Peer-reviewed article
Mapping the evidence on stillbirth prevention across the reproductive continuum: an umbrella review.
Gadapani Pathak B, Vats P, Manna S, Yadav S, Bhatt A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This umbrella review examined evidence from 116 systematic reviews on interventions to prevent stillbirth and perinatal mortality across pregnancy and birth. Several interventions showed clear benefits, including balanced nutrition supplements, community health worker home visits, labour induction after 37 weeks, and skilled birth attendance. However, many widely used interventions like routine ultrasound and group antenatal care showed unclear or inconclusive effects. The review identified significant evidence gaps, particularly in low- and middle-income countries where stillbirth rates remain highest.
Key points
- Interventions with clear benefit for reducing perinatal mortality include balanced energy-protein supplementation, home visits by community health workers, birth preparedness interventions, labour induction at or beyond 37 weeks, and skilled or community-based intrapartum care
- Reduced antenatal visit schedules showed possible harm with increased risk of stillbirth or perinatal mortality compared with standard care
- Many interventions with widespread implementation lack strong evidence, including group antenatal care, nutritional education, routine ultrasound monitoring, and antibiotic treatment for bacterial vaginosis
- Evidence gaps are substantial, particularly for context-specific implementation in low- and middle-income countries where stillbirth burden is highest
- Review synthesised 116 systematic reviews covering preconception, antenatal, intrapartum and immediate newborn periods
Limitations
This umbrella review synthesises existing systematic reviews rather than primary studies, so findings are constrained by the quality and scope of included reviews. The review cannot determine optimal implementation strategies or provide country-specific evidence, particularly for contexts with highest stillbirth burden.
Abstract
Objectives To collate and appraise evidence from existing systematic reviews and meta-analyses on interventions to prevent stillbirth and reduce perinatal mortality across the reproductive continuum, including preconception, antenatal, intrapartum and immediate newborn periods. Design Umbrella review synthesising evidence from systematic reviews, including meta-analyses where available. Data sources A comprehensive search was conducted in CENTRAL (via Cochrane Register of Studies Online), PubMed, Embase and Web of Science, along with trial registries (WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN Registry), from inception to 12 January 2026. Eligibility criteria Systematic reviews and meta-analyses synthesising randomised controlled trials or quasi-experimental studies that reported stillbirth, perinatal mortality, fetal loss or fetal death were included. Reviews focused exclusively on predefined high-risk populations were excluded. Data extraction and synthesis Two reviewers independently extracted data and assessed methodological quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty ratings were extracted as reported by the original review authors. Evidence synthesis followed a structured framework adapted from Ota et al, integrating direction of effect and certainty of evidence based on pooled estimates and GRADE assessments. Publication overlap was assessed using the Corrected Covered Area index where relevant. Results A total of 116 systematic reviews were included, synthesising evidence from randomised controlled and quasi-experimental studies across preconception, antenatal, intrapartum and immediate newborn periods. Evidence from individual reviews showed clear benefit for several interventions, including balanced energy-protein supplementation, home visits by community health workers, birth preparedness interventions, labour induction at or beyond 37 weeks of gestation and skilled or community-based intrapartum care, primarily for reducing perinatal mortality. Reduced antenatal visit schedules compared with standard care were associated with a possible increase in stillbirth or perinatal mortality, indicating potential harm. Many interventions-such as group antenatal care (ANC), nutritional education, case-note provision, routine ultrasound or Doppler monitoring, antibiotic treatment for bacterial vaginosis, antiretroviral therapy in pregnancy and several pharmacological or hormonal interventions-demonstrated unknown or inconclusive effects on stillbirth or perinatal mortality, largely due to imprecision and heterogeneity. Conclusions This umbrella review identifies a range of interventions with evidence of effectiveness across the reproductive continuum, particularly those addressing maternal nutrition, continuity of ANC and quality intrapartum and newborn care. However, substantial evidence gaps remain, especially for interventions widely implemented without strong supporting evidence. These findings highlight the need for context-specific implementation research and prioritisation of proven strategies in low- and middle-income countries, where the burden of stillbirth remains highest. Prospero registration number CRD42024531100.