Understanding stillbirth: New analyses from around the world

Despite sustained efforts in perinatal survival, 2.3 million neonatal deaths and 1.9 million late gestation stillbirths occurred in 2023. Both have been associated with pathways resulting in fetal growth restriction and/or preterm birth. Advances in ending preventable deaths have been slow due to multiple factors, including the lack of epidemiological data to identify high-risk groups and guide targeted interventions. To address this, we analysed individual-level data (2000 to 2023) from national and subnational sources across 20 countries to calculate i) prevalence of size-for-gestational age, ii)gestational age-specific perinatal mortality using the fetuses-at-risk approach and iii) population attributable risk. We found that the median prevalence of SGA was higher among stillbirths than neonatal deaths and livebirths. Perinatal mortality was highest for those < 3rd centile. At the population level, SGA was responsible for a fifth of deaths, so targeted interventions are urgent for this vulnerable group

Stillbirths remain a critical yet understudied public health challenge especially in the low resource settings of sub-Saharan Africa. The PRECISE cohort study (2019-2022) prospectively followed 5,772 pregnant women across seven health facilities in Kenya, Mozambique, and The Gambia to assess stillbirth incidence and associated risk factors. Overall stillbirth incidence was 29.2 per 1,000 births, with significant country variation: Kenya (17.5), Mozambique (32.8), and The Gambia (49.8). Most stillbirths (89.1%) occurred at ≥28 weeks gestation. Multivariable analysis identified key modifiable risk factors including previous stillbirth history, hypertension, antepartum hemorrhage, and delivery outside health facilities. This presentation will examine the multifactorial determinants of stillbirth and discuss evidence-based strategies for integrated antenatal and intrapartum care to address both clinical risk factors and systemic barriers preventing facility-based delivery across diverse African settings.

This study provides a large-scale, multi-country analysis of LBW prevalence and factors associated with it among stillbirths and early infant deaths across the CHAMPS network from 2016 to 2023. CHAMPS generates detailed and robust data on the causes of death among stillbirths and under-5 year deaths. Sites conduct active surveillance for deaths among catchment populations and seek to enroll deaths and conduct minimally invasive tissue sampling within 24 hours of the death. DeCoDe expert panels review data from medical records, verbal autopsies, and laboratory results and assign immediate, intermediate, and underlying causes of death. In addition to the high prevalence of LBW (61%) among stillbirths and early infant deaths, we identify key modifiable risk factors such as being born in the community, fetal growth restriction, maternal hypertensive disorders, and maternal HIV infection. Our findings also highlight regional disparities, with higher LBW in South Africa, Bangladesh, and Ethiopia.