Instead of carrying Kylie in her arms, Adams clung to tokens: molds of her stillborn daughter's hands, wisps of hair, a photograph. And she made plans to bury her baby.

Adams had a healthy pregnancy she felt her daughter kick just one week before her delivery one month early so one question was constant:

"Why? Why would this happen?" the 31-year-old South Jordan mother of three recalls. "You almost think back, what did I do wrong? Did I do something I shouldn't have?"

To help parents nationwide seeking similar answers, the University of Utah is analyzing all stillbirths in Salt Lake County from 2006 through 2008 and attempting to pinpoint the many causes of death.

Most parents who lose their babies during pregnancy never find out the true cause. With almost 27,000 losses a year, stillbirth is 10 times more likely to happen than Sudden Infant Death Syndrome.

But pregnancy loss remains largely unscrutinized in the United States. Doctors are hesitant to suggest autopsies. Insurance companies may not cover them. And there's an attitude that fetal death is "God's will," or is at least unavoidable.

For the thousands of parents who never get to bring their babies home, the research under way represents hope. Doctors can't prevent stillbirths if they don't know what caused them in the first place.

"Look at SIDS: SIDS deaths have dropped dramatically [since] they started doing research," says Rose Carlson, program director of the Missouri-based national office of Share Pregnancy and Infant Loss Support.

"People haven't focused." The U. is doing its research as one of five universities in the Stillbirth Collaborative Research Network, created after parents lobbied the National Institutes of Health (NIH) to help them.

The network is attempting to answer basic questions: How often does stillbirth occur? What are the causes, and what are the best protocols to investigate the deaths?

Robert Silver, chief of the U.'s division of maternal and fetal medicine and principal investigator for Utah's portion of the study, notes researchers have done a better job of preventing infant death.

Infant mortality dropped 35 percent from 1985 to 2001; stillbirth rates declined just 17 percent in the same time period.

"People haven't focused on [stillbirths] as much as something we could potentially intervene and do something about," he said.

But intervention can work.

After losing a second son to stillbirth last January, Alma Mozqueda of Taylorsville enrolled in the study and believes she is receiving better care during her new pregnancy.

In her two previous births, the 22-year-old suffered what's called an "incompetent cervix," in which the tip of the womb opens too early, allowing bacteria to infect the baby.

In her apartment with her 6-year-old daughter, Marie, snug at her side, Mozqueda said she feels a part of her family has been ripped from her.

"I only touched his little fingers and hands," she said. "I feel guilty for not holding him and letting him know, "I am here for you even though you are not here with me.' 2

She planned to give up on having more children, but she subsequently became pregnant, and daughter Leticia is due in March. Mozqueda's cervix has been sewn shut and she is taking medication to prevent another infection.

"I have a lot more hope this time," she said.

Rates and risks. The NIH suspects thousands of stillbirths are never reported. To help discover the true number, U. researchers check Salt Lake County hospital logs and will compare those numbers with what is reported to the Utah Department of Health.

After nurses have learned of a stillbirth, they have the delicate task of seeing if families want to participate in the research. They also enroll mothers of live births as a control group.

To determine risk factors, mothers are questioned about their prenatal care, stress levels, medical conditions, previous pregnancies, and use of drugs, alcohol, cigarettes and vitamins.

Doctors already know that women who are black, overweight, over 35, or have diabetes, blood clots or high blood pressure are at a higher risk of stillbirth. With this study, they will try to figure out why.

"Maybe if you have diabetes plus a certain gene you have a stillbirth, whereas if you have diabetes with a different gene you don't," says Silver.

Amazingly, there is no standard protocol for investigating stillbirths. One study goal is to advise doctors on what tests are most useful.

Researchers are arranging autopsies, examining placentas and testing mothers' blood. They are looking for viruses, bacteria, genetic problems or complications with the placenta or umbilical cord.

Autopsies are a touchy subject. Just 20 percent of Utah hospitals perform them, even though it is a valuable tool, Silver says. Losses are often chalked up to "cord complications" when in fact that may not be the cause, he says.

Through the study, 70 percent of the Utah women have agreed to autopsies of their babies. Even then, answers may not be found.

The role of genetics.

Nicole Hawkins joined the study last year after losing her son, Matthew, when she was seven months pregnant. While Christmas shopping, she realized the baby had stopped moving.

Once at the hospital, "there was no heartbeat," says Hawkins, a psychologist who lives in Bluffdale.

She agreed to an autopsy, but the results weren't conclusive.

The baby had Down Syndrome, there was evidence of a lack of oxygen and signs of cancer. She chalks it up to "God's way of intervening."

But the process of searching for an answer was valuable, she says. "You definitely want to know if there's something wrong with you or something you could have done differently."

When the problem is genetics, little can be done.

Silver estimates that 20 percent of stillbirths can't be saved because of severe genetic problems in the fetuses. As part of the study, the U. will be using experimental genetic tests to find new causes of death.

Traditionally, genetic tests search for missing or extra chromosomes, but they can't narrow in to find problems in a single gene, unless researchers know what they are looking for. Silver says a marriage of computer technology and molecular genetics is allowing researchers to randomly screen thousands of genes at the same time.

"We think that in a lot of cases of stillbirth, there's going to be a mistake in a single gene," he says.

That still leaves a large number of stillbirths that could be saved. Anecdotally, Silver is finding causes that include abnormal placentas, bacterial infections (including group B steptococcus) and medical conditions that put the mother at risk for blood clots.

"A majority of these babies that get past 20 weeks are reasonably healthy," Silver says. "Only by figuring out which of those hundreds of causes your family fits into, will that give us the best chance of preventing it from happening again."

Hawkins was closely monitored during the last trimester of her subsequent pregnancy and was induced early. At birth, Michael was a healthy 9-pounder.

"Please bless Kylie." Adams also enrolled in the study and learned the reason for Kylie's death: neonatal hemochromatosis. The disease, in which the baby has toxic amounts of iron, is usually deadly in the womb or kills babies in the first weeks of life.

Now, Adams can stop blaming herself the cause of the syndrome remains a medical mystery. But the diagnosis adds new complications. She has an 80 percent chance of having the same problem in a subsequent pregnancy, according to the American Hemochromatosis Society.

But she continues to have faith.

"The family prayer," says Adams, "is, 'Please bless Kylie and bless that Mom will have another baby.' "

hmay@sltrib.com