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Published on: November 20, 2015
The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes
Darios Getahun1, Jean M Lawrence, Michael J Fassett
1Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group, Pasadena, CA 91101, USA. Darios.T.Getahun@kp.org
Objective:
We sought to examine the association between first-pregnancy stillbirth and subsequent adverse perinatal outcomes.
Study Design:
This cohort study examined the first 2 singleton deliveries at 20-44 weeks' gestation from 1991-2008 (n = 71,315) using birth certificate, hospitalization, and outpatient encounter files. Multivariable logistic regression models were used to assess the association.
Results:
Stillbirth was observed in 5.3 of 1000 first deliveries. There was an increased risk of ischemic placental disease (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1), fetal distress (OR, 2.8; 95% CI, 1.7-4.5), chorioamnionitis (OR, 2.3; 95% CI 1.5-4.3), extreme preterm birth (OR, 4.2; 95% CI, 1.8-9.9), and early neonatal mortality (OR, 8.3; 95% CI, 3.7-18.6) in pregnancies after stillbirth vs pregnancies after live birth. Interpregnancy intervals <2 and > or =4 years after stillbirth increased the risk of ischemic placental disease and spontaneous preterm birth. Risks varied by stillbirth subtype.
Conclusion:
A first-pregnancy stillbirth may increase adverse perinatal outcomes in subsequent pregnancy.
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