Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. The Cochrane Pregnancy and Childbirth Group has done many reviews of interventions that might prevent stillbirth and, in December 2020, they brought these together in an overview. In this podcast, one of the Group’s researchers, Dell Horey, talks with lead author Erika Ota, a professor at the St. Luke’s International University in Japan, about the findings.

Dell: Hello Erika, first of all, could you tell us a little about stillbirth. What is it and what’s its impact on people?

Erika: Hello Dell and thanks for this opportunity to discuss our overview. A stillbirth is generally defined as the death of a baby before birth, at or after 24 weeks of development, and it can be very upsetting for families. It’s most common in low‐ and middle‐income countries but also affects people in high‐income countries. However, although the numbers of stillbirths have not fallen much in the last 20 years, they remain a neglected issue globally, invisible in policies and programmes, underfinanced and in urgent need of attention.

Dell: That suggests that it’s important to have good quality research, such as your overview, to tackle this problem. How might this evidence on antenatal interventions to prevent stillbirth, fetal loss and perinatal death help?

Erika: If we can identify and implement effective pregnancy interventions, this would reduce stillbirths and improve maternal and neonatal outcomes, especially in settings with high rates of stillbirth. Improvements in pregnancy related care could lead to large reductions in stillbirths in low and middle-income countries and so we need to raise awareness of effective methods of preventing stillbirths, particularly in those countries. Our overview of Cochrane Reviews brings together evidence on the interventions and strategies aimed at preventing stillbirths during pregnancy into a single document and should make it easier for people to access and use this large body of research. 

Dell: Did you find the evidence you needed, and what does it say about these pregnancy interventions?

Erika: We identified 43 Cochrane Reviews that assessed 61 different ways of either preventing stillbirth during pregnancy, or infant deaths around the time of birth. We grouped them into four different areas: nutrition, preventing infection, managing mothers' other healthcare problems and looking after the baby before it is born. While most of the review were unable to demonstrate a clear effect of an intervention in reducing stillbirth or perinatal death, there were several that suggested a clear benefit. These include balanced energy/protein supplements, midwife-led models of care, training traditional birth attendants and antenatal cardiotocography. We also found possible benefits for insecticide-treated anti-malarial nets and community-based intervention packages. 

Dell: What about the safety aspect? What evidence did you find about complications and adverse events for the pregnancy interventions?

Erika: One thing we found was a possibility that a reduced number of antenatal care visits was linked to an increase in perinatal death. However, for other adverse events, the risks were either likely to be similar with or without the intervention, or the evidence was too uncertain to come to a firm conclusion.

Dell: Overall, what’s your take-home message about antenatal interventions to prevent stillbirth?

Erika: The main message would be that the overview approach we took shows that the effectiveness of the methods used to prevent stillbirth varies depending on where they took place, highlighting the importance of understanding how the interventions were tested. This means that the findings cannot simply be applied to women in general and across all global settings but that people need to look at the fine detail in the research that we have brought together in the overview. 

Dell: Thanks Erika. With that in mind, if people would like to read the review, how can they get hold of it?

Erika: Thanks Dell. The review’s available online at Cochrane Library dot com. If people go to the website and type 'antenatal interventions for preventing stillbirth' in the search box, they’ll see it near the top of the list.