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BMC Public Health

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Open Access 01-12-2011 | Review

Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review

Authors: Sidra Ishaque, Mohammad Yawar Yakoob, Aamer Imdad, Robert L Goldenberg, Thomas P Eisele, Zulfiqar A Bhutta

Published in: BMC Public Health | Special Issue 3/2011

Abstract

Background

Infection is a well acknowledged cause of stillbirths and may account for about half of all perinatal deaths today, especially in developing countries. This review presents the impact of interventions targeting various important infections during pregnancy on stillbirth or perinatal mortality.

Methods

We undertook a systematic review including all relevant literature on interventions dealing with infections during pregnancy for assessment of effects on stillbirths or perinatal mortality. The quality of the evidence was assessed using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach by Child Health Epidemiology Reference Group (CHERG). For the outcome of interest, namely stillbirth, we applied the rules developed by CHERG to recommend a final estimate for reduction in stillbirth for input to the Lives Saved Tool (LiST) model.

Results

A total of 25 studies were included in the review. A random-effects meta-analysis of observational studies of detection and treatment of syphilis during pregnancy showed a significant 80% reduction in stillbirths [Relative risk (RR) = 0.20; 95% confidence interval (CI): 0.12 - 0.34) that is recommended for inclusion in the LiST model. Our meta-analysis showed the malaria prevention interventions i.e. intermittent preventive treatment (IPTp) and insecticide-treated mosquito nets (ITNs) can reduce stillbirths by 22%, however results were not statistically significant (RR = 0.78; 95% CI: 0.59 – 1.03). For human immunodeficiency virus infection, a pooled analysis of 6 radomized controlled trials (RCTs) failed to show a statistically significant reduction in stillbirth with the use of antiretroviral in pregnancy compared to placebo (RR = 0.93; 95% CI: 0.45 – 1.92). Similarly, pooled analysis combining four studies for the treatment of bacterial vaginosis (3 for oral and 1 for vaginal antibiotic) failed to yield a significant impact on perinatal mortality (OR = 0.88; 95% CI: 0.50 – 1.55).

Conclusions

The clearest evidence of impact in stillbirth reduction was found for adequate prevention and treatment of syphilis infection and possibly malaria. At present, large gaps exist in the growing list of stillbirth risk factors, especially those that are infection related. Potential causes of stillbirths including HIV and TORCH infections need to be investigated further to help establish the role of prevention/treatment and its subsequent impact on stillbirth reduction.

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Title: Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review
Authors: Sidra Ishaque
Mohammad Yawar Yakoob
Aamer Imdad
Robert L Goldenberg
Thomas P Eisele
Zulfiqar A Bhutta
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: BMC Public Health / Issue Special Issue 3/2011
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/1471-2458-11-S3-S3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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Breastfeeding and the risk for diarrhea morbidity and mortality

Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size

The effect of folic acid, protein energy and multiple micronutrient supplements in pregnancy on stillbirths