title: Predictors of stillbirth among HIV-infected Tanzanian women.
abstract: OBJECTIVE
  To determine maternal risk factors for stillbirth among pregnant HIV-infected women in sub-Saharan Africa.
  
  
  METHODS
  Prospective cohort study nested within a micronutrient trial. At enrollment, maternal sociodemographic, obstetric, immunologic, clinical, and nutritional variables were measured. Women were followed through monthly clinic visits until delivery. Multivariate predictors of stillbirth were identified in Poisson regression models.
  
  
  METHODS
  Antenatal clinic in a tertiary care hospital in urban Dar es Salaam, Tanzania.
  
  
  METHODS
  N=1,078 women enrolled between 12 and 27 weeks of gestation.
  
  
  METHODS
  Stillbirth (delivery of dead baby > or = 28 weeks' gestation), fresh stillbirth, and macerated stillbirth.
  
  
  RESULTS
  Among 1,017 singleton pregnancies, there were 49 stillbirths, yielding a stillbirth risk of 50.0 per 1,000 deliveries (95% Confidence Interval(CI) = 37.2, 65.6). Of stillbirths with known type, 53.7% were fresh and 46.3% macerated. In multivariate analyses, baseline measures of late (> or = 21 weeks' gestation) study entry (Relative Risk (RR) = 2.13, 95% CI = 1.17, 3.87), CD3 count > or = 1,179 cells/ml (RR = 2.15, 95% CI = 1.16, 4.01), stillbirth history (RR = 3.53, 95% CI = 1.30, 9.59), primiparity (RR = 3.65, 95% CI = 1.83, 7.29), and syphilis infection (RR = 2.06, 95% CI = 1.09, 3.88) predicted increased stillbirth risk. Late study entry, illiteracy, stillbirth history, primiparity, CD3 count > or = 1,179 cells/ml, gonorrhea infection, and previous hospitalization predicted increased risk of fresh stillbirth, while living alone and syphilis infection predicted increased risk of macerated stillbirth.
  
  
  CONCLUSIONS
  Applying antenatal screening and preventive tools for the socioeconomic, obstetric, immunologic, and clinical risk factors identified may assist in reducing the high incidence of stillbirth among HIV-infected women in urban sub-Saharan Africa.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. rkupka@post.harvard.edu
authors.forename: Roland
authors.initials: R
authors.lastname: Kupka
authors.forename: Tarik
authors.initials: T
authors.lastname: Kassaye
authors.forename: Elmar
authors.initials: E
authors.lastname: Saathoff
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.forename: Gernard I
authors.initials: GI
authors.lastname: Msamanga
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D003906:Developing Countries; D005260:Female; D005865:Gestational Age; D006069:Gonorrhea / Q000150:complications* / Q000401:mortality; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D018655:Lymphocyte Count; D015999:Multivariate Analysis; D016017:Odds Ratio; D010298:Parity; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D013587:Syphilis / Q000150:complications* / Q000401:mortality; D013590:Syphilis, Congenital / Q000150:complications / Q000401:mortality; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult