Download PDF
Am J Perinatol 2024; 41(S 01): e3018-e3024
DOI: 10.1055/s-0043-1776349
Original Article

Neonatal and Maternal Outcomes of Pregnancies following Stillbirth

Eleanor S. Brakewood 
1   Department of Medical Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Kara Stoever
2   Department of OB/GYN, Boston Medical Center, Boston, Massachusetts
,
Phinnara Has
3   Division of Research, Lifespan Health System, Providence, Rhode Island
,
Nina K. Ayala 
4   Division of Maternal Fetal Medicine, Department of OB/GYN, Women and Infants Hospital of Rhode Island, Rhode Island
,
Valery A. Danilack-Fekete
5   Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut
,
David Savitz
6   Department of OB/GYN, Women and Infants Hospital of Rhode Island, Rhode Island
,
Adam K. Lewkowitz 
7   Division of Maternal Fetal Medicine, Department of OB/GYN, Women and Infants Hospital of Rhode Island, Rhode Island
› Author Affiliations Funding National Institutes of Child Health and Human Development grant 1R01HD077592, Principal investigator: D.S. Title: Effect of iatrogenic delivery at 34–38 weeks' gestation on pregnancy outcome.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Prior stillbirth increases risk of subsequent stillbirth but has unclear effect on subsequent liveborn pregnancies. We examined associations between prior stillbirth, adverse neonatal outcomes, and maternal morbidity in subsequent liveborn pregnancies.

Study Design This is a secondary analysis of a large, National Institutes of Health-funded retrospective cohort study of parturients who delivered a singleton infant at a tertiary-care hospital from January 2002 to March 2013 and had a past medical/obstetric history of diabetic, and/or hypertensive disorders, and/or pregnancy with fetal growth restriction. Our analysis included all multiparous patients from the parent study. The primary outcome was a neonatal morbidity composite (neonatal resuscitation, neonatal birth injury, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis). Secondary outcomes included a maternal morbidity composite (venous thromboembolism, intensive care unit admission, disseminated intravascular coagulation, sepsis, hysterectomy, pulmonary edema, renal failure, blood transfusion), other maternal/delivery complications, and neonatal intensive care unit (NICU) admission. Outcomes were compared between those with versus without prior stillbirth. Negative binomial regression controlled for maternal comorbidities and delivery year.

Results Among 171 and 5,245 multiparous parturients with versus without prior stillbirth, respectively, those with prior stillbirth had higher rates of pregestational diabetes, autoimmune disease, and clotting disorders. After controlling for these differences and delivery year, infants of parturients with prior stillbirth had similar risk of composite neonatal morbidity (adjusted relative ratio [aRR] 1.19; 95% confidence interval [CI] 0.99–1.45) but higher risk of NICU admission (aRR 1.42; 95% CI 1.06–1.91) compared with infants of parturients without prior stillbirth, despite delivering at similar gestational ages. Multiparous patients with prior stillbirth had equal maternal morbidity risk but higher risk of developing preeclampsia with severe features (aRR 2.11; 95% CI 1.19–3.72).

Conclusion Compared with high-risk multiparous patients without prior stillbirth, those with prior stillbirth have higher risk of NICU admission and preeclampsia with severe features.

Key Points

  • Prior stillbirth increases risk in subsequent livebirth for NICU admission and neonatal morbidity.

  • Prior stillbirth increased the risk of severe preeclampsia for mothers in subsequent livebirth.

  • Additional monitoring of pregnancies of patients with prior history of demise may be warranted.

Keywords

fetal demise - NICU - antepartum care - pregnancy complications - neonatal morbidity - maternal morbidity - high-risk pregnancy

Note

This manuscript was presented as a poster in SMFM's 41st Virtual Annual Pregnancy Meeting held from January 25 to 30, 2021 (abstract no.: 1085).


Supplementary Material



Publication History

Received: 28 April 2023

Accepted: 26 September 2023

Article published online:
31 October 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Reddy UM. Management of pregnancy after stillbirth. Clin Obstet Gynecol 2010; 53 (03) 700-709
    CrossrefPubMedGoogle Scholar
  • 2 Graham N, Stephens L, Heazell AE. Care in pregnancies subsequent to stillbirth or perinatal death. Obstet Gynaecol 2021; 23 (01) 48-59
    CrossrefPubMedGoogle Scholar
  • 3 Robson S, Chan A, Keane RJ, Luke CG. Subsequent birth outcomes after an unexplained stillbirth: preliminary population-based retrospective cohort study. Aust N Z J Obstet Gynaecol 2001; 41 (01) 29-35
    CrossrefPubMedGoogle Scholar
  • 4 Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis. BMJ 2015; 350: h3080
    CrossrefPubMedGoogle Scholar
  • 5 Bhattacharya S, Prescott GJ, Black M, Shetty A. Recurrence risk of stillbirth in a second pregnancy. BJOG 2010; 117 (10) 1243-1247
    CrossrefPubMedGoogle Scholar
  • 6 Fretts RC. Etiology and prevention of stillbirth. Am J Obstet Gynecol 2005; 193 (06) 1923-1935
    CrossrefPubMedGoogle Scholar
  • 7 Gordon A, Raynes-Greenow C, McGeechan K, Morris J, Jeffery H. Stillbirth risk in a second pregnancy. Obstet Gynecol 2012; 119 (03) 509-517
    CrossrefPubMedGoogle Scholar
  • 8 Lamont K, Scott NW, Gissler M, Gatt M, Bhattacharya S. Risk of recurrent stillbirth in subsequent pregnancies. Obstet Gynecol 2022; 139 (01) 31-40
    CrossrefPubMedGoogle Scholar
  • 9 Metz TD, Snipe Berry R, Fretts RC, Reddy UM, Turrentine MA. Management of stillbirth: Obstetric Care Consensus No, 10. Obstet Gynecol 2020; 135 (03) e110-e132
    CrossrefPubMedGoogle Scholar
  • 10 Roseingrave R, Murphy M, O'Donoghue K. Pregnancy after stillbirth: maternal and neonatal outcomes and health service utilization. Am J Obstet Gynecol MFM 2022; 4 (01) 100486
    CrossrefPubMedGoogle Scholar
  • 11 Heinonen S, Kirkinen P. Pregnancy outcome after previous stillbirth resulting from causes other than maternal conditions and fetal abnormalities. Birth 2000; 27 (01) 33-37
    CrossrefPubMedGoogle Scholar
  