The relationship between sociodemographic variables and pregnancy loss in a rural area of Bangladesh

Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982-2011): a cross-sectional, population-based study

OBJECTIVES

To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011.

METHODS

Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI).

RESULTS

34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes.

CONCLUSIONS

The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care.

Assessment of risk factors for stillbirth among pregnant women in Jamaica

A case - control study was conducted to assess the risk factors of stillbirth among pregnant women in Jamaica. A total of 314 women participated (160 with stillborn babies and 154 with live-born babies). A questionnaire designed to collect information on sociodemographic characteristics, antenatal care, medical and sexually transmitted disease (STD) history, method of delivery and infant birth and health status was administered to each woman. Medical records were reviewed to verify medical history. Six variables were found to be significant predictors of stillbirth by multivariate logistic regression. Low birth weight (OR = 4.3, CI = 2.4 - 7.7), complications during pregnancy or delivery (OR = .19, CI = 0.09 - 0.41), method of delivery (caesarean section; OR = 7.2, CI = 1.6 - 33.2), number of living children (OR = 0.54, CI = 0.40 - 0.73), number of antenatal visits (less than three; OR = 2.0, CI = 1.3 - 3.1), and presence of unfavourable and /or adverse fetal outcome (OR = 4.0, CI = 1.8 - 9.2) were found to be associated with stillbirth. These findings have important implications in establishing policies for prenatal care in Jamaica.