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A recent review of stillbirths in the Uinta Basin seemed to confirm a midwife's concerns about premature infant deaths and birth defects in 2013.

Both the Utah Department of Health and the Tri-County Health Department declined to dig any deeper into the data in March, choosing to focus on maternal nutrition and wait and see if adverse pregnancy outcomes continue.

But Utah Physicians for a Healthy Environment doesn't want to wait and see. The doctors will hold a public forum tonight in Vernal as part of a year-long education campaign.

"We're not gonna come out here and say we're 100 percent sure this is a direct link tied to the air pollution problems," said Tim Wagner, executive director of Utah Physicians. "But it certainly seems like all the studies and information we've seen continue to show a pretty strong correlation between certain air pollutants and these kinds of outcomes."

In March, state health officials confirmed an uptick in stillbirths documented by a midwife two years ago. But in a larger statistical picture, the apparent rise does not set the region apart from the rest of Utah, said Sam Lefevre, state epidemiologist.

LeFevre's analysis did not seek to pinpoint any environmental links, but did break down the possible causes listed for each of the stillbirths.

The study of Daggett, Duchesne and Uintah counties reviewed data from 1991 to 2013 and found that about three in four stillbirths were "a complication at the time of birth involving the cord or placenta."

Such problems could stem from a variety of issues, including genetics, blood clots, tissue tears and high blood pressure, said Bob Silver, a University of Utah professor who specializes in stillbirths.

Another 12 percent of the tri-county stillbirths were due to developmental anomalies. Seven percent were attributed to pre-existing maternal health conditions, including diabetes. Three percent were related to trisomy, a genetic defect where fetuses develop with three chromosomes. And 2 percent resulted from Rh-factor sensitivity.

That breakdown is not significantly different from the causes of stillbirth in other parts of the country and the state.

Some Utah obstetricians-gynecologists and anesthesiologists point to other research that air pollution affects development during pregnancy and in childhood, citing studies from California and Ohio.

But managers at the Utah Department of Health worry the growing body of research is not conclusive. They note the studies do not pinpoint pollution as the cause and warn against alarming women.

"We all want better air quality. We just don't want to scare women in the process," Alfred Romeo, a nurse with the department's Pregnancy Risk Line and Mother To Baby Utah program, said recently. "Increased anxiety can cause bad outcomes and we get calls already from anxious women."

The Uinta Basin produces 80 percent of the state's oil and gas and its wintertime air pollution sometimes exceeds levels the U.S. Evironmental Protection Agency considers healthy. Pollution, like smoking, may raise the odds of having a stillbirth, Silver said. If mothers are predisposed for genetic or other reasons, poor air quality "could throw you over the edge."

A variety of other factors, including stress, diabetes and obesity also can play a part, said George Saade, a University of Texas stillbirth researcher who has collaborated with the University of Utah. Despite its importance in fetal development, Saade adds, few studies are focused on toxins found in the placenta.

"We know the placenta is important, but we don't know how to study it," Saade said. "It's hard to find tangible, actionable results. It's a frustrating topic."

Saade and researchers across the country are considering new ways to study adverse birth outcomes while the child is still in utero.

In Vernal, the decision of whether to pursue further study rests with the Tri-County Health Department. Director Jordan Mathis said his department will wait for more data from 2014 and 2015.

Boring into environmental factors could take a more invasive study that would involve swabbing the cheeks of family members and documenting their routines and diets.

Another option is for doctors to examine placenta, umbilical cord and fetal tissue for chemicals or toxins. Few stillbirths result in such an exam. Families often decline them under the misconception they won't be able to bury the child, Silver said. And doctors don't want to cause more pain by pushing for it.

Meanwhile, local health managers are pledging to improve prenatal programs. Officials are taking a hard look at nutrition and other initiatives for new mothers. They also plan to meet with local hospital staff.

"We can always do better," Mathis said.

Donna Young, a midwife whose 2013 report of about a dozen stillbirths in Vernal sparked the state investigation, believes the push won't curb adverse birth outcomes such as late-term miscarriages, birth defects and premature births. Young says the mothers she documented were already healthy and had good prenatal care.

aknox@sltrib.com Twitter: @anniebknox —

If you go

What • 'Air pollution and pregnancy' forum

Where • Vernal Junior High audtorium, 161 N. 1000 West

When • Friday at 7 p.m.