Predictors of stillbirth in sub-saharan Africa.
OBJECTIVE
To describe the incidence and predictors of stillbirth in a predominantly human immunodeficiency virus (HIV)-infected African cohort.


METHODS
Human Immunodeficiency Virus (HIV) Prevention Trials Network (HPTN) 024 was a randomized controlled trial of empiric antibiotics to reduce chorioamnionitis-related perinatal HIV transmission. A proportion of HIV-uninfected individuals were enrolled to reduce community-based stigma surrounding the trial. For this analysis, only women who gave birth to singleton infants were included.


RESULTS
Of 2,659 women enrolled, 2,434 (92%) mother- child pairs met inclusion criteria. Of these, 2,099 (86%) infants were born to HIV-infected women, and 335 (14%) were born to HIV-uninfected women. The overall stillbirth rate was 32.9 per 1,000 deliveries (95% confidence interval [CI] 26.1-40.7). In univariable analyses, predictors for stillbirth included previous stillbirth (odds ratio [OR] 2.3, 95% CI 1.2-4.3), antenatal hemorrhage (OR 14.4, 95% CI 4.3-47.9), clinical chorioamnionitis (OR 20.9, 95% CI 5.1-86.2), and marked polymorphonuclear infiltration on placental histology (OR 2.9, 95% CI 1.7-5.2). When compared with pregnancies longer than 37 weeks, those at 34-37 weeks (OR 1.7, 95% CI 0.8-3.4) and those at less than 34 weeks (OR 22.8, 95% CI 13.6-38.2) appeared more likely to result in stillborn delivery. Human immunodeficiency virus infection was not associated with a greater risk for stillbirth in either univariable (OR 1.5, 95% CI 0.7-3.0) or multivariable (adjusted OR 1.11, 95% CI 0.38-3.26) analysis. Among HIV-infected women, however, decreasing CD4 cell count was inversely related to stillbirth risk (P=.009).


CONCLUSIONS
In this large cohort, HIV infection was not associated with increased stillbirth risk. Further work is needed to elucidate the relationship between chorioamnionitis and stillbirth in African populations.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00021671


METHODS
II.
Chi
Benjamin H
BH
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. bchi@cidrz.org
Wang
Lei
L
Read
Jennifer S
JS
Taha
Taha E
TE
Sinkala
Moses
M
Brown
Elizabeth R
ER
Valentine
Megan
M
Martinson
Francis
F
Goldenberg
Robert L
RL
D017954:Africa South of the Sahara / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002821:Chorioamnionitis / Q000188:drug therapy* / Q000517:prevention & control; D015331:Cohort Studies; D003906:Developing Countries; D004311:Double-Blind Method; D004651:Employment; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000150:complications* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000401:mortality*; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D013590:Syphilis, Congenital / Q000401:mortality / Q000517:prevention & control
D000900:Anti-Bacterial Agents