Epidemiology of stillbirths and maternal post-discharge outcomes following stillbirths in Uganda: a prospective cohort study

Methods

This prospective cohort study analyzed maternal and perinatal health data from 7131 women who delivered 7359 newborns at the Mbarara and Jinja Regional Referral Hospitals between April, 2022 and September, 2023. A stillbirth was defined as the death of a foetus ≥28 weeks of gestation. Univariate logistic regression models were used to determine potential predictors associated with stillbirth .

Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results: Among 7129 women who survived and were discharged post-delivery, 261 (3.7%) experienced a stillbirth. Six-week post-discharge readmission of women of stillborn infants was 8.5% as compared to 3% among those who were discharged with a live newborn.

Previous child death was strongly associated with stillbirth (OR: 7.11, 95% CI: 5.5–9.17, p <0.001), followed by transport delays >1 hour (OR: 2.71, 95% CI: 1.95–3.75) and pregnancy-related illnesses (OR: 1.70, 95% CI: 1.30–2.25). Each additional year of maternal age increased odds by 2% (OR: 1.02, 95% CI: 1.00–1.04). Protective factors included adequate antenatal care (4–8 visits) (OR: 0.51, 95% CI: 0.40–0.66) and partner support (OR: 0.72, 95% CI: 0.56–0.95).

Conclusion: Maternal morbidity following stillbirths is high. Furthermore, several demographic, health, and socioeconomic characteristics are strongly associated with stillbirths. Many stillbirths may be prevented following early identification of these characteristics through interventions to ensure expectant mothers receive adequate support during their pregnancy.

Ethics Declaration: This study was approved by Makerere University School of Public Health (MakSPH) Research and Ethics Committee (SPH-2021-177), the Uganda National Council of Science and Technology (UNCST) in Uganda (HS2174ES), and the University of British Columbia in Canada (H21-03709). This study has been registered at clinicaltrials.gov (NCT05730387). NOTE for restricted files: If you are not yet a CoLab member, please complete our membership application survey to gain access to restricted files within 2 business days.

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