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Changes in state-level definitions of fetal death and the reporting of fetal death and periviable live births in the United States, 1996-2021: A panel study.

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Τίτλος: Changes in state-level definitions of fetal death and the reporting of fetal death and periviable live births in the United States, 1996-2021: A panel study.
Συγγραφείς: Bustos B; Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, CA, USA. Electronic address: vazqueb3@hs.uci.edu., Stolte A; Department of Sociology, University of Virgina, Charlottesville, VA, USA., Gemmill A; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA., Casey JA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA., Sarnak D; Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA., Catalano R; School of Public Health, University of California, Berkeley, Berkeley, CA, USA., Bruckner TA; Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, CA, USA; Center for Population, Inequality, and Policy, University of California, Irvine, CA, USA.
Πηγή: Annals of epidemiology [Ann Epidemiol] 2026 Apr; Vol. 116, pp. 110056. Date of Electronic Publication: 2026 Feb 17.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Country of Publication: United States NLM ID: 9100013 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2585 (Electronic) Linking ISSN: 10472797 NLM ISO Abbreviation: Ann Epidemiol Subsets: MEDLINE
Imprint Name(s): Original Publication: New York, NY : Elsevier, c1990-
Ιατρικοί όροι (MeSH): Live Birth*/epidemiology , Fetal Mortality*/trends , Fetal Death* , Fetal Viability*, United States/epidemiology ; Infant Mortality/trends ; Humans ; Female ; Pregnancy ; Infant, Newborn ; Gestational Age
Περίληψη: Background: The World Health Organization's 2030 Sustainable Development Goals include reducing the risk of fetal death. Even in high-income countries such as the United States (US), fetal deaths remain under-counted, with reporting showing variable quality across place and time. In the US, a uniform national definition of fetal death does not exist. Scant work characterizes whether, and to what extent, definitional changes in fetal death in US states over time affect fetal death reporting as well as counting of live births among similarly very frail (i.e., periviable [born <26 weeks]) infants. We aimed to (i.) identify state-level changes in fetal death reporting guidelines or definitions for all 50 US states from 1995 to 2020 and (ii.) examine whether counts of fetal deaths, periviable births, and neonatal deaths among periviable births shifted in the years following such changes.
Methods: We retrieved data for all 50 US states from 1996 to 2021 for this descriptive analysis (n = 642,551 fetal deaths, n = 420,000 periviable births, n = 195,663 neonatal deaths among periviable births). We reviewed the fetal death user guides for state changes in reporting guidelines and conducted an internet search to find other state changes in the definition of fetal death. Next, we modeled fixed-effects linear regressions to examine associations between changes in fetal death reporting guidelines and our three outcomes.
Results: Over the test period, 12 states changed their definition of fetal death. Regression results show increases in the counts of fetal deaths, periviable births, and neonatal deaths among periviable births following changes in reporting guidelines. These increases followed any change in reporting guidelines-whether perceived as a more inclusive or more restrictive change. Results hold across a range of alternative specifications.
Conclusions: Our findings cohere with the notion that any state-level change in fetal death definitions corresponds with broader efforts to improve data collection and reporting protocols among not only fetal deaths but also periviable births. The fact that we observe such associations should encourage strategies to control for such "data breaks" for scientists and officials concerned with fetal death and/or periviable birth.
(Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.)
Competing Interests: Declaration of Competing Interest The authors declare no competing interests.
