Risk of Recurrent Stillbirth in Subsequent Pregnancies

Lamont, Kathleen; Scott, Norman; Gissler, Mika; Gatt, Miriam; Bhattacharya, Sohinee

doi:10.1097/aog.0000000000004626

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…Compared to the seven-fold increase in the odds of stillbirth in our study, in Finland having a stillbirth increased the risk of future stillbirths and spontaneous abortions by 20% even after controlling for all major obstetric complications [ 26 ]. In a pooled analysis of births from Finland, Malta, and Scotland, women with stillbirth in the first pregnancy were twice as likely to have a subsequent stillbirth [ 27 ] and similar results were reported in the Netherlands as well [ 28 ]. Using random effects to adjust for unobserved heterogeneity or maternal vulnerability, we also found that the risk of having recurrent stillbirth could be attributed to observed maternal characteristics, which included the prior stillbirth.…”

Section: Discussionmentioning

confidence: 66%

Risk of recurrent stillbirth and neonatal mortality: mother-specific random effects analysis using longitudinal panel data from Indonesia (2000 – 2014)

Dev

2022

BMC Pregnancy Childbirth

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Background Despite significant government investments to improve birth outcomes in low and middle-income countries over the past several decades, stillbirth and neonatal mortality continue to be persistent public health problems. While they are different outcomes, there is little evidence regarding their shared and unique population-level risk factors over a mother’s reproductive lifespan. Data gaps and measurement challenges have left several areas in this field unexplored, especially assessing the risk of stillbirth or neonatal mortality over successive pregnancies to the same woman. This study aimed to assess the risk of stillbirth and neonatal mortality in Indonesia during 2000–2014, using maternal birth histories from the Indonesia Family Life Survey panel data. Methods Data from three panels were combined to create right-censored birth histories. There were 5,002 unique multiparous mothers with at least two singleton births in the sample. They reported 12,761 total births and 12,507 live births. Random effects (RE) models, which address the dependency of variance in births to the same mother, were fitted assuming births to the same mother shared unobserved risk factors unique to the mother. Results The main finding was that there having had a stillbirth increased the odds of another stillbirth nearly seven-fold and that of subsequent neonatal mortality by over two-fold. Having had a neonatal death was not associated with a future neonatal death. Mothers who were not educated and nullipara were much more likely to experience a neonatal death while mothers who had a prior neonatal death had no risk of another neonatal death due to unmeasured factors unique to the mother. Conclusions The results suggest that for stillbirths, maternal heterogeneity, as explained by a prior stillbirth, could capture underlying pathology while the relationship between observed risk factors and neonatal mortality could be much more dependent on context. Establishing previous adverse outcomes such as neonatal deaths and stillbirth could help identify high-risk pregnancies during prenatal care, inform interventions, and improve health policy.

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Section: Discussionmentioning

confidence: 66%

Risk of recurrent stillbirth and neonatal mortality: mother-specific random effects analysis using longitudinal panel data from Indonesia (2000 – 2014)

Dev

2022

BMC Pregnancy Childbirth

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“…Additional research can help clarify whether risk stratification is, in fact, needed for patients based on the presence of prior history of stillbirth, 22 though our findings suggest that additional postnatal surveillance may be warranted for these infants. Chronic or recurring maternal factors may contribute both to initial stillbirth and lead to future pregnancy complications, including placental issues such as abruption, 5 8 12 medical comorbidities, including pregestational diabetes, 3 8 obstetric complications like preeclampsia, 8 12 and demographic factors, including low socioeconomic status and smoking history. 8…”

