Predictors of stillbirth among HIV‐infected Tanzanian women

Abstract

Objective-To determine maternal risk factors for stillbirth among pregnant HIV-infected women in sub-Saharan Africa.Design-Prospective cohort study nested within a micronutrient trial. At enrollment, maternal sociodemographic, obstetric, immunologic, clinical, and nutritional variables were measured. Women were followed through monthly clinic visits until delivery. Multivariate predictors of stillbirth were identified in Poisson regression models.Setting-Antenatal clinic in a tertiary care hospital in urban Dar es Salaam, Tanzania.Population-N = 1,078 women enrolled between 12 and 27 weeks of gestation.Main outcome measures-Stillbirth (delivery of dead baby ≥ 28 weeks' gestation), fresh stillbirth, and macerated stillbirth.Results-Among 1,017 singleton pregnancies, there were 49 stillbirths, yielding a stillbirth risk of 50.0 per 1,000 deliveries (95% Confidence Interval(CI) = 37.2, 65.6). Of stillbirths with known type, 53.7% were fresh and 46.3% macerated. In multivariate analyses, baseline measures of late ( ≥ 21 weeks' gestation) study entry (Relative Risk (RR) = 2.13, 95% CI = 1.17, 3.87), CD3 count ≥ 1,179 cells/ml (RR = 2.15, 95% CI = 1.16, 4.01), stillbirth history (RR = 3.53, 95% CI = 1.30, 9.59), primiparity (RR = 3.65, 95% CI = 1.83, 7.29), and syphilis infection (RR = 2.06, 95% CI = 1.09, © 2009 Informa UK Ltd.Correspondence: Roland Kupka, UNICEF Regional Office for West and Central Africa, P.O. Box 29720, Dakar-Yoff, Senegal. rkupka@post.harvard.edu. Publisher's Disclaimer: Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.Clinical Trial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00197743. Declaration of interest:The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper. The opinions and statements in this article are those of the author, and may not represent official UNICEF policies. NIH Public Access Author ManuscriptActa Obstet Gynecol Scand. Author manuscript; available in PMC 2010 January 1. Conclusions-Applying antenatal screening and preventive tools for the socioeconomic, obstetric, immunologic, and clinical risk factors identified may assist in reducing the high incidence of stillbirth among HIV-infected women in urban sub-Saha...

Community‐based stillbirth rates and risk factors in rural Sarlahi, Nepal

“…Both low and high maternal age have been associated with an increased stillbirth risk [3,17,18,20]. However, when the present analysis was stratified by parity, mothers below the age of 20 years did not have a higher rate of stillbirths, a finding that is corroborated by previous data from Sarlahi [19].…”

“…Nulliparity is a well-established risk factor for stillbirth [17], intrapartum stillbirth [18], and intrapartum-related neonatal mortality [11]. Mothers who have never experienced vaginal childbirth may be at a higher risk for delivering a stillborn infant because of pelvic contraction and obstruction of labor.…”

“…Studies in low-, middle-and high-income countries have linked low socioeconomic status and stillbirth [21,22], particularly antepartum and intrapartum stillbirth occurring at term [18,21]. A low socioeconomic status may lead to stillbirth via several pathways, including poor access to prenatal and/or intrapartum obstetric care; lack of education about, and poor recognition of, danger signs to seek care; behaviors during pregnancy that increase the risk of stillbirth (smoking, heavy physical labor, poor hygiene); increased risk for maternal infections; increased maternal morbidity; poor living conditions and associated psychosocial stress; and malnutrition (stunting, wasting, and anemia).…”

Predictors of HIV positivity among pregnant women presenting for obstetric care in South India – a case-control study

“…This specifically translated into three times higher likelihood of being infected with HIV-1 if presenting for care late in the (Cohen et al, 2008;Kupka et al, 2009;Lemos et al, 2009;Pai et al, 2008). It is unknown, if this phenomenon is due to a prior knowledge of HIV status and stigma and discrimination related to that , versus a general lack of health seeking behavior among HIV-positive women (Chomat et al, 2009).…”

“…We think it is the latter, as a higher percentage of HIV-positive women were primigravida, with little probability of having HIV testing outside of antenatal care. In addition, late presentation for care has been associated with adverse pregnancy outcomes such as still birth (Kupka et al, 2009). Interestingly, we found a third of HIVpositive women had a history of fetal loss and/or loss of live born as compared to only 18% among HIVnegative (pB0.0001) with a 2.4 times higher risk of HIV positivity.…”