Evidence map›Paper›PMID 41469596›Full record

ArticleBMC pregnancy and childbirth2025

Prevalence and risk factors of stillbirths among pregnant women from twelve high-volume birthing facilities of Karachi, Pakistan: a longitudinal cohort study.

Danya Arif Siddiqi, Muhammad Zia Muneer, Sundus Iftikhar, Mubarak Taighoon Shah, Vijay Kumar Dharma, Fatima Miraj, Mariam Mehmood, Irshad Ali Sodhar, Farrukh Raza Malik, Subhash Chandir

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Article in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

10 authors.

Danya Arif Siddiqi *IRD Global, The Great Room, Level 10, Singapore, One George Street, 049145, Singapore. Danyaarif@gmail.com.
Muhammad Zia Muneer *Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building Korangi Creek, Karachi, 75190, Pakistan.
Sundus IftikharMaternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building Korangi Creek, Karachi, 75190, Pakistan.
Mubarak Taighoon ShahIRD Global, The Great Room, Level 10, Singapore, One George Street, 049145, Singapore.
Vijay Kumar DharmaMaternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building Korangi Creek, Karachi, 75190, Pakistan.
Fatima MirajMaternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building Korangi Creek, Karachi, 75190, Pakistan.
Mariam MehmoodMaternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building Korangi Creek, Karachi, 75190, Pakistan.
Irshad Ali SodharDepartment of Health, Government of Sindh, Karachi, Pakistan.
Farrukh Raza MalikEstablishment Division, Government of Pakistan, Karachi, Pakistan.
Subhash ChandirIRD Global, The Great Room, Level 10, Singapore, One George Street, 049145, Singapore.

Funding

Bill and Melinda Gates Foundation Investment ID INV-006273Gates Foundation INV-006273
6 · The paper itself

Abstract

backgroundStillbirth, defined as the death of a fetus at or after 22 weeks of gestation, remains a neglected public health issue, with approximately 2 million stillbirths occurring annually. Pakistan ranks among the top three countries with the highest number of stillbirths, yet progress in reducing stillbirth rates remains slower than regional and global averages. Despite the substantial burden, there is a lack of evidence on the prevalence, geographic variation, and predictors of stillbirths in Pakistan, particularly from marginalized settings.

methodsWe conducted a longitudinal cohort study in 12 selected public and private birthing facilities located in Karachi, Sindh, Pakistan between February 9, 2021, and January 1, 2022. We enrolled pregnant women visiting the selected birthing sites during antenatal care visits and those directly visiting for deliveries. We used the World Health Organization (WHO) standard definition of stillbirth occurring at a gestational age of ≥22 weeks. We analyzed stillbirth rates across birthing sites, geographic location, and gestational age, and used firth logistic regression to identify risk factors for stillbirths.

resultsOf the pregnant women enrolled (n = 21,523), 63.5% (13,668/21,523) with a gestational age ≥ 22 weeks delivered their babies at the study birthing facilities. The overall weighted stillbirth rate was 12.0 per 1,000 births across all sites. The prevalence varied substantially across sites, geographic location, gestational age, and facility type (public or private). Multivariable logistic regression showed a significant association between polio-endemic super high-risk union councils (AHR: 3.53; CI: 1.84-6.75), preterm delivery (AHR: 3.97; CI: 1.42-11.16), unvaccinated for Tetanus Toxoid (TT) vaccine during pregnancy (AHR: 5.29; CI: 2.61-10.74), and having received <8 ANC visits (AHR: 2.40; CI: 1.04-5.53) with stillbirth outcomes.

conclusionOur study found significant variation in stillbirth prevalence across birthing facilities and geographic locations, with notably higher stillbirth rates in polio-endemic regions. These findings highlight the need for integrated approaches that combine polio eradication efforts with enhanced maternal healthcare services including maternal immunizations to maximize efficiency and impact. Additionally, efforts are needed to ensure high-quality antenatal care services and efficient management of medical conditions and prematurity during pregnancy.

Indexed as

Birthing CentersStillbirthAdultFemaleGestational AgeHumansLongitudinal StudiesPakistanPregnancyPrenatal CarePrevalenceRisk FactorsYoung AdultAntenatal careBirthing facilitiesMaternal healthPregnancy outcomesPre-term birthsStillbirths

Identifiers

PMID41469596
PMCPMC12805683

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