The origins of stillbirth: infectious diseases.

This article reviews the literature on infectious diseases as a cause of stillbirth. Identifying a specific infection as a cause of stillbirth is limited by many obstacles. Nevertheless, "good faith" efforts estimate that approximately 9% to 15% of stillbirths are caused by infections. Infection may be especially important as a cause of stillbirth occurring early in pregnancy. Recognized causes include syphilis, toxoplasmosis, parvovirus B-19, chorioamnionitis, and Listeria monocytogenes. Other organisms that are "purported to cause" stillbirth include the genital mycoplasmas, Chlamydia trachomatis, HIV, group B streptococci, and others. No single strategy has been developed for effective prevention of stillbirth caused by infection. Six potential strategies and their rationale are presented, but the low rate of stillbirth in most situations would require large intervention trials for hypothesis testing. Infection is an important cause of stillbirth. Within the framework if determining epidemiological etiology, research should be initiated in the role of infectious causes.