Risk factors related to stillbirth in pregnant mothers: a case-control study

Document Type : Original Article

Authors

1 M.Sc. of Epidemiology, Qaen Treatment and Health Network, Birjand University of Medical Sciences, Birjand, Iran.

2 M.Sc. of Epidemiology, Komijan Treatment and Health Network, Arak University of Medical Sciences, Arak, Iran.

3 B.Sc. of Public Health, Qaen Treatment and Health Network, Birjand University of Medical Sciences, Birjand, Iran.

4 General practitioner, Faculty of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran.

Abstract

Introduction: Stillbirth is one of the adverse outcomes of birth in both developing and developed countries. Worldwide, more than a million pregnancies end in stillbirth, most of which occur in low- and middle-income countries. This study was conducted with aim to determine maternal and fetal risk factors for stillbirth in Qaenat city.
Methods: This case-control study was conducted from 2016-2021 on 104 stillbirths and 208 live births (controls) in urban and rural health centers of Qaenat city. Data related to stillbirths were collected using a researcher-made checklist. Data analysis was done using SPSS software (version 26) and chi-square and logistic tests. P< 0.05 was considered statistically significant.
Results: The total stillbirth rate was 9.88 per 1000 live births. In univariate analysis, mother's age (P=0.04), husband's age (P=0.009), history of twin birth (P=0.006), history of underlying disease (P=0.04), gestational age (P=0.001), birth weight (P=0.001), history of abortion (P=0.02) and history of stillbirth (P=0.03) showed a significant relationship with stillbirth. In the multivariate logistic regression analysis, the birth of a baby under 37 weeks (aOR=17.77, CI:7.20-43.83, P<0.001), birth weight less than 2500 gr (aOR=5.36, CI:2.22-12.96, P<0.001) and history of abortion (aOR=2.38, CI:1.07-5.27, P=0.03) showed a significant relationship with stillbirth.
Conclusion: The prevalence of stillbirth in Qaenat city was relatively high. In this study, several maternal and fetal risk factors such as birth less than 37 weeks gestational age, birth weight less than 2500 gr and history of abortion were identified for stillbirth. Early identification of at-risk pregnancies and appropriate intervention may help reduce the occurrence of stillbirths. Therefore, it is necessary to identify high-risk people and provide them with necessary training and counseling.

