Still birth and the risk factors in Babol, Northern Iran

Dear Editor, Stillbirth rate still continues to be high in the world. Some studies have reported stillbirth rate to be between 10.4 and 46.4 per 1000 birth. The aim of this case control study was to investigate the incidence of stillbirth and the risk factors at Babol hospitals, Northern Iran. A total of 4219 live births and 86 stillbirths were reported in the 7 month period. The rate of stillbirth was 19.9 per 1000 births (86/4305). This rate in a similar study in Kenya and India was 30.5 and 26.8 per 1000 births, respectively. As shown in Table 1, demographic characteristics were different in the case and control groups. High maternal age (>35 years) was more in mothers with stillbirth than that in those with live birth. Similar to our results, a study in Sweden showed an increased risk for late fetal death in pregnant and employed women ≥40 years. Gold and Tomich reported that job stressors such as work shifts and standing for long hours associated with increased risk of stillbirth and preterm birth. In our study, illiteracy in stillbirth mothers was nearly twice as compared to those with live birth. In China stillbirth rate was more in the no booked women too. Kumar and Singhi reported a higher rate in poor socio-economically levels. Inability to pay for health care can be a strong predictor of fetal death, underestimating the need to maternity care for low income women. A higher percentage of our stillbirth mothers were in highgravida (>3) than the groups with live birth. A study in Maputo revealed the same result. We showed a significant relationships between stillbirth and gestational age. More stillborn infants were premature (<37) and/or immature (<28). Low Birth Weights (<2500 gr) and also Very Low Birth Weights (<1500 gr) were significantly higher in cases than controls. Others showed that perinatal mortality reduced with an increase in the weight of fetus and gestation period. In India a history of previous stillbirth significantly increased the risk of stillbirth. Kumara and Singhi reported an increased risk among those who did not receive even a single antenatal care visit. Therefore, antenatal care that reduce the risk of stillbirths need to be identified. It was shown that those who received tetanus toxoid received a higher number of antenatal care which is identical to our results. We noticed an association between the risk of stillbirth and intake of iron tablets. Other studies demonstrated the same results. Most of our stillborn fetuses were boys as opposed to the control group which were mostly girls. Bekedam showed a significantly increased risk in women carrying male fetuses. It is concluded that a significant number of stillbirths are preventable with an accurate prenatal care. Identification of high risk pregnancies allows appropriate fetal evaluation that can reduce intrauterine stillbirth rates.