Not every stillbirth can be prevented, but many of the known risk factors are things you can actively manage. In the United States, stillbirth affects roughly 5.4 out of every 1,000 pregnancies, and that rate has been slowly declining. While some causes remain unpredictable, research has identified several concrete steps that reduce risk.
What Counts as Stillbirth
Stillbirth is the loss of a pregnancy at 20 weeks of gestation or later. A loss before 20 weeks is classified as a miscarriage. Within stillbirth, there’s a further distinction: early fetal death occurs between 20 and 27 weeks, and late fetal death occurs at 28 weeks or beyond. Late stillbirths are generally considered more preventable because they’re more likely to involve conditions that prenatal care can detect and manage.
Sleep Position in the Third Trimester
One of the simplest preventive steps is how you position yourself when you fall asleep. A large analysis combining data from five studies (over 3,100 pregnancies) found that women who fell asleep on their backs had about 2.6 times the risk of late stillbirth compared to women who fell asleep on their left side. The connection is biologically straightforward: lying flat on your back allows the weight of the uterus to compress major blood vessels, reducing blood flow to the placenta.
Sleeping on your right side did not show increased risk, so either side works. The key moment is the position you fall asleep in, not every position you shift into overnight. Researchers estimated that if all pregnant women avoided falling asleep on their backs in the third trimester, late stillbirths could drop by about 6%. A pillow behind your back can help you stay on your side through the night.
Tracking Fetal Movement
A noticeable decrease in your baby’s movements is one of the most important warning signs of fetal distress. Many providers recommend starting “kick counts” around 28 weeks. The standard approach is to pick a time when your baby is typically active, then see how long it takes to feel 10 movements (not counting hiccups). What matters most isn’t a single number but changes from your baby’s normal pattern: fewer movements than usual, weaker movements, or a sudden shift in activity level.
It’s worth being honest about the evidence here. Clinical trials have not proven that formal kick-counting programs directly reduce stillbirth rates. But paying attention to movement remains valuable because it’s the primary way you can detect a problem between prenatal visits. If something feels different, getting evaluated promptly gives your care team the chance to intervene. When you report decreased movement, your provider will typically perform a heart rate monitoring test and possibly an ultrasound to check on the baby’s well-being.
Managing Chronic and Pregnancy-Related Conditions
Several medical conditions significantly raise stillbirth risk, and keeping them well controlled is one of the most effective forms of prevention. High blood pressure (whether chronic or pregnancy-related), diabetes, and obesity are the most common culprits. These conditions can impair blood flow through the placenta, gradually starving the baby of oxygen and nutrients.
If you’re at high risk for preeclampsia, a dangerous form of high blood pressure in pregnancy, your provider may recommend a daily low-dose aspirin (81 mg) starting after 12 weeks. This is a well-established prevention strategy backed by the U.S. Preventive Services Task Force. Risk factors for preeclampsia include a history of the condition in a prior pregnancy, chronic hypertension, kidney disease, carrying multiples, or having certain autoimmune conditions.
For gestational diabetes, staying on top of blood sugar monitoring and following your treatment plan matters directly for stillbirth prevention. Uncontrolled blood sugar can cause the baby to grow too large, stress the placenta, and increase the risk of sudden fetal death in the final weeks.
Getting Vaccinated During Pregnancy
Infections during pregnancy are an underappreciated cause of stillbirth. A population-based study found that women who received the seasonal flu vaccine during pregnancy had a 51% lower risk of stillbirth compared to unvaccinated women. The reduction was even more pronounced for births occurring just after flu season, when the protective effect had the most time to accumulate. Despite this, fewer than 1 in 10 pregnant women in the study had been vaccinated.
Flu and other infections can trigger inflammation that damages the placenta or directly infect the fetus. Staying current on recommended vaccines during pregnancy is a straightforward protective measure.
How Prenatal Care Catches Problems Early
Regular prenatal visits are designed, in part, to screen for conditions that can lead to stillbirth. Growth problems are a major risk factor. A baby that isn’t growing properly may be suffering from placental insufficiency, where the placenta can’t deliver enough blood and nutrients. Providers screen for this using fundal height measurements (measuring your belly with a tape measure at each visit) and, when something seems off, ultrasound to estimate the baby’s size.
If growth restriction is suspected, specialized Doppler ultrasound can measure blood flow through the umbilical artery. This is the most reliable tool for determining whether a small baby is actually in danger versus simply small. Abnormal flow patterns indicate the placenta is failing and can prompt closer monitoring or early delivery. Currently available blood tests for placental problems have low accuracy, so ultrasound remains the primary screening method.
Timing of Delivery
One of the most powerful tools for preventing late stillbirth is simply delivering the baby before the risk peaks. A large national study in England found that inducing labor at 39 weeks in low-risk pregnancies was associated with a small but real reduction in adverse outcomes, including stillbirth and newborn complications. The absolute reduction was modest (about 1 fewer adverse outcome for every 360 inductions), but the benefit was more pronounced for first-time mothers and women in lower-income groups.
For women with high-risk conditions like preeclampsia, growth restriction, or diabetes, providers often recommend delivery even earlier, sometimes at 37 or 38 weeks, because the risk of continuing the pregnancy outweighs the small risks of an earlier birth. If your provider recommends induction before your due date, this is often a direct stillbirth prevention strategy.
Lifestyle Factors You Can Control
Smoking is one of the strongest modifiable risk factors for stillbirth. It damages the placenta, restricts blood flow, and increases the risk of the baby being dangerously small. Quitting at any point during pregnancy reduces risk, though quitting before or early in pregnancy provides the greatest benefit.
Alcohol and recreational drug use also increase stillbirth risk through similar mechanisms of placental damage and impaired fetal development. Obesity raises risk independently of the conditions it contributes to (like diabetes and hypertension), likely because excess weight promotes chronic inflammation that affects placental function. Reaching a healthy weight before pregnancy is ideal, but even moderate improvements in diet and activity during pregnancy can help manage related conditions.
What Can’t Be Prevented
Even with perfect prenatal care and every known precaution, some stillbirths occur for reasons that are not yet preventable. Genetic abnormalities in the baby, umbilical cord accidents, placental abruption (where the placenta suddenly separates from the uterine wall), and unexplained causes still account for a significant share of losses. In many cases, no cause is identified at all. This is important to understand: experiencing a stillbirth does not mean you or your provider failed to do something. The goal of prevention strategies is to reduce overall risk, not to guarantee any individual outcome.