Modifiable risk factors for stillbirth: a literature review

Modifiable risk factors for stillbirth: a literature review

Ms. Tamara Escañuela Sánchez (1), Dr. Sarah Meaney (2), Dr. Keelin O’Donoghue (1)

(1) Pregnancy Loss Research Group, INFANT Center, University College Cork, Ireland; (2) Pregnancy Loss Research Group, National Perinatal Epidemiology Centre, University College Cork, Ireland.

Introduction
Stillbirth is defined in Ireland as an infant born weighing 500grammes and/or at 24 weeks gestation who shows no signs of life. Having a stillborn baby has a wide range of individual and societal consequences. The aim of this work was to review the literature on risk factors that have a behavioural component.

Methods
To conduct this review, the most relevant studies in the research area of risk factors for stillbirth were selected. The first step was an exploratory literature review including all risk factors, once this work was completed; a focused literature review on modifiable risk factors was conducted.

Results
Evidence from this literature review found that supports that maternal modifiable behaviours have an impact on the risk of stillbirth. Attendance at antenatal care visits allows healthcare practitioners to monitor pregnancies, detect potential risk factors and diagnose pregnancy complications. The findings from this literature review suggest that smoking and illicit drug use may have the highest impact (OR 1.44 95%CI 1.20 to 1.73 and OR 1.94 95%CI 1.16 to 3.27 respectively) yet there is consensus in the literature that more clinical trials are needed to establish the safety of medical drug use during pregnancy. Maternal weight also needs to be taken into consideration when planning a pregnancy since it is not only an independent risk factor, but it can also lead to other risks such as gestational hypertension or diabetes. With regard to maternal sleeping habits, avoiding left-side sleeping might be a simple measure to reduce stillbirth risk (aOR left side 1.00; right side 2.54 95%CI 1.04 – 3.01; back 2.54, 95%CI 1.28 – 4.19), being possibly the most easily modifiable behaviour included in this review.

Conclusion
All these behaviours can be addressed through antenatal interventions. More research is needed to establish interventions targeting these behaviours as preventive measures to reduce the risk of adverse outcomes such as stillbirth.

Ethics statement
No ethical approval was sought or necessary for the completion of this literature review.

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