Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2011 Apr 13;11 Suppl 3(Suppl 3):S3.
doi: 10.1186/1471-2458-11-S3-S3.

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

Sidra Ishaque  1 , Mohammad Yawar Yakoob, Aamer Imdad, Robert L Goldenberg, Thomas P Eisele, Zulfiqar A Bhutta
Affiliations
Meta-Analysis

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

Sidra Ishaque et al. BMC Public Health. .

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 randomized 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram showing identification of studies
Figure 2
Figure 2
Forest plot for meta-analysis of the effect of malaria prevention in pregnancy (IPTp and ITNs) used during first or second pregnancy on preventing stillbirths
Figure 3
Figure 3
Treatment of HIV in pregnancy: Any antiretroviral vs. placebo Outcome: Stillbirth
Figure 4
Figure 4
Treatment of bacterial vaginosis in pregnancy: Any antibiotic versus placebo/no Outcome: Perinatal death
See this image and copyright information in PMC

References

    1. Lawn JE, Yakoob MY, Haws RA, Soomro T, Darmstadt GL, Bhutta ZA. 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Pregnancy Childbirth. 2009;9(Suppl 1):S2. doi: 10.1186/1471-2393-9-S1-S2. - DOI - PMC - PubMed
    1. Goldenberg RL, McClure EM, Saleem S, Reddy UM. Infection-related stillbirths. Lancet. pp. 1482–1490. - DOI - PMC - PubMed
    1. Goldenberg RL, Thompson C. The infectious origins of stillbirth. Am J Obstet Gynecol. 2003;189(3):861–873. doi: 10.1067/S0002-9378(03)00470-8. - DOI - PubMed
    1. Herschel M, Hsieh HL, Mittendorf R, Khoshnood B, Covert RF, Lee KS. Fetal death in a population of black women. Am J Prev Med. 1995;11(3):185–189. - PubMed
    1. Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000;342(20):1500–1507. doi: 10.1056/NEJM200005183422007. - DOI - PubMed