN Ontario, 2021 - 2022 fiscal year                                                                                                                             

  1. Number of spontaneous stillbirths (antepartum or intrapartum) among infants born in Ontario. Expressed as a percentage of all infants >=20 weeks gestation or >=500 grams born in Ontario.
  2. Data were extracted from the BORN Information System (BIS) on February 11, 2022. Note that data submission to the BIS is both voluntary and open to updates and amendments. This table represents a snapshot of the BIS on the date of data extraction.
  3. Stillbirth includes any spontaneous stillbirth that occurred during the antepartum or intrapartum period. Stillbirths that resulted from an pregnancy termination are not included.
  4. Only records that had a birth child encounter submitted and a valid birth ID were included in the denominator.   
  5. Data submission for September and October 2021 may not be complete due to delays in transfers of birth records from hospitals into the registry.              
  6. There were 77 records that were unable to be linked to a vaccination record due to missing data.

More Detailed Study in the Works...

sign saying "Coming Soon, stay tuned"It is important to note that the data table only presents basic numbers and does not take into consideration when an individual received the vaccine or other factors that can affect stillbirth such as age of the mother, pregnancy complications, smoking, COVID infection etc.

A more detailed study is underway to properly account for all of these factors. We will be sharing that information as soon as it is available. 

Resources

Other reputable information sources related to vaccination in pregnancy include the following: 

References:

1 Money et al. Canadian Surveillance of COVID-19 in Pregnancy: Epidemiology, Maternal and Infant Outcomes (2021). https://med-fom-ridprogram.sites.olt.ubc.ca/files/2021/10/CANCOVID_Preg-report-4-19oct2021.pdf

2 Vousden et al. Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort (2021).  https://www.medrxiv.org/content/10.1101/2021.07.22.21261000v1

3 Allotey et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. (2019) BMJ Sep 1:370. https://pubmed.ncbi.nlm.nih.gov/32873575/

4 Jering et al. Clinical Characteristics and Outcomes of Hospitalized Women Giving Birth With and Without COVID-19. (2021) JAMA Intern Med May 1;181(5):714-717. https://pubmed.ncbi.nlm.nih.gov/?sort=date&term=Claggett+BL&cauthor_id=33449067