Rates of stillbirth have risen sharply among young women in Alberta. Health authorities say there are many possible reasons for the increase, as well as a need for further investigation.
Between 2012 and 2023, the rate of stillbirths per 1,000 total births increased slightly, from 6.18 to 9.43, which is in line with the national average. Among women aged 15 to 19, however, the rate of stillbirth quadrupled during that same period, from 6.27 in 2012 to 26.32 in 2023, according to data from Alberta Health. The rate of stillbirth for women 20 to 24 was twice as high in 2023 as it was in 2012.
"The causes of the increase in stillbirth rates in Alberta are multifactorial, influenced by factors such as variations in how stillbirths are categorized across jurisdictions and rising rates of risk-increasing factors like syphilis and substance use. Investigation into these causes is ongoing," a spokesperson for Alberta Health said in an e-mail.
About one-third of untreated syphilis infections in early pregnancy result in spontaneous abortion, fetal demise, or late-term stillbirth, according to the Canadian Pediatric Society.
Since 2016, Alberta has experienced a syphilis outbreak, and there's "no question" it has caused some of the increase in stillbirth rates in the province, said Joan Robinson, professor and divisional director in the Department of Pediatrics in the Faculty of Medicine & Dentistry at the University of Alberta.
"The increase [in stillbirth rates] since 2016, at least some of those cases are clearly due to congenital syphilis. That's probably not the only explanation, though," Robinson said.
In 2012, Alberta recorded 128 cases of infectious syphilis. By 2016, the number of cases had risen to 418. In 2022, the last year for which provincial data is available, there were 3,326 cases of syphilis reported in the province.
Robinson said the problem with congenital syphilis, infections passes from mother to fetus, is much worse in the north zone, but she expects that could change if steps aren't taken to stop outbreak.
"Certainly syphilis has gotten into populations, especially in inner-city Edmonton and some of the northern remote communities. That hasn't happened yet anywhere south of Red Deer nearly to the same extent. But their turn is probably coming. Because we haven't been able to do anything about it," she said.
Robinson studied cases of congenital syphilis and stillbirth in Edmonton between 2015 and 2021. In every single case where congenital syphilis resulted in stillbirth, the mother did not get proper prenatal care and the infection wasn't treated.
"It's nothing more complicated than that," Robinson said. "If you go to the doctor when you are pregnant, and you get the blood work done, and you have syphilis, we treat it. But the problem with every single case, is that the mom never got the blood work done, or they couldn't track her down so she never got treated."
With treatment, Robinson said stillbirth is incredibly rare.
The syphilis problem has been talked about within the public health sphere for years, but "COVID came along and derailed everything to do with public health. And then the public health budgets, with everything being cut, there's not the money to fix this problem."
Better data collection, more research needed
Part of the difficulty in identifying the cause of changes in rates of stillbirths in Canada lies with how data is collected, said Nadine Belzile, co-founder of the Canadian Collaborative for Stillbirth Prevention (CC4SP).
"Statistics Canada and most of the provinces count stillbirth as pregnancy loss at 20 weeks or more," but all cases are lumped together as one number, whether they are naturally occurring or terminations for medical reasons, such as if screening identifies life-threatening a heart problems.
CC4SP is lobbying to create an action plan to reduce rates of stillbirth in Canada by 30 per cent by 2030 and to reduce disparities in stillbirths between different populations. This action plan must include more resources for research.
Alberta Health said there are resources available to help mitigate known risk factors and promote healthy pregnancies.
"Initiatives such as AHS Healthy Parents Healthy Children (HPHC) and Ready or Not (RON) provide valuable resources and information aimed at mitigating risk factors and promoting healthier pregnancy outcomes.
"HPHC delivers evidence-informed health information customized for expectant parents, parents of children up to six years old, and pertinent service providers in Alberta, accessible at www.healthyparentshealthychildren.ca. Likewise, RON provides provides awareness and knowledge of the importance of preconception health to adults aged 18-44 years old who could be either planning or not currently planning pregnancy."
