Hammad Mohammad, Halli Shivalingappa, Rahman Mohammad Hifz Ur
Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Manipal, India.
College of Community and Global Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
BMC Public Health. 2025 Jul 9;25(1):2422. doi: 10.1186/s12889-025-23617-z.
Stillbirth, defined by foetal death at or beyond 28 weeks of gestation, represents a significant challenge in India, contributing to approximately 500,000 foetal deaths each year. The country's stillbirth rate of 12.2 per 1000 births underscores the imperative to address this preventable occurrence. While maternal metabolic conditions diabetes, and hypertension, are widely recognized as established risk factors for stillbirth worldwide, the extent of their impact on India's stillbirth burden remains inadequately elucidated due to limited evidence.
This cross-sectional study utilized NFHS-5 data to examine stillbirths in the most recent pregnancy outcomes of 204,723 women aged 15-49 years, sampled from all states and union territories of India. The primary exposures assessed were diabetes, and hypertension. Descriptive analyses were conducted to determine the prevalence of diabetes, hypertension and stillbirths. Logistic regression was used to quantify the association between diabetes, hypertension and the risk of stillbirth, indicated by adjusted odds ratios (AOR) with 95% confidence intervals (CI). The study also assessed effect modification by maternal age, education, wealth quintile, and social category.
The prevalence of diabetes and hypertension was 1% and 3% respectively, while the stillbirth rate was 1%. diabetes conferred a significantly higher risk of stillbirth with an increase of 74% (AOR 1.74, CI 1.14-2.67) as compared to women without diabetes. The risk was potential among mothers with hypertension with an increase of 50% (AOR 1.50, CI 1.16-1.95) on contrary to women without hypertension. The combined model (i.e. having diabetes or hypertension) also showed a significant risk of stillbirth with a higher risk of 58% (AOR 1.58, CI 1.25-1.99) indicating a synergistic interaction. Stratified analyses revealed the stillbirth risk among mothers belonging to the scheduled caste category (AOR 1.30, CI 1.10-1.53).
Diabetes, and hypertension, increase stillbirth risk in India, highlighting the need for better metabolic health management pre- and during pregnancy. Our research highlights the need of integrated care for diabetes and hypertension is crucial. Targeted interventions for high-risk mothers and improved screening are vital to reduce stillbirth rates. More research is needed to understand these risks better. Collaboration across medical fields is essential to save lives and improve pregnancy outcomes.
死产定义为妊娠28周及以后的胎儿死亡，这在印度是一项重大挑战，每年导致约50万例胎儿死亡。该国每1000例出生中有12.2例的死产率凸显了解决这一可预防情况的紧迫性。虽然孕产妇代谢状况（糖尿病和高血压）在全球范围内被广泛认为是死产的既定风险因素，但由于证据有限，它们对印度死产负担的影响程度仍未得到充分阐明。
这项横断面研究利用了全国妇女和儿童健康调查（NFHS - 5）的数据，以检查从印度所有邦和联邦属地抽取的204,723名15 - 49岁女性最近一次妊娠结局中的死产情况。评估的主要暴露因素是糖尿病和高血压。进行描述性分析以确定糖尿病、高血压和死产的患病率。使用逻辑回归来量化糖尿病、高血压与死产风险之间的关联，用调整后的优势比（AOR）及95%置信区间（CI）表示。该研究还评估了孕产妇年龄、教育程度、财富五分位数和社会类别对效应的修正作用。
糖尿病和高血压的患病率分别为1%和3%，而死产率为1%。与无糖尿病的女性相比，糖尿病使死产风险显著增加74%（AOR 1.74，CI 1.14 - 2.67）。与无高血压的女性相比，患有高血压的母亲死产风险增加50%（AOR 1.50，CI 1.16 - 1.95）。联合模型（即患有糖尿病或高血压）也显示出死产的显著风险，风险更高，为58%（AOR 1.58，CI 1.25 - 1.99）表明存在协同相互作用。分层分析显示，在册种姓类别的母亲存在死产风险（AOR 1.30，CI 1.10 - 1.53）。
在印度，糖尿病和高血压会增加死产风险，这突出了在孕前和孕期更好地进行代谢健康管理的必要性。我们的研究强调，对糖尿病和高血压进行综合护理至关重要。针对高危母亲的有针对性干预措施和改进筛查对于降低死产率至关重要。需要更多研究以更好地了解这些风险。医学领域之间的合作对于挽救生命和改善妊娠结局至关重要。
