Does screening, treatment and prevention for infectious diseases by attending 4 antenatal care visits decrease the risk of stillbirth and poor birth outcomes in rural uganda?

Abstract

OBJECTIVES: Infectious causes of stillbirth, including syphilis and malaria, are prevalent in resource-limited settings. Infection screening, treatment, and prevention are pillars of antenatal care (ANC). Data are lacking on whether ANC decreases stillbirth and adverse neonatal outcomes. We hypothesized that risk of stillbirth in Uganda is significantly lower in women attending _4 ANC visits compared to those attending <4. METHODS: We performed a secondary analysis of a prospective cohort of 4,231 women presenting to a regional referral hospital for delivery in 2015. Women were followed to determine in-hospital incidence of postpartum infection, and a subset of 1,785 women underwent structured interview and chart review. Data were collected on socio demographics, medical conditions, antenatal care, and maternal and neonatal outcomes. Our primary outcome was documented stillbirth; a secondary composite poor birth outcome included early neonatal death, low birth weight (<2500g), 5-minute APGAR <7, and stillbirth. We performed bivariate analysis using Chi squared, Wilcoxon Rank Sum, and t-tests, and univariable and multivariable logistic regression analyses to identify independent correlates of stillbirth and composite poor birth outcomes, with particular focus on antenatal care and infections. women with IBD report higher prevalence of vulvovaginal discomfort when IBD is poorly controlled. Further evaluation of vaginal health and the vaginal microbiota in women with IBD could identify areas for intervention to improve sexual and reproductive health