Keywords


  1. Tasew H, Zemicheal M, Teklay G, Mariye T. Risk factors of stillbirth among mothers delivered in public hospitals of Central Zone, Tigray, Ethiopia. African health sciences 2019; 19(2):1930-7.
  2. Tiruneh D, Asegid A. Mothers’ experiences with still birth: a dead fetus as a’tax’given to Allah: qualitative phenomenological study. Int J Pregnancy Child Birth 2019; 5(4):160-5.
  3. Joseph KS, Basso M, Davies C, Lee L, Ellwood D, Fell DB, et al. Rationale and recommendations for improving definitions, registration requirements and procedures related to fetal death and stillbirth. Bjog 2017; 124(8):1153.
  4. World Health Organization. Organization WH. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. World Health Organization; 2004.
  5. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet 2016; 387(10018):587-603.
  6. Aminu M, Bar‐Zeev S, van den Broek N. Cause of and factors associated with stillbirth: a systematic review of classification systems. Acta obstetricia et gynecologica Scandinavica 2017; 96(5):519-28.
  7. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health 2016; 4(2):e98-108.
  8. Khalili N, Heidarzadeh M, Habibelahi A, Tayefi B, Ramezani M, Rampisheh Z, et al. Stillbirth in Iran and associated factors (2014-2016): A population-based study. Medical Journal of the Islamic Republic of Iran 2020; 34:38.
  9. Safaei Nezhad A, Akrami F, Kharaghani R, Rastegari L. Maternal, Fetal, and Delivery Risk Factors for Stillbirth: A Population-Based Study. Journal of Critical Care Nursing 2018; 11(3):1-6.
  10. Aminu M, Bar-Zeev S, White S, Mathai M, van den Broek N. Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa. BMC pregnancy and childbirth 2019; 19(1):1-10.
  11. Berhe B, Mardu F, Legese H, Gebrewahd A, Gebremariam G, Tesfay K, et al. Prevalence of anemia and associated factors among pregnant women in Adigrat General Hospital, Tigrai, northern Ethiopia, 2018. BMC research notes 2019; 12(1):1-6.
  12. Berhe T, Gebreyesus H, Teklay H. Prevalence and determinants of stillbirth among women attended deliveries in Aksum General Hospital: a facility based cross-sectional study. BMC research notes 2019; 12:1-6.
  13. Nankali A, Hematti M, Mahdavi Z. Study of the factors associated with stillbirth in pregnant women admitted in Imam Reza Teaching Hospital in Kermanshah (2011-2014). Iran J Obstet Gynecol Infertil 2017; 20(1):1-9.
  14. Heazell AE, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, et al. Stillbirths: economic and psychosocial consequences. The Lancet 2016; 387(10018):604-16.
  15. Zolfizadeh F, Soltani M, Soltani S, Kamali S, Tabatabaee HR, Nasiri N, et al. The Correlation Between Stillbirth and Related Risk Factors: A Case-Control Study. Hormozgan Medical Journal 2019; 23(3):e92616-.
  16. Egbe TO, Ewane EN, Tendongfor N. Stillbirth rates and associated risk factors at the Buea and Limbe regional hospitals, Cameroon: a case-control study. BMC pregnancy and childbirth 2020; 20:1-8.
  17. Hajipour M, Tabatabaee HR, Etemad K, Ansari H, Moghadam AA, Mohammadi M, et al. The pre-pregnancy risk factors of stillbirth in pregnant Iranian women: A population-based case-control study. Health Scope 2019; 8(3).
  18. Hajian-Tilaki K, Esmaielzadeh S, Sadeghian G. Trend of stillbirth rates and the associated risk factors in Babol, northern Iran. Oman medical journal 2014; 29(1):18.
  19. Abebe H, Shitu S, Workye H, Mose A. Predictors of stillbirth among women who had given birth in Southern Ethiopia, 2020: A case-control study. Plos one 2021; 16(5):e0249865.
  20. Wang H, Bhutta ZA, Coates MM, Coggeshall M, Dandona L, Diallo K, et al. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet 2016; 388(10053):1725-74.
  21. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. Bmj 2013;346.
  22. Walfisch A, Brown R, Mallozzi A, Hallak M, Shrim A. Maternal characteristics of pregnancies with intrauterine fetal demise. Journal of Perinatal Medicine 2016;44(7):779-84.
  23. Choudhary A, Gupta V. Epidemiology of intrauterine fetal deaths: a study in tertiary referral centre in Uttarakhand. IOSR J Dent Med Sci 2014;13(3):03-6.
  24. Berhie KA, Gebresilassie HG. Logistic regression analysis on the determinants of stillbirth in Ethiopia. Maternal health, neonatology and perinatology 2016; 2:1-10.
  25. Jahani MA, Akbarian RZ, Naghavian M, Salmanian T, Haghshenas MM. Factors affecting stillbirth rate in the hospitals affiliated to Babol University of Medical Sciences. Iranian Journal of Neonatology 2015; 6(3):22-27.
  26. Mobaseri S. The prevalence of stillbirth and infant mortality: Maternal and neonatal factors. Preventive Care in Nursing & Midwifery Journal 2016; 6(3):82-9.
  27. Zarei R, Athari F, Aghaie N. Assessing of the frequency of intrauterine fetal death and related factors in Ahvaz Imam Khomeini hospital. Scientific Medical Journal (AJUMS) 2010; 8(4):437-43.
  28. Safarzadeh A, Ghaedniajahromi M, Ghaedniajahromi M, Rigi F, Massori N. Intra uterine fetal death and some related factors: A silent tragedy in southeastern Iran. J Pain Relief 2014; 3(129):2167-846.
  29. Ghorat F, Ghafarzadeh R, Jafarzadeh Esfehani R. Perinatal mortality and its associated risk factors: A study in the north-east of Iran. Iranian Journal of Neonatology IJN 2016; 7(1):47-51.
  30. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reproductive health 2013; 10(1):1-14.
  31. Okonofua FE, Ntoimo LF, Ogu R, Galadanci H, Mohammed G, Adetoye D, et al. Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study. BMC Pregnancy and childbirth 2019; 19:1-9.
  32. Chuwa FS, Mwanamsangu AH, Brown BG, Msuya SE, Senkoro EE, Mnali OP, et al. Maternal and fetal risk factors for stillbirth in Northern Tanzania: A registry-based retrospective cohort study. PloS one 2017; 12(8):e0182250.
  33. Fikre R, Ejeta S, Gari T, Alemayhu A. Determinants of stillbirths among women who gave birth at Hawassa university comprehensive specialized hospital, Hawassa, Sidama, Ethiopia 2019: a case-control study. Maternal Health, Neonatology and Perinatology 2021; 7(1):1-9.
  34. Maghsoudlou S, Cnattingius S, Aarabi M, Montgomery SM, Semnani S, Stephansson O, et al. Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population‐based case–control study. Acta obstetricia et gynecologica Scandinavica 2015; 94(10):1095-101.