Prevalence of Congenital Abnormalities in Abortuses and Stillbirths in India: A Systematic Review and Meta-Analysis.

Congenital abnormalities (CAs) are a major contributor to perinatal mortality and morbidity in India, particularly among abortuses and stillbirths. Despite the Ministry of Health and Family Welfare, India, introducing stillbirth surveillance guidelines, national data on the burden of CAs remain limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of CAs in fetal losses and assess variations by organ system, region, and diagnostic approach. A comprehensive search following PRISMA 2020 guidelines was conducted in PubMed and Google Scholar. Twenty-two hospital-based studies published between 1967 and 2024 were included. Data were critically appraised using the Joanna Briggs Institute's Critical Appraisal checklist. Meta-analysis was performed in Review Manager software using a random-effects model. Subgroup analyses explored differences by fetal outcome, publication year, diagnostic method, and geographic region, while publication bias was assessed using funnel plots and Egger's test. The pooled prevalence of CAs in fetal losses was 0.21 (95% CI: 0.17-0.25), higher among abortuses (0.38) than stillbirths (0.12) and in autopsy-based studies (0.26) than non-autopsy studies (0.09). Central nervous system anomalies were most frequent (0.42), followed by multiple anomalies (0.37). The Central region reported the highest prevalence (0.66) and the North-East the lowest (0.03). The findings highlight the need for consistent surveillance, improved diagnostic methods, and preventive strategies-particularly periconceptional folic acid supplementation and integration of CA reporting into national programmes-to reduce fetal losses and enhance maternal and child health outcomes in India and similar low- and middle-income settings.