References: Am J Perinatol. 2014 Jun;31(6):521-8. (PMID: 24008398)
Can J Public Health. 1961 Aug;52:321-3. (PMID: 13727971)
Proc (Bayl Univ Med Cent). 2022 May 5;35(5):731-735. (PMID: 35991752)
Pediatrics. 2013 May;131(5):855-60. (PMID: 23545381)
Lancet. 2021 Aug 28;398(10302):772-785. (PMID: 34454675)
J Pediatr. 2021 Jun;233:16-25.e1. (PMID: 33691163)
Lancet. 2024 Jun 22;403(10445):2751-2754. (PMID: 38795714)
Lancet. 2024 Nov 16;404(10466):1902-1903. (PMID: 39510109)
BMC Pediatr. 2014 Apr 22;14:108. (PMID: 24755366)
Lancet. 1995 Aug 19;346(8973):486-8. (PMID: 7637485)
Paediatr Perinat Epidemiol. 2000 Apr;14(2):152-8. (PMID: 10791659)
Matern Child Health J. 2016 Feb;20(2):337-46. (PMID: 26518007)
Bioethics. 2015 Jul;29(6):413-23. (PMID: 25395144)
Semin Perinatol. 2024 Feb;48(1):151873. (PMID: 38143212)
Am Fam Physician. 2007 Nov 1;76(9):1341-6. (PMID: 18019878)
Lancet. 2016 Feb 6;387(10018):587-603. (PMID: 26794078)
Public Health Rep. 2012 Sep-Oct;127(5):507-15. (PMID: 22942468)
Cochrane Database Syst Rev. 2020 Dec 18;12:CD009599. (PMID: 33336827)
Hippokratia. 2021 Jan-Mar;25(1):1-7. (PMID: 35221649)
Soc Sci Med. 2004 May;58(10):1929-52. (PMID: 15020009)
Children (Basel). 2024 Mar 23;11(4):. (PMID: 38671603)
Can J Public Health. 2025 Feb;116(1):113-123. (PMID: 39251543)
Lancet. 2016 Feb 13;387(10019):703-716. (PMID: 26794079)
Grant Information: R01 HD103736 United States HD NICHD NIH HHS
Contributed Indexing: Keywords: Fetal death definition; Fetal death reporting; Neonatal death; Periviable births
Entry Date(s): Date Created: 20260219 Date Completed: 20260708 Latest Revision: 20260813
Update Code: 20260813
PubMed Central ID: PMC13242943
DOI: 10.1016/j.annepidem.2026.110056
PMID: 41713713
Βάση Δεδομένων: MEDLINE
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  Data: Changes in state-level definitions of fetal death and the reporting of fetal death and periviable live births in the United States, 1996-2021: A panel study.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Bustos+B%22&quot;&gt;Bustos B&lt;/searchLink&gt;; Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, CA, USA. Electronic address: vazqueb3@hs.uci.edu.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Stolte+A%22&quot;&gt;Stolte A&lt;/searchLink&gt;; Department of Sociology, University of Virgina, Charlottesville, VA, USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Gemmill+A%22&quot;&gt;Gemmill A&lt;/searchLink&gt;; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Casey+JA%22&quot;&gt;Casey JA&lt;/searchLink&gt;; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Sarnak+D%22&quot;&gt;Sarnak D&lt;/searchLink&gt;; Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Catalano+R%22&quot;&gt;Catalano R&lt;/searchLink&gt;; School of Public Health, University of California, Berkeley, Berkeley, CA, USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Bruckner+TA%22&quot;&gt;Bruckner TA&lt;/searchLink&gt;; Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, University of California, Irvine, CA, USA; Center for Population, Inequality, and Policy, University of California, Irvine, CA, USA.
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– Name: Abstract
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  Data: Background: The World Health Organization&#39;s 2030 Sustainable Development Goals include reducing the risk of fetal death. Even in high-income countries such as the United States (US), fetal deaths remain under-counted, with reporting showing variable quality across place and time. In the US, a uniform national definition of fetal death does not exist. Scant work characterizes whether, and to what extent, definitional changes in fetal death in US states over time affect fetal death reporting as well as counting of live births among similarly very frail (i.e., periviable [born &amp;lt;26 weeks]) infants. We aimed to (i.) identify state-level changes in fetal death reporting guidelines or definitions for all 50 US states from 1995 to 2020 and (ii.) examine whether counts of fetal deaths, periviable births, and neonatal deaths among periviable births shifted in the years following such changes.&lt;br /&gt;Methods: We retrieved data for all 50 US states from 1996 to 2021 for this descriptive analysis (n = 642,551 fetal deaths, n = 420,000 periviable births, n = 195,663 neonatal deaths among periviable births). We reviewed the fetal death user guides for state changes in reporting guidelines and conducted an internet search to find other state changes in the definition of fetal death. Next, we modeled fixed-effects linear regressions to examine associations between changes in fetal death reporting guidelines and our three outcomes.&lt;br /&gt;Results: Over the test period, 12 states changed their definition of fetal death. Regression results show increases in the counts of fetal deaths, periviable births, and neonatal deaths among periviable births following changes in reporting guidelines. These increases followed any change in reporting guidelines-whether perceived as a more inclusive or more restrictive change. Results hold across a range of alternative specifications.&lt;br /&gt;Conclusions: Our findings cohere with the notion that any state-level change in fetal death definitions corresponds with broader efforts to improve data collection and reporting protocols among not only fetal deaths but also periviable births. The fact that we observe such associations should encourage strategies to control for such &quot;data breaks&quot; for scientists and officials concerned with fetal death and/or periviable birth.&lt;br /&gt; (Copyright &#169; 2026 The Authors. Published by Elsevier Inc. All rights reserved.)
