Risk Factors Associated with Stillbirth in a Case-Control Study in Faridpur, Bangladesh, 2022-2023

Introduction: There are around 2 million stillbirths worldwide every year. Bangladesh is among the countries with the highest prevalence of stillbirths – over eight times higher than the United States. The objective of this study is to describe potential risk factors associated with stillbirth in Faridpur, Bangladesh. Methods: We performed a case-control study, recruiting mothers presenting for delivery at Faridpur Medical College and Hospital. We enrolled mothers who experienced stillbirths (defined as delivery of nonviable fetuses at least 28 weeks gestational age) (cases) and age-matched (+/- 2 years) mothers who had liveborn deliveries (controls). A physician collected data regarding the mother’s sociodemographics, symptoms or other complications during pregnancy, and maternal comorbidities via questionnaire and medical record review. Results: We enrolled 99 cases and 99 controls from July 2022 – March 2023. The average age of all mothers was 27 years. Cases had lower education on average, with 12% completing a bachelor’s degree or higher compared to 28% of controls. Environmental risk factors associated with stillbirth included the use of tube wells instead of piped water (adjusted odds ratio [aOR] = 4.7, 95% confidence interval [CI]: 1.29, 17.15), smoking during pregnancy (aOR = 1.9, 95% CI: 0.99, 3.60), and not treating drinking water before consumption (aOR = 3.6, 95% CI: 1.15, 11.28). Participants had a higher odds of stillbirth if they experienced pregnancy complications, including diarrhea (aOR = 2.52, 95% CI: 0.84, 7.53), preeclampsia/eclampsia (aOR = 3.29, 95% CI: 1.45, 7.47), oligo- or poly-hydramnios (aOR = 4.02, 95% CI: 1.08, 15.0), or bleeding (aOR = 3.54, 95% CI: 1.46, 8.54). Discussion: The association between stillbirths, water source/treatment, and diarrhea potentially implicates water, sanitation, and hygiene deficits as mediating the risk of stillbirth. While tube wells are generally considered improved water sources, environmental toxins such as arsenic and/or contamination with infectious agents due to inadequately maintained infrastructure may be contributing to excess stillbirths. However, these factors may also be linked with socioeconomic status, which was not evaluated in the current study. Future studies should collect measures of socioeconomic status and incorporate biological indicators such as blood and placental tissue samples to further elucidate the etiologies of stillbirths and identify opportunities for prevention.