Ishaque et al. BMC Public Health 2011, 11(Suppl 3):S3 http://www.biomedcentral.com/1471-2458/11/S3/S3 R E V I E W Open Access Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review Sidra Ishaque1, Mohammad Yawar Yakoob1, Aamer Imdad1, Robert L Goldenberg2, Thomas P Eisele3, Zulfiqar A Bhutta1* Abstract Background: Infection is a well acknowledged cause of stillbirths and may account for about half of all perinatal deaths today, especially in developing countries. This review presents the impact of interventions targeting various important infections during pregnancy on stillbirth or perinatal mortality. Methods: We undertook a systematic review including all relevant literature on interventions dealing with infections during pregnancy for assessment of effects on stillbirths or perinatal mortality. The quality of the evidence was assessed using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach by Child Health Epidemiology Reference Group (CHERG). For the outcome of interest, namely stillbirth, we applied the rules developed by CHERG to recommend a final estimate for reduction in stillbirth for input to the Lives Saved Tool (LiST) model. Results: A total of 25 studies were included in the review. A random-effects meta-analysis of observational studies of detection and treatment of syphilis during pregnancy showed a significant 80% reduction in stillbirths [Relative risk (RR) = 0.20; 95% confidence interval (CI): 0.12 - 0.34) that is recommended for inclusion in the LiST model. Our meta-analysis showed the malaria prevention interventions i.e. intermittent preventive treatment (IPTp) and insecticide-treated mosquito nets (ITNs) can reduce stillbirths by 22%, however results were not statistically significant (RR = 0.78; 95% CI: 0.59 – 1.03). For human immunodeficiency virus infection, a pooled analysis of 6 radomized controlled trials (RCTs) failed to show a statistically significant reduction in stillbirth with the use of antiretroviral in pregnancy compared to placebo (RR = 0.93; 95% CI: 0.45 – 1.92). Similarly, pooled analysis combining four studies for the treatment of bacterial vaginosis (3 for oral and 1 for vaginal antibiotic) failed to yield a significant impact on perinatal mortality (OR = 0.88; 95% CI: 0.50 – 1.55). Conclusions: The clearest evidence of impact in stillbirth reduction was found for adequate prevention and treatment of syphilis infection and possibly malaria. At present, large gaps exist in the growing list of stillbirth risk factors, especially those that are infection related. Potential causes of stillbirths including HIV and TORCH infections need to be investigated further to help establish the role of prevention/treatment and its subsequent impact on stillbirth reduction. Background Stillbirth, defined as a newborn having no sign of life at delivery, is one of the most common adverse outcomes of pregnancy. About 3.2 million stillbirths occur world- wide each year [1]. The highest overall figures of * Correspondence: zulfiqar.bhutta@aku.edu 1Division of Women and Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi-74800, Pakistan Full list of author information is available at the end of the article stillbirths have been reported from countries in South- East Asia and sub-Saharan Africa [1]. Globally, infection is a leading cause of stillbirth and accounts for an esti- mated half of all stillbirths today, especially in develop- ing countries [2]. A notable association exists between infection and gestational age. A review reported that the earlier the fetal death during gestation, the more likely it is to be caused by an infection [3]. For example, in one study, 19% of fetal deaths less than 28 weeks were © 2011 Ishaque et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.