– Name: Abstract
  Label: Competing Interests
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  Data: Declaration of Competing Interest The authors declare no competing interests.
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  Data: Am J Perinatol. 2014 Jun;31(6):521-8. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2224008398%22&quot;&gt;24008398)&lt;/searchLink&gt;&lt;br /&gt;Can J Public Health. 1961 Aug;52:321-3. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2213727971%22&quot;&gt;13727971)&lt;/searchLink&gt;&lt;br /&gt;Proc (Bayl Univ Med Cent). 2022 May 5;35(5):731-735. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235991752%22&quot;&gt;35991752)&lt;/searchLink&gt;&lt;br /&gt;Pediatrics. 2013 May;131(5):855-60. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2223545381%22&quot;&gt;23545381)&lt;/searchLink&gt;&lt;br /&gt;Lancet. 2021 Aug 28;398(10302):772-785. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2234454675%22&quot;&gt;34454675)&lt;/searchLink&gt;&lt;br /&gt;J Pediatr. 2021 Jun;233:16-25.e1. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2233691163%22&quot;&gt;33691163)&lt;/searchLink&gt;&lt;br /&gt;Lancet. 2024 Jun 22;403(10445):2751-2754. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238795714%22&quot;&gt;38795714)&lt;/searchLink&gt;&lt;br /&gt;Lancet. 2024 Nov 16;404(10466):1902-1903. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2239510109%22&quot;&gt;39510109)&lt;/searchLink&gt;&lt;br /&gt;BMC Pediatr. 2014 Apr 22;14:108. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2224755366%22&quot;&gt;24755366)&lt;/searchLink&gt;&lt;br /&gt;Lancet. 1995 Aug 19;346(8973):486-8. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%227637485%22&quot;&gt;7637485)&lt;/searchLink&gt;&lt;br /&gt;Paediatr Perinat Epidemiol. 2000 Apr;14(2):152-8. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2210791659%22&quot;&gt;10791659)&lt;/searchLink&gt;&lt;br /&gt;Matern Child Health J. 2016 Feb;20(2):337-46. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2226518007%22&quot;&gt;26518007)&lt;/searchLink&gt;&lt;br /&gt;Bioethics. 2015 Jul;29(6):413-23. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2225395144%22&quot;&gt;25395144)&lt;/searchLink&gt;&lt;br /&gt;Semin Perinatol. 2024 Feb;48(1):151873. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238143212%22&quot;&gt;38143212)&lt;/searchLink&gt;&lt;br /&gt;Am Fam Physician. 2007 Nov 1;76(9):1341-6. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2218019878%22&quot;&gt;18019878)&lt;/searchLink&gt;&lt;br /&gt;Lancet. 2016 Feb 6;387(10018):587-603. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2226794078%22&quot;&gt;26794078)&lt;/searchLink&gt;&lt;br /&gt;Public Health Rep. 2012 Sep-Oct;127(5):507-15. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2222942468%22&quot;&gt;22942468)&lt;/searchLink&gt;&lt;br /&gt;Cochrane Database Syst Rev. 2020 Dec 18;12:CD009599. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2233336827%22&quot;&gt;33336827)&lt;/searchLink&gt;&lt;br /&gt;Hippokratia. 2021 Jan-Mar;25(1):1-7. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235221649%22&quot;&gt;35221649)&lt;/searchLink&gt;&lt;br /&gt;Soc Sci Med. 2004 May;58(10):1929-52. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2215020009%22&quot;&gt;15020009)&lt;/searchLink&gt;&lt;br /&gt;Children (Basel). 2024 Mar 23;11(4):. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238671603%22&quot;&gt;38671603)&lt;/searchLink&gt;&lt;br /&gt;Can J Public Health. 2025 Feb;116(1):113-123. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2239251543%22&quot;&gt;39251543)&lt;/searchLink&gt;&lt;br /&gt;Lancet. 2016 Feb 13;387(10019):703-716. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2226794079%22&quot;&gt;26794079)&lt;/searchLink&gt;
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        Type: general
      – SubjectFull: Infant Mortality trends
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