Is Stillbirth Rate Higher among HIV Positive than HIV Negative Mothers?: A 10-year Experience in a Nigerian Tertiary Hospital Trend in stillbirth among HIV-positive and negative mothers

Abstract

Background: It's not clear to what extent public health interventions have reduced the stillbirth rate among HIV-negative and HIV-positive mothers over the past decade. Objectives: The trend in stillbirth was compared between HIV-negative and HIV-positive mothers who delivered in Nnamdi Azikiwe University Teaching Hospital (NAUTH) between 2011 and 2021. Materials and Methods: A retrospective review of records of all 579 mothers who had stillbirths during the period was conducted. Proforma was used to abstract data from the delivery register and antenatal cards. Data were analyzed using SPSS version 21. Statistical significance was set at P<0.05. Results: The ratio of HIV-negative: to HIV-positive mothers was 4.4:1. The HIV-negative and HIV-positive mothers had a comparable median age (30[8] versus 30[7] years, p=0.149) and parity (3[2] versus 3[3], p=0.455). The HIV-negative mothers were predominantly unbooked in NAUTH in contrast to HIV-positive ones (94.3% versus 22.4%; p<0.001). Overall, the stillbirth rate was 67/1000 total births (579/8641). This was comparable between HIV-negative and HIV-positive mothers (67/1000 versus 65/1000 total births, p=0.768). Stillbirth declined by 47.8%, 48.7%, and 56.8% in the general, HIV-negative, and HIV-positive populations, respectively. There was no significant difference between the stillbirth trend of the two groups(p=0.295). HIV-negative had a non-significantly higher stillbirth rate compared to HIV-positive mothers in all years except 2013, 2015, and 2020. About two-thirds of the stillborn were delivered during call-duty hours and had abnormal birth weight. Conclusion: The stillbirth rate is comparable between predominantly booked HIV-positive and predominantly unbooked (possibly high-risk) HIV-negative mothers in NAUTH. Although stillbirth almost halved between 2011 and 2021, the rate remains high in both populations.