Lays Janaina Prazeres Marques, Gizelton Pereira Alencar, Darío Elías, Zilda Pereira da Silva, Gabriella Ferreira Demarque, Gerusa Maria Figueiredo, Mara Sandra Hoshida, Osmara Alves dos Santos, Luciana Duzolina Manfré Pastro, Rafael Junqueira Buralli, Clarisse Martins Machado, Luciana Regina Meireles, Rodrigo Melim Zerbinati, Andrés Jimenez Galisteo, Regina Schultz, Laura C. Rodrigues, Rossana Pulcineli Vieira Francisco, Hillegonda Maria Dutilh Novaes, Nélson Gouveia, Márcia Furquim de Almeida
BACKGROUND: Stillbirth remains a significant public health issue, with socioeconomic, demographic, environmental, behavioral, healthcare, and biological factors influencing its occurrence. This study aimed to investigate the risk factors for stillbirths in São Paulo, Brazil. METHODS: This population-based case-control study included stillbirths (cases) and live births (controls) from 14 public hospitals in the city of São Paulo, Brazil. Data were obtained from interviews with women after delivery, hospital records, antenatal care registries, placental samples, and maternal blood samples for analysis of infection biomarkers. A logistic regression model was used to estimate the odds ratio (OR) with a 95% confidence interval. RESULTS: The study included 401 stillbirths (348 antepartum and 53 intrapartum) and 419 live births. The final model identified significant risk factors for stillbirth, including the absence of a partner (OR = 1.76; 95%CI: 1.15–2.68), smoking during pregnancy (OR = 1.94; 95%CI: 1.10–3.47), inadequate antenatal care access (OR = 2.15; 95%CI: 1.38–3.39), hyperglycemia (OR = 1.91; 95%CI: 1.21–3.03), the presence of placental lesions (OR = 3.15; 95%CI: 2.20–4.52), fetal growth restriction (OR = 6.16; 95%CI: 3.76–10.4), and congenital malformations (OR = 4.25; 95%CI: 2.42–7.67). CONCLUSIONS: This study identifies critical maternal and fetal factors associated with stillbirth risk in a middle-income country, showing its complex profile.