Adverse Perinatal Outcome in Subsequent Pregnancy after Stillbirth by Placental Vascular Disorders

Abstract

ObjectiveTo evaluate outcome in the pregnancy following a stillbirth (SB) by a placental vascular disorders.Study DesignA prospective, observational, multicenter study was conducted in woman with a history of stillbirth (> 22 weeks) between 2005 and June 2013, in 3 Italian University Hospitals. Causes of SB were previously identified after extensive investigations. Pregnant women were enrolled within the first trimester. The main outcome was “adverse neonatal outcome”, including perinatal death, fetal growth restriction, early preterm birth <33+6 weeks, hypoxic-ischemic encephalopathy, intracranial hemorrhage or respiratory distress.ResultsOut of 364 index pregnancies, 320 women (87.9%) had a subsequent pregnancy during the study period. Forty-seven had an early pregnancy loss. Out of 273 babies, 67 (24.5%) had an adverse perinatal outcome, including 1 SB and 1 early neonatal death (3.7/1000).Women who had a SB related to placental vascular disorders (39.6%), were at higher risk of an adverse neonatal outcome compared with women whose SB was unexplained or resulted from other causes (Adj. OR = 2.1, 95%CI: 1.2–3.8). Moreover, also obesity independently predicts an adverse perinatal outcome (Adj OR = 2.1, 95%CI: 1.1–4.3).ConclusionWhen previous SB is related to placental vascular disorders there is a high risk for adverse neonatal outcomes in the subsequent pregnancy. Maternal obesity is an additional risk factor.

Risk of stillbirth, preterm delivery, and fetal growth restriction following exposure in a previous birth: systematic review and meta‐analysis

“…With the exception of two studies, all studies controlled for one or more covariates (Tables S3–S5), either by adjustment, clustering, or matching, using a range of sociodemographic, pregnancy complications, and other risk factors. The most commonly adjusted variables were: maternal age, marital status, and mother's level of education (among sociodemographic factors); gestational diabetes, pre‐eclampsia, and hypertensive diseases (among pregnancy complications); and inter‐pregnancy interval, mother's smoking status, body mass index (BMI), parity, and year of subsequent delivery.…”

“…Three of the studies were from North America, 13,26,27 eight were from Europe, [28][29][30][31][32][33][34][35] two were from Australia, 36,37 one was from Asia, 38 one was from Latin America, 39 one was from the Middle East, 40 and one was from Africa, Asia, and Latin America combined. 41 Eleven studies investigated stillbirth from a range of gestational ages, including ≥20 weeks (n = 8), 13,26,27,29,34,[36][37][38] ≥22 weeks (n = 3), 30,33,41 or later (≥23, ≥24, or ≥28 weeks). 28,31,35,40 One study did not describe the gestational week from which the stillbirth was recorded.…”

“…28,31,35,40 One study did not describe the gestational week from which the stillbirth was recorded. 32 Although PTB <37 weeks of gestation was used by most studies (n = 13), 13,[26][27][28][29]31,32,[35][36][37][38][39]41 seven investigated PTBs <34 weeks of gestation (n = 2), 13,29 <33 weeks of gestation (n = 2), 27,30 and <32 weeks of gestation (n = 3). 35,36,38 Five studies classified subgroups of gestational age: moderate PTB (32-36, 33-36 and 34-36 weeks of gestation); 26,30,[33][34][35] very PTB (28-32 and 29-33 weeks of gestation); 26,33,34 and extremely PTB (20-27, 20-28, and 22-27 weeks of gestation).…”

“…26,33,34 For the five studies that did not report odds ratios for PTB, we used the counts for subcategories of PTB to estimate odds ratios. 26,30,[33][34][35] Seven studies defined SGA (as a proxy for FGR) as birthweights below the tenth percentile, 26,27,31,33,37,40,41 whereas three others used birthweights that were two standard deviations (2SDs) below the mean. 32,34,35 With the exception of two studies, 30,40 all studies controlled for one or more covariates (Tables S3-S5), either by adjustment, clustering, or matching, using a range of sociodemographic, pregnancy complications, and other risk factors.…”

Evaluation and Management of Women who Have Experienced Stillbirth in Their Previous Pregnancies

“…In our series, 71.4% of the pregnancies ended up with a healthy newborn. This finding is important since the subsequent pregnancies of these patients are more likely to be complicated (24).…”