Meeting paper
SMFM paper
The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes

Presented at the 29th Annual Meeting of the Society for Maternal-Fetal Medicine, San Diego, CA, Jan. 26-31, 2009.
https://doi.org/10.1016/j.ajog.2009.06.071Get rights and content

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 ≥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.

Section snippets

Materials and Methods

We conducted a retrospective cohort study of all births to Kaiser Permanente Southern California members for the years 1991-2008 (approximately 30,000 annual deliveries). The study was approved by our institutional review board. Using each member's unique medical record number, we linked 3 databases: the perinatal services system, maternal and infant hospitalization in all of our hospitals, and outpatient health care encounter files. The perinatal services system data file contains data from

Results

The incidence of stillbirth in the first pregnancy was 5.3 per 1000 singleton births. The incidence rates of antepartum and intrapartum stillbirth were 3.5 per 1000 and 1.2 per 1000 singleton births, respectively, while the rate of unknown stillbirth subtype was 0.6 per 1000 singleton births.

The distribution of maternal and fetal characteristics in the second pregnancy based on stillbirth and live birth status in the first pregnancy is presented in Table 1. When we examined maternal demographic

Comment

The findings of this study suggest that women whose first pregnancy resulted in stillbirth are at increased risk of conditions that constitute IPD (preeclampsia, SGA, intrauterine growth retardation, and abruption), fetal distress, chorioamnionitis, SPTB, and early neonatal mortality in their second pregnancy. Antepartum but not intrapartum stillbirth in the first pregnancy was associated with increased risk of IPD in the second pregnancy. This study also provides evidence that the interval

Acknowledgment

The authors thank Vicki Chiu, MS, senior consulting data analyst, for her technical support.

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    • Cited by (0)

    This study was supported by Kaiser Permanente Direct Community Benefit funds.

    Cite this article as: Getahun D, Lawrence JM, Fassett MJ, et al. The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes. Am J Obstet Gynecol 2009;201:378.e1-6.

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