Pregnancy loss in rural Bangladesh: an analysis of rates, proportions, timing, and determinants based on data from a Health and Demographic Surveillance System

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Background: Pregnancy loss, encompassing miscarriage/spontaneous and induced abortion, has substantial physical and mental health consequences for women. However, population-level evidence on its occurrence in Bangladesh remains limited, with most data derived from reports and small-scale community-based studies. Here we provide population-level estimates of pregnancy loss and examine associated factors in rural Bangladesh. Methods: We analysed data from 61 428 women aged 15-49 years and 7612 pregnancies, extracted from the Baliakandi Health and Demographic Surveillance System of icddr,b and covering the period from 1 August 2021 to 30 June 2023. We used descriptive statistics with 95% confidence intervals (CIs) to report rates and proportions, and a generalised linear mixed model to identify factors associated with pregnancy loss. Results: Overall, the rate of pregnancy loss was 13.9 (95% CI = 13.2-14.6) per 1000 women per year, while the proportion was 14% of all recognised pregnancies. Around 11% of pregnancies resulted in miscarriage/spontaneous abortion and 3% in induced abortion. Miscarriage/spontaneous abortions peaked between 11 and 13 weeks, and induced abortions between 6 and 7 weeks of gestation. Women with a prior history of pregnancy loss or stillbirth had higher odds of miscarriage/spontaneous abortion. Higher maternal age was associated with both miscarriage/spontaneous abortion and induced abortion, while induced abortion was associated with women with larger family sizes. Conclusions: Pregnancy loss is notably prevalent in rural Bangladesh, predominantly occurring spontaneously and during the first trimester. Maternal health initiatives should prioritise closer monitoring and support during the early stages of pregnancy, particularly for women with a history of pregnancy loss.

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