First Global Review Examines Measures to Prevent Over 3.2 million Stillbirths

Researchers from the Johns Hopkins Bloomberg School of Public Health, along with colleagues from Aga Khan University and Save the Children, have conducted the first global review of potential maternal interventions to avert stillbirths. Prompted by the 3.2 million stillbirths that occur globally, the researchers, led by Dr. Zulfiqar Bhutta at Aga Khan University in Karachi, Pakistan, reviewed multiple interventions and outlined research, program and policy recommendations to greatly reduce the number of stillbirths in low- to middle-income countries. Their results are published in six papers featured in the May online issue of BMC Pregnancy and Childbirth.

"We found compelling evidence for impact of several interventions on preventing stillbirths, especially emergency obstetric care; screening and treatment for maternal infections such as syphilis, and prevention and treatment of malaria,” said Gary Darmstadt, MD, MS, co-author and co-editor of the study and former director of the Johns Hopkins Bloomberg School of Public Health’s International Center for Advancing Neonatal Health. “We also have parallel evidence from a range of delivery strategies which suggest that these interventions can be implemented and scaled up in situations where they are most needed. While key data gaps remain, the largest remaining gap is for more widespread recognition and political commitment to reduce this massive loss of life."

In an attempt to decrease the number of stillbirths globally, researchers examined stillbirth prevention methods in a series of six papers. Paper one addresses the global burden, and the epidemiology, risk factors and causes of stillbirths, and lays down the methodology and framework for the worldwide review. Papers two and three cover the behavioral and medical interventions used before and during pregnancy, including interventions targeted at medical conditions and infections in the mother. Paper four focuses on screening and monitoring interventions during pregnancy and labor, including ultrasound and Doppler studies, managing maternal diabetes, and partographs and cardiotocography, among others. Paper five deals with the evidence of interventions during labor, while paper six examines health system solutions, including training health workers in facilities and at the community level to improve care during pregnancy and childbirth.

The release of the study comes during an International Conference on Prematurity and Stillbirth being held May 7 to 10 in Seattle, Wash., to examine the neglected issues of prematurity and stillbirth. Every year 3.2 million stillbirths occur around the world and 98 percent take place in low- to middle-income countries. Stillbirths continue to be underreported and largely absent from data records and national policy making. The global burden of intrapartum stillbirths–stillbirths that take place during labor–is around 1 million, again mostly in low- and middle-income countries, which is more than all child deaths from malaria worldwide. Despite this, the investment and attention given to tackling stillbirths is low.

This stillbirth review provides substantial evidence for maternal interventions. The collaborative analysis is a crucial foundation to strengthen the knowledge and efforts to prevent this enormous health burden, and emphasizes the need for stillbirth data to be included in global data tracking systems and policy dialogue.

“Stillbirths–the global picture and evidence-based solutions,”was edited by Zulfiqar A. Bhutta, Gary L. Darmstadt, Joy E. Lawn and Robert L Goldenberg, and co-written with Rachel Haws from the Department of International Health and Yawar Yakoob at Aga Khan University.

The research was supported by the Saving Newborn Lives program of Save the Children-US through a grant from the Bill & Melinda Gates Foundation.