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Effectiveness of Interventions to Screen and Treat Infections during Pregnancy

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More Intervention Effect Estimate Summaries

Reference
Ishaque S, Yakoob MY, Imdad A, Goldenberg RL, Eisele TP, Bhutta ZA.  Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review. BMC Public Health 2011 ; 11 (Suppl 3):  S3.

Background

  • Globally, infections during pregnancy account for an estimated half of 2.65 million stillbirths, especially in developing countries. (1, 2)
  • Among infections, various organisms have been implicated as causing stillbirth, including bacteria, viruses, protozoa, helminthes and fungi. (3)
  • This paper includes perinatal mortality as an outcome because most studies do not report disaggregated data for stillbirths, but combine stillbirths with early neonatal deaths (i.e. perinatal mortality).

Intervention Effects

Detection and Treatment (with penicillin) of Maternal Syphilis on Stillbirths

  • 80% reduction in stillbirths (RR: 0.20, 95% CI 0.12-0.34) –  meta-analysis of 8 observational studies (4) 
  • Low outcome-specific quality of evidence

Intermittent Preventive Treatment (IPTp) and Insecticide-treated Mosquito Nets (ITNs) on Stillbirths

  • 22% reduction in stillbirths (RR: 0.78, 95% CI 0.59-1.03) from IPTp and ITNs combined 
    • 6 RCTs – moderate outcome specific quality
  • 33% reduction in fetal loss with use of ITNs in pregnancy (RR: 0.67, 95% CI 0.47-0.97)  
    • 3 cRCTs – high outcome-specific quality 
  • No effect on stillbirths (RR: 0.96, 95% CI 0.62-1.50) or perinatal mortality (RR: 0.78, 95% CI 0.52-1.17) with IPTp
    • 3 RCTs – high outcome-specific quality of evidence

Antiretroviral Treatment for Maternal HIV on Stillbirths

  • No statistically significant reduction in stillbirth with the use of antiretrovirals in pregnancy compared to placebo (RR: 0.93, 95% CI 0.45-1.92) –  meta-analysis of 6 RCTs

Treatment of Bacterial Vaginosis on Perinatal Mortality

  • Non-significant reduction in perinatal mortality (OR: 0.88, 95% CI 0.50-1.55) – meta-analysis of 4 RCTs.  
  • Sub-group analysis showed similar results with the use of oral (OR: 0.96, 95% CI 0.53-1.73) and vaginal (OR 0.35, 95% CI 0.05-2.52) antibiotics on perinatal mortality

Intervention Recommendation

Treatment of maternal syphilis and prevention of malaria during pregnancy reduces the incidence of stillbirths. Existing data from randomized trials or observational studies on effectiveness of interventions for diseases such as HIV, ascending bacterial infections and TORCH infections in reducing stillbirths show null findings.

References from Ishaque Paper Cited Here

  1. Bhutta ZA, Yakoob MY, Lawn JE, Rizvi A, Friberg IK, Weissman E, Buchmann E, Goldenberg RL; Lancet’s Stillbirths Series steering committee. Stillbirths: what difference can we make and at what cost? Lancet 2011 Apr 30; 377(9776):1523-38.
  2. Goldenberg RL, McClure EM, Saleem S, Redy UM. Infection-related stillbirths. Lancet 275(9724): 1482-1490.
  3. Goldenberg RL, Culhane JF, Johnson DC. Maternal infection and adverse fetal and neonatal outcomes. Clin Perinataol 2005, 32(3): 523-559.
  4. Blencowe H, Cousens S, Kamb H, Lawn JE. Detection and treatment of syphilis in pregnancy to prevent syphilis related stillbirths and neonatal mortality. BMC Public Health 2011, 11(Suppl 3) S9.

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