Section: Discussionmentioning

confidence: 99%

Neonatal and Maternal Outcomes of Pregnancies following Stillbirth

Brakewood,

Stoever,

Has

et al. 2023

Am J Perinatol

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Objective Prior stillbirth increases risk of subsequent stillbirth but has unclear effect on subsequent liveborn pregnancies. We examined associations between prior stillbirth, adverse neonatal outcomes, and maternal morbidity in subsequent liveborn pregnancies. Study Design This is a secondary analysis of a large, National Institutes of Health-funded retrospective cohort study of parturients who delivered a singleton infant at a tertiary-care hospital from January 2002 to March 2013 and had a past medical/obstetric history of diabetic, and/or hypertensive disorders, and/or pregnancy with fetal growth restriction. Our analysis included all multiparous patients from the parent study. The primary outcome was a neonatal morbidity composite (neonatal resuscitation, neonatal birth injury, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis). Secondary outcomes included a maternal morbidity composite (venous thromboembolism, intensive care unit admission, disseminated intravascular coagulation, sepsis, hysterectomy, pulmonary edema, renal failure, blood transfusion), other maternal/delivery complications, and neonatal intensive care unit (NICU) admission. Outcomes were compared between those with versus without prior stillbirth. Negative binomial regression controlled for maternal comorbidities and delivery year. Results Among 171 and 5,245 multiparous parturients with versus without prior stillbirth, respectively, those with prior stillbirth had higher rates of pregestational diabetes, autoimmune disease, and clotting disorders. After controlling for these differences and delivery year, infants of parturients with prior stillbirth had similar risk of composite neonatal morbidity (adjusted relative ratio [aRR] 1.19; 95% confidence interval [CI] 0.99–1.45) but higher risk of NICU admission (aRR 1.42; 95% CI 1.06–1.91) compared with infants of parturients without prior stillbirth, despite delivering at similar gestational ages. Multiparous patients with prior stillbirth had equal maternal morbidity risk but higher risk of developing preeclampsia with severe features (aRR 2.11; 95% CI 1.19–3.72). Conclusion Compared with high-risk multiparous patients without prior stillbirth, those with prior stillbirth have higher risk of NICU admission and preeclampsia with severe features. Key Points

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“…For instance, in the case of pre-eclampsia, research suggests that the risk of recurrence is approximately 15% for women who experienced pre-eclampsia in one previous pregnancy, and it rises to around 30% when two pregnancies are affected [ 65 ]. Similarly, for stillbirth, women who experienced a stillbirth in their first pregnancy have a heightened risk of subsequent stillbirth, with an adjusted hazard ratio ranging from 1.86 to 2.72 compared to women who had a live birth in their first pregnancy [ 66 ]. Concerning fetal growth restriction (FGR), women with a previous pregnancy affected by FGR face a recurrence risk ranging from 20% to 30% in subsequent pregnancies.…”

Section: Reviewmentioning

confidence: 99%

“…Concerning fetal growth restriction (FGR), women with a previous pregnancy affected by FGR face a recurrence risk ranging from 20% to 30% in subsequent pregnancies. Currently, limited effective preventive strategies are available to mitigate this risk [ 66 ].…”

Section: Reviewmentioning

confidence: 99%

Navigating Perinatal Challenges: A Comprehensive Review of Cholestasis of Pregnancy and Its Impact on Maternal and Fetal Health

Abdul Waheed,

Jaiswal,

Yelne

et al. 2024

Cureus

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Cholestasis of pregnancy (CP), or intrahepatic CP (ICP), represents a condition peculiar to pregnancy, marked by impaired bile acid flow and consequent accumulation in the maternal bloodstream. Primarily emerging in the third trimester, CP is linked with considerable risks to both the mother and fetus, including heightened incidences of preterm birth, fetal distress, and stillbirth, alongside maternal complications such as intense pruritus and liver dysfunction. Despite its clinical significance, the etiology of CP, which involves genetic, hormonal, and environmental factors, remains partially understood. This comprehensive review delves into the physiology and pathophysiology of CP, outlines its clinical manifestations and diagnostic criteria, and discusses the associated maternal and fetal complications. Furthermore, it evaluates current management strategies, prognostic implications, and potential long-term effects on maternal and child health. It also explores future research directions, emphasizing the need for advancements in understanding the pathophysiology of CP, developing novel therapeutic interventions, and improving risk stratification models. By offering a thorough overview of CP, this review aims to enhance clinical awareness, guide management practices, and identify areas requiring further investigation, ultimately contributing to better health outcomes for affected women and their babies.

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Risk of Recurrent Stillbirth in Subsequent Pregnancies

Abstract: To compare the prospective risk of stillbirth between women with and without a stillbirth in their first pregnancy.

Cited by 10 publications

References 30 publications

Risk of recurrent stillbirth and neonatal mortality: mother-specific random effects analysis using longitudinal panel data from Indonesia (2000 – 2014)

Risk of recurrent stillbirth and neonatal mortality: mother-specific random effects analysis using longitudinal panel data from Indonesia (2000 – 2014)

Neonatal and Maternal Outcomes of Pregnancies following Stillbirth

Navigating Perinatal Challenges: A Comprehensive Review of Cholestasis of Pregnancy and Its Impact on Maternal and Fetal Health

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