ObjeCtiveTo determine the risk of recurrent stillbirth. DesignSystematic review and meta-analysis of cohort and case-control studies. Data sOurCesEmbase, Medline, Cochrane Library, PubMed, CINAHL, and Scopus searched systematically with no restrictions on date, publication, or language to identify relevant studies. Supplementary efforts included searching relevant internet resources as well as hand searching the reference lists of included studies. Where published information was unclear or inadequate, corresponding authors were contacted for more information.stuDy seleCtiOn Cohort and case-control studies from high income countries were potentially eligible if they investigated the association between stillbirth in an initial pregnancy and risk of stillbirth in a subsequent pregnancy. Stillbirth was defined as fetal death occurring at more than 20 weeks' gestation or a birth weight of at least 400 g. Two reviewers independently screened titles to identify eligible studies based on inclusion and exclusion criteria agreed a priori, extracted data, and assessed the methodological quality using scoring criteria from the critical appraisal skills programme. Random effects meta-analyses were used to combine the results of the included studies. Subgroup analysis was performed on studies that examined unexplained stillbirth. results 13 cohort studies and three case-control studies met the inclusion criteria and were included in the meta-analysis. Data were available on 3 412 079 women with pregnancies beyond 20 weeks duration, of who 3 387 538 (99.3%) had had a previous live birth and 24 541 (0.7%) a stillbirth. A total of 14 283 stillbirths occurred in subsequent pregnancies, 606/24 541 (2.5%) in women with a history of stillbirth and 13 677/3 387 538 (0.4%) among women with no such history (pooled odds ratio 4.83, 95% confidence interval 3.77 to 6.18). 12 studies specifically assessed the risk of stillbirth in second pregnancies. Compared with women who had a live birth in their first pregnancy, those who experienced a stillbirth were almost five times more likely to experience a stillbirth in their second pregnancy (odds ratio 4.77, 95% confidence interval 3.70 to 6.15). The pooled odds ratio using the adjusted effect measures from the primary studies was 3.38 (95% confidence interval 2.61 to 4.38). Four studies examined the risk of recurrent unexplained stillbirth. Methodological differences between these studies precluded pooling the results. COnClusiOnsThe risk of stillbirth in subsequent pregnancies is higher in women who experience a stillbirth in their first pregnancy. This increased risk remained after adjusted analysis. Evidence surrounding the recurrence risk of unexplained stillbirth remains controversial.
To compare the prospective risk of stillbirth between women with and without a stillbirth in their first pregnancy.
The ideal interpregnancy interval (IPI) following a miscarriage is controversial as the World Health Organization (WHO) advise women to delay pregnancy for at least six months. Subsequent research has found that IPI less than six months is beneficial for both mother and baby. The impact of this guidance on the decision-making process for couples/women in this predicament is unknown. Views of women regarding the optimum IPI following miscarriage were investigated using a thematic framework applied to discussion threads from a popular online forum, Mumsnet (www.mumsnet.com). A systematic search of all online information was also undertaken to identify all relevant patient information regarding conceiving another pregnancy after a miscarriage. The findings from the search were tabulated and analysed in relation to the themes identified from the discussion threads on Mumsnet. Ninety-four discussion threads were included. Women saw no reason to wait if they felt ready. Women posted about their frustrations at the multiple sources of conflicting advice they received, at the lack of professional sympathy and felt that being told to wait before trying to conceive after a miscarriage was outdated advice. However, these findings were not corroborated by the patient information currently available online. All web-based patient information gave consistent advice, to wait for at least one normal period before trying to conceive again after a miscarriage and to try for another pregnancy when they felt physically mentally and emotionally ready. None advised waiting for six months. This study highlights that sometimes despite contradictory clinical advice, women are keen to make their own decisions regarding reproductive choice. These decisions are often empowered by peer support and advice which women trust over inconsistent information received from healthcare professionals. In this case, health information appears to have been updated in response to womens choice rather than the other way around.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.