Infection-related stillbirths

Abstract

Infection is an important cause of stillbirths worldwide: in low-income and middle-income countries, 50% of stillbirths or more are probably caused by infection. By contrast, in high-income countries only 10-25% of stillbirths are caused by infection. Syphilis, where prevalent, causes most infectious stillbirths, and is the infection most amenable to screening and treatment. Ascending bacterial infection is a common cause of stillbirths, but prevention has proven elusive. Many viral infections cause stillbirths but aside from vaccination for common childhood diseases, we do not have a clear prevention strategy. Malaria, because of its high prevalence and extensive placental damage, accounts for large numbers of stillbirths. Intermittent malarial prophylaxis and insecticide-treated bednets should decrease stillbirths. Many infections borne by animals and vectors cause stillbirths, and these types of infections occur frequently in low-income countries. Research that better defines the relation between these infections and stillbirths, and develops strategies to reduce associated adverse outcomes, should play an important part in reduction of stillbirths in low-income countries.

Figure 1

Histological chorioamnionitis in stillborn babies by gestational age Reproduced from Lahra and colleagues, with permission from Elsevier.

Figure 2

Global distribution of infection with Plasmodium falciparum malaria Reproduced from Hay and Snow, and licensed to the Malaria Atlas Project (http://www.map.ox.ac.uk). PfAPI=P falciparum annual parasite incidence per 1000 people per year. PfPR_2–10=P falciparum parasite rate age-standardised to 2–10 years.