Causes of and factors associated with stillbirth in low‐ and middle‐income countries: a systematic literature review

Abstract

Background Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand causes and contributing factors. Methods We conducted a systematic review of studies reporting factors associated with and cause(s) of stillbirth in low‐ and middle‐income countries (2000–13). Narrative synthesis to compare similarities and differences between studies with similar outcome categories. Main results A total of 142 studies with 2.1% from low‐income settings were investigated; most report on stillbirths occurring at health facility level. Definition of stillbirth varied; 10.6% of studies (mainly upper middle‐income countries) used a cut‐off point of ≥22 weeks of gestation and 32.4% (mainly lower income countries) used ≥28 weeks of gestation. Factors reported to be associated with stillbirth include poverty and lack of education, maternal age (>35 or <20 years), parity (1, ≥5), lack of antenatal care, prematurity, low birthweight, and previous stillbirth. The most frequently reported cause of stillbirth was maternal factors (8–50%) including syphilis, positive HIV status with low CD4 count, malaria and diabetes. Congenital anomalies are reported to account for 2.1–33.3% of stillbirths, placental causes (7.4–42%), asphyxia and birth trauma (3.1–25%), umbilical problems (2.9–33.3%), and amniotic and uterine factors (6.5–10.7%). Seven different classification systems were identified but applied in only 22% of studies that could have used a classification system. A high percentage of stillbirths remain ‘unclassified’ (3.8–57.4%). Conclusion To build capacity for perinatal death audit, clear guidelines and a suitable classification system to assign cause of death must be developed. Existing classification systems may need to be adapted. Better data and more data are urgently needed.

Stillbirth in Nigeria: Rates and Risk Factors Based on 2013 Nigeria DHS

“…Generally, our regression analysis revealed some risk factors to be strongly associated with SBs as has been reported in the literature: advanced maternal age (greater than 35 years); low or lack of maternal education; socio-economic disadvantage; antenatal care utilization; ethnic minority; pregnancy desire; place of delivery; type of delivery; indoor air pollution from solid fuels; rural residence; maternal obesity; use of contraception; sex of baby and type of pregnancy [6]. According to Aminu et al, these risk factors could broadly be classified into four: maternal; fetal; health system and socioeconomic [6].…”

“…According to Aminu et al, these risk factors could broadly be classified into four: maternal; fetal; health system and socioeconomic [6].…”

“…The independent or explanatory are listed above with their operational definitions. These variables were selected based on review of empirical research [6]- [8] [13].…”

Analysis of risk factors of stillbirth: a hospital based study in a tertiary care centre

“…Sociodemographic factors and health care delivery related variables like poverty, lack of education, pre-pregnancy obesity, advanced maternal age, lack of antenatal care, smoking have been implicated in stillbirth. [3][4][5][6] Exposure to high levels of fine particulate air pollution in the third trimester of pregnancy is reported to be associated with increased stillbirth risk. 7 However pregnancy complication or feto-placental pathology are the major cause of fetal death.The pregnancy complication commonly associated with IUFD as reported in literature are preeclampsia, antpartum haemorrhage (APH), oligohydramnios, intrauterine growth restriction (IUGR).…”

Cobertura y oportunidad de la atención prenatal en mujeres pobres de 6 países de Mesoamérica

“…Una cantidad de estudios han demostrado la importancia de la atención prenatal (AP) para mejorar los resultados de salud materna, del niño y del lactante [1][2][3]. La AP permite a los proveedores de la salud evitar, detectar y manejar complicaciones obstétricas y además se asocia a un menor riesgo de mortalidad materna, parto prematuro y bajo peso al nacer [4][5][6].…”