Alexander Kristinn Smárason Among Authors of New Study on Stillbirth

The first author is Ragnheiður Inga Bjarnadóttir, and this is the third publication arising from her doctoral research at the University of Iceland. Her doctoral thesis, Stillbirth in Iceland: Causes and Clinicopathological Phenotypes, will be defended on 17 August. Alexander serves on her doctoral committee.

The findings presented in the paper are based on all singleton stillbirths recorded in Iceland between 1996 and 2021, comprising a total of 338 cases. The aim of the study was to improve understanding of placental and umbilical cord abnormalities associated with stillbirth and how these relate to the clinical characteristics of pregnancy.

The results show that characteristic placental abnormalities were identified in more than 70% of cases, providing important clues to the underlying causes of stillbirth. The researchers identified four distinct patterns of placental injury and demonstrated that each pattern is associated with different risk factors and different stages of pregnancy.

One of the key findings is that placental changes related to impaired maternal blood flow were frequently associated with well-established risk factors such as hypertensive disorders of pregnancy and fetal growth restriction. In contrast, abnormalities involving umbilical cord blood flow and certain inflammatory changes in the placenta were often present without obvious clinical warning signs during pregnancy, particularly in cases of term stillbirth.

The authors describe the placenta as the "black box" following a stillbirth. A better understanding of placental and umbilical cord pathology can improve counselling for bereaved parents, help assess the risk of recurrence, and support the planning of surveillance in future pregnancies. In the longer term, increased knowledge of these pathological changes may contribute to further reducing the incidence of stillbirth.

"It has been incredibly rewarding to have the opportunity to serve on Ragnheiður Inga's doctoral committee and to contribute to research on this important topic. Although we are fortunate to live in a country where stillbirths have become very rare—among the lowest rates in the world—every child is infinitely precious, and the loss of a baby is a profound tragedy. We must do everything we can to better understand why babies die, so that we can increase the chances not only of a live birth in subsequent pregnancies but ultimately save more babies.

The next step is a major research project funded by the Icelandic Centre for Research (Rannís), which will investigate ways to identify placental insufficiency before irreversible harm occurs. The participation of SAk staff in research is essential, not only for advancing scientific knowledge but also because it helps ensure that the care provided at SAk is based on the best available evidence," says Alexander K. Smárason.

You can read the article here: "Clinicopathological phenotypes of singleton stillbirth: A retrospective cohort study."