Epidemiology of stillbirths and maternal post-discharge outcomes following stillbirths in Uganda: a prospective cohort study

BackgroundStillbirth remains a critical public health challenge in low-resource settings and is a significant cause of perinatal mortality, where gaps in antenatal care, healthcare access, and socioeconomic disparities exacerbate risks. Understanding maternal post-discharge outcomes and identifying modifiable predictors for stillbirths is essential to improve care pathways. MethodsThis prospective cohort study analyzed maternal and perinatal health data from 7131 women who delivered 7359 newborns at the Mbarara and Jinja Regional Referral Hospitals between April, 2022 and September, 2023. A stillbirth was defined as the death of a foetus >28 weeks of gestation. Univariate logistic regression models were used to determine risk factors. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. ResultsAmong 7129 women who survived and were discharged post-delivery, 261 (3.7%) experienced a stillbirth. Six-week post-discharge readmission of women of stillborn infants was 8.5% as compared to 3% among those who were discharged with a live newborn. The strongest risk factor for a stillbirth was previous child death (OR: 7.11, 95% CI: 5.5-9.17, p <0.001), followed by transport delays >1 hour (OR: 2.71, 95% CI: 1.95-3.75) and pregnancy-related illnesses (OR: 1.70, 95% CI: 1.30-2.25). Each additional year of maternal age increased odds by 2% (OR: 1.02, 95% CI: 1.00-1.04). Protective factors included adequate antenatal care (4-8 visits) (OR: 0.51, 95% CI: 0.40-0.66) and partner support (OR: 0.72, 95% CI: 0.56-0.95). ConclusionMaternal morbidity following stillbirths is high. Furthermore, several demographic, health, and socioeconomic strongly influenced the risk of stillbirths. Many stillbirths may be prevented following early identification of these risk factors through interventions to ensure expectant mothers receive adequate support during their pregnancy.