Prevalence and risk factors for stillbirths in India: secondary analysis of ICMR-Stillbirth Pooled India Cohort (ICMR-SPIC)
Year: 2026
Type: article
Abstract: Background: Despite substantial reductions in stillbirth rate (SBR) over the past two decades, India continues to bear one of the highest burden of stillbirths worldwide. The available national evidence on stillbirth is fragmented, regionally variable, and often limited in scope. We aimed to determine stillbirth burden and risk factors leveraging a pooled cohort from ten prospective studies conducted across various settings in India. Methods: We established the Indian Council of Medical Research-Stillbirth Pooled India Cohort (ICMR-SPIC), combining individual-level data from ten prospective cohort studies conducted across multiple sites of India. The pooled dataset included prospective pregnancy cohort studies conducted across India between 1994 and 2023 from rural, urban, hospital, and community settings, with participant recruitment and follow-up periods varying across individual studies. After exclusions, 227,821 pregnancies were included. Harmonised analytical datasets were constructed, and weighted SBR was estimated. Multivariable mixed-effects modified Poisson regression was used to evaluate the association between stillbirth and independent maternal and antenatal risk factors. Population attributable fractions (PAFs) were calculated for modifiable exposures. Findings: A total of 3935 stillbirths occurred among 227,821 pregnancies, yielding a pooled weighted stillbirth rate of 14.8 per 1000 births (95% CI: 13.4-16.3). Independent risk factors included maternal age (>30 years) (aIRR 1.64, 95% CI: 1.55-1.72; PAF 3.23%, 95% CI: 2.97-3.48), informal maternal education (aIRR 1.45, 95% CI: 1.32-1.58; PAF 8.86%, 95% CI: 7.07-10.66), biomass fuel use (aIRR 1.37, 95% CI: 1.21-1.57; PAF 13.95%, 95% CI: 9.11-18.79), maternal height (<145 cm) (aIRR 1.32, 95% CI: 1.21-1.44; PAF 2.47%, 95% CI: 1.81-3.13), nulliparity (aIRR 1.36, 95% CI: 1.27-1.45; PAF 13.66%, 95% CI: 11.03-16.28), and previous history of stillbirth (aIRR 2.14, 95% CI: 1.15-3.97; PAF 2.13%, 95% CI: 0.97-3.29). Among obstetric complications, hypertensive disorders of pregnancy (aIRR 4.18, 95% CI: 3.54-4.94; PAF 10.27%, 95% CI: 9.74-10.81) and antepartum haemorrhage (aIRR 12.12, 95% CI: 9.54-15.40; PAF 6.33%, 95% CI: 6.19-6.47) showed strong associations. Interpretation: Our study shows that stillbirth burden remains high and factors such as women's education, biomass fuel use, hypertensive disorders, and antepartum haemorrhage were associated with higher risk of stillbirths. Funding: Indian Council of Medical Research, India.
Authors: Pratibha Dwarkanath, John Michael Raj, Anura V. Kurpad, Tinku Thomas, Ramachandran Thiruvengadam, Ayushi, Rahul Jain, Nitya Wadhwa, Shinjini Bhatnagar, Kalpana Basany, Shailendra Dandge, Catherine L. Haggerty, P.S. Reddy, Giridhara R. Babu, Debarati Mukherjee, Deepa R, Yamuna Ana, Manisha Nair, Saswati Sanyal Choudhury, Shivaprasad S. Goudar, Manjunath S. Somannavar, Sangappa M. Dhaded, Avinash Kavi, Deepthy M. Sadanandan, Archana Patel, Kunal Kurhe, Prabir Kumar Das, Vaishali Khedikar, Alka Dafare, Chittaranjan S. Yajnik, Urmila Deshmukh, Onkar Deshmukh, Sadhana Joshi, Girija Wagh, Sanjay Lalwani, Sanjay Gupte, Juhi Nema, Ranadip Chowdhury, Rukman Manapurath, Sunita Taneja, Neeta Dhabhai, Nita Bhandari, Reema Mukherjee, Bharati Kulkarni, Ravindra Mohan Pandey
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,250
Awards: G4004817514, G459845144
OpenAlex ID: W7204007377