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Grand Rounds

Predictive Risk Factors for Stillbirth

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BACKGROUND AND PURPOSE: 

  • Lamont et al. (Obstetrics & Gynecology, 2022) investigated subsequent risk for stillbirth among women with and without previous stillbirth    

METHODS: 

  • Cohort study 
  • Population 
    • Women from Malta, Finland or Scotland who had at least two singleton deliveries 
  • Exposures 
    • Stillbirth in first pregnancy 
    • Live birth in first pregnancy 
  • Study design 
    • Primary outcome was assessed using a Cox proportional hazards model 
    • Time-to-event analyses were conducted to investigate whether first pregnancy outcome had an effect on time to or the number of pregnancies preceding subsequent stillbirth 
  • Primary outcome 
    • Risk of stillbirth in any subsequent pregnancy 

RESULTS: 

  • 1,064,564 women 
    • Stillbirth at first pregnancy: 6288 women (0.59%) 
  • Compared to live birth, women with a stillbirth in the first pregnancy were more likely to have a subsequent stillbirth 
    • Adjusted hazard ratio 2.25, (95% CI, 1.86 to 2.7) 
  • Women who had a stillbirth in the first pregnancy  
    • Were less likely to have had their first antenatal appointment at ≤12 weeks  
    • Had increased risk for stillbirth with increasing parity in subsequent pregnancies  
    • Were more likely to have another pregnancy within 1 year 
  • The following were independently associated with subsequent stillbirth 
    • Maternal age younger <25 years or ≥40 years  
    • Smoking 
    • Low socioeconomic status 
    • Not having a partner 
    • Pre-existing diabetes 
    • Preeclampsia 
    • Placental abruption 
    • Fetal growth restriction  
  • Absolute risk of subsequent stillbirth 
    • Previous live birth: 0.5% 
    • Previous stillbirth: 2.5% 

CONCLUSION: 

  • Prior stillbirth increases the risk of subsequence stillbirth, regardless of number of pregnancies 
  • The authors state 

…women with a stillbirth in their first pregnancy have more than double the risk of stillbirth in any subsequent pregnancy 

Despite significantly raised relative risk, the absolute risk remains low 

Learn More – Primary Sources: 

Risk of Recurrent Stillbirth in Subsequent Pregnancies 

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Related ObG Topics:

Can Daughters Inherit a Predisposition Towards Stillbirth from Their Mothers?
Stillbirth Risks from 37 Weeks and Beyond
How Well Can Perceived Changes in Fetal Movements Predict Stillbirth?

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