Ishaque et al. BMC Public Health 2011, 11(Suppl 3):S3 http://www.biomedcentral.com/1471-2458/11/S3/S3 Table 2 Quality assessment of trials of the evidence for prevention in malaria in pregnancy (IPTp and ITNs) used during first or second pregnancy for preventing stillbirths Quality assessment Directness No of Design Limitations Consistency of Generalizability Generalizability studies results to population to intervention of interest of interest IPTp for preventing stillbirths:High outcome-specific quality 3 RCT Consistent X2 High High for heterogeneity (2 df) = 0.23 ITNs for preventing stillbirths:High outcome-specific quality 4 CRCT Not Consistent X2 High High blinded for heterogeneity (3 df) = 0.03 Effect of IPTp and ITNs combined on stillbirths :Moderate outcome-specific quality 7 RCT/ Consistent X2 High High CRCT for heterogeneity (6 df) = 1.76 Summary findings Intervention Control Number Denominator Number Denominator of of events events 44 1,489 36 1,083 Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Page 8 of 12 RR (95% CI) 0.96 (0.62- 1.50) 0.67 (0.47- 0.97) 0.78 (0.59- 1.03) RCT: Randomized controlled trial: CRCT: Community randomized controlled trial: RR: Relative risk: CI: Confidence Interval. death were ranked as having a ‘moderate’ grade of evi- dence. Included studies had limitations, including a low recruitment response and unclear allocation conceal- ment. The evidence to date does not suggest any benefit of screening and treating all pregnant women for asymptomatic BV to prevent stillbirths. Although anti- biotic treatment targeting bacterial vaginosis may be of value in some women [37], further research needs to be carried out to study the potential impact of antibiotics on chorioamnionitis, which is a well-established risk fac- tor for stillbirth [6]. There are very few RCTs that have looked at the impact of periodontal care on stillbirth or perinatal mor- tality, with most trials reporting preterm birth as an out- come. A recent meta-analysis of periodontal care suggests that there may be an impact on stillbirths (Middleton P, 2010 personal communication), but needs confirmation in further trials from developing countries. This is an emerging area of research that needs more studies. There is very limited evidence of the impact of anti- helminthic therapy on stillbirths. There has been a ten- dency towards increased risk of stillbirths and perinatal mortality that is non-significant based on RCTs [17]. Maternal deworming, however, does hold promise for improving the health of pregnant women in endemic areas, particularly in terms of alleviating risk of anemia and subsequently the risk of adverse pregnancy out- comes [18]. It is, therefore, recommended in specific, situational contexts such as where soil associated hel- minthiasis rates are high and iron-deficiency anemia rates endemic [69]. TORCH infection is an important risk factor for still- births [8]. However, the pathways which lead from infectious risk factors to fetal death are, for the most part, not well defined [70,71]. There is a dearth of good quality evidence on association of treatment of TORCH on stillbirth and we recommend further research to study the associations of these infections with stillbirth and perinatal mortality. Table 3 Quality assessment of trials of interventions for infections (HIV) in pregnancy Quality Assessment Summary of Findings Directness No of events No of Design Limitations Consistency Generalizability Generalizability Intervention Control Relative Risk studies to population of to intervention (95% CI) (ref) interest of interest Any anti-retroviral use for HIV and stillbirth: MODERATEoutcome specific quality 6 RCTs none Some heterogeneity from Yes Yes 22 22 RR (fixed) = 0.93 meta-analysis; 4 out of 8 data (0.45 - 1.92) sets showing benefit