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Association between pregravid physical activity and family history of stroke and risk of stillbirth: population-based cohort study
  1. Grace M Egeland1,
  2. Grethe S Tell1,
  3. Øyvind Næss2,
  4. Jannicke Igland1,
  5. Kari Klungsøyr1
  1. 1 Department of Global Public Health and Primary Care, Norwegian Institute of Public Health, & Professor, University of Bergen, Bergen, Norway
  2. 2 Institute of Health and Society, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Grace M Egeland; G.Egeland{at}


Objectives To evaluate whether family history of disease and pregravid lifestyle and cardiovascular risk factors are associated with subsequent stillbirth delivery.

Design Prepregnancy cohort study.

Setting Cohort Norway regional health surveys (1994–2003) linked to Medical Birth Registry of Norway for deliveries through 2012.

Participants 13 497 singleton births (> 22 weeks gestation) in 8478 women.

Main outcome measure Risk of stillbirth evaluated by Poisson regression.

Results Mean (SD) length of follow-up was 5.5 (3.5) years. In analyses adjusting for baseline age and length of follow-up, ≥3 hours of baseline past-year vigorous physical activity per week (resulting in shortness of breath/sweating) was associated with increased risk of stillbirth compared with <1 hour/week of vigorous activity (incidence rate ratio, IRR 2.46; 95% CI 1.23 to 4.90). In contrast, baseline past-year light physical activity of ≥3 hours per week associated with reduced risk of stillbirth compared with <3 hours of light physical activity per week (IRR 0.53; 95% CI 0.30 to 0.93). A family history of stroke associated with increased risk of stillbirth delivery (IRR 2.53; 95% CI 1.06 to 6.01). Because overweight/obese women may experience shortness of breath and sweating with less physical exertion than normal weight women, a sensitivity analysis was conducted limited to women with a normal BMI (> 18.5 and <25 kg/m2). Vigorous activity of ≥3 hours per week (IRR of 4.50; 95% CI 1.72 to 11.79) and a family history of stroke (IRR of 3.81; 95% CI 1.31 to 11.07) were more strongly related to stillbirth risk among women with a normal BMI than that observed for all women combined. Established risk factors also associated with stillbirth risk.

Conclusions The study identified physical activity and family history of stroke as potential new risk factors for stillbirth delivery.

  • pregnancy
  • physical activity
  • exercise
  • stillbirth
  • stroke
  • myocardial infarction.

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  • Contributors GME designed the secondary use of the data, conducted analyses, drafted original and revised text; GST and ØN planned and implemented the baseline CONOR health surveys; KK implemented quality assurance for the MBRN; ØN and Jon M.G. Wickmann implemented data linkages. GST, ØN, JI, and KK provided critical feedback and intellectual content. GME is guarantor.

  • Funding Secondary data analyses and record linkages were funded by the Norwegian Institute of Public Health and The Norwegian Sudden Infant Death and Stillbirth Society.

  • Disclaimer The funders did not influence the conduct of the study, analysis or interpretation of the data, the writing of this report or the decision to publish.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Regional Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Bona fide researchers can apply to use data through formal protocols, review, and agreements (