Stillbirth Gestational Age as a Predictor of Recurrence Risk

Abstract

Objective We evaluated risk of subsequent stillbirth (SB) according to gestational age at initial SB.

Study Design We retrospectively reviewed a cohort of women delivering a singleton SB with at least one subsequent pregnancy. Relative risks (RRs) were calculated using an initial SB gestational age of 36 to < 40 weeks as the referent. Multivariable logistic regression accounted for potential confounders.

Results In all, 2,887 mothers and 5,090 subsequent births met inclusion criteria. For the immediately next pregnancy, the linear trend for gestational age was not significant (RR 0.41; 95% confidence interval [CI] 0.03 to 5.53). However, women with index SBs occurring between 20 and 23^6/7 weeks' gestation had a RR for subsequent stillbirth of 2.9 (95% CI 1.2 to 7.1). When including subsequent pregnancies, the test for trend for gestational age was nonsignificant (RR 1.5; 95% CI 0.3 to 8.7). However, women suffering a stillbirth between 20^0/7 and 23^6/7 weeks' gestation in the index pregnancy had an almost threefold increase in the risk of subsequent stillbirth. Women suffering an index stillbirth between 28^0/7 and 31^6/7 weeks' and after 40 weeks' gestation had a 2.5- to 3.5-fold increased risk of subsequent SB.

Conclusions Gestational age at initial SB predicts risk of recurrent SB. This effect is most pronounced in women with very preterm or with postterm pregnancies.

Keywords

pregnancy complications - recurrence risk - stillbirth

Notes

Poster presentation at the 2012 Society for Gynecologic Investigation 59th Annual Meeting, San Diego, California.

The authors report no conflict of interest.

Partial support for all data sets within the Utah Population Database is being provided by the Huntsman Cancer Institute.

The project was partially supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Condensation

Gestational age at stillbirth influences recurrence risk.

• References

• 1 Smith GCS. Predicting antepartum stillbirth. Curr Opin Obstet Gynecol 2006; 18: 625-630
• 2 Frøen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray-Pedersen B. Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986–1995. Am J Obstet Gynecol 2001; 184: 694-702
• 3 Reddy UM. Prediction and prevention of recurrent stillbirth. Obstet Gynecol 2007; 110: 1151-1164
• 4 Greenwood R, Samms-Vaughan M, Golding J, Ashley D. Past obstetric history and risk of perinatal death in Jamaica. Paediatr Perinat Epidemiol 1994; 8 (Suppl. 01) 40-53
• 5 Samueloff A, Xenakis EM, Berkus MD, Huff RW, Langer O. Recurrent stillbirth. Significance and characteristics. J Reprod Med 1993; 38: 883-886
• 6 Bhattacharya S, Prescott GJ, Black M, Shetty A. Recurrence risk of stillbirth in a second pregnancy. BMJ 2010; 117: 1243-1247
• 7 Faiz AS, Demissie K, Rich DQ, Kruse L, Rhoads GG. Trends and risk factors of stillbirth in New Jersey 1997–2005. J Matern Fetal Neonatal Med 2012; 25: 699-705
• 8 Silver RM, Heuser CC. Stillbirth workup and delivery management. Clin Obstet Gynecol 2010; 53: 681-690
• 9 Stillbirth Collaborative Research Network Writing Group. Association between stillbirth and risk factors known at pregnancy confirmation. JAMA 2011; 306: 2469-2479
• 10 Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA 2011; 306: 2459-2468
• 11 Esplin MS, O'Brien E, Fraser A , et al. Estimating recurrence of spontaneous preterm delivery. Obstet Gynecol 2008; 112: 516-523
• 12 Sharma PP, Salihu HM, Kirby RS. Stillbirth recurrence in a population of relatively low-risk mothers. Paediatr Perinat Epidemiol 2007; 21 (Suppl. 01) 24-30
• 13 Heuser C, Manuck T, Hossain S, Silver R, Varner M. Non-anomalous stillbirth by gestational age: trends differ based on method of epidemiologic calculation. J Matern Fetal Neonatal Med 2010; 23: 720-724
• 14 Heinonen S, Kirkinen P. Pregnancy outcome after previous stillbirth resulting from causes other than maternal conditions and fetal abnormalities. Birth 2000; 27: 33-37
• 15 Getahun D, Lawrence JM, Fassett MJ , et al. The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes. Am J Obstet Gynceol 2009; 201: 378.e1-378.e6
• 16 Silver RM. Optimal “work-up” of stillbirth: evidence!. Am J Obstet Gynecol 2012; 206: 1-2
• 17 Heuser CC, Hunn J, Varner M, Hossain S, Vered S, Silver RM. Correlation between stillbirth vital statistics and medical records. Obstet Gynecol 2010; 116: 1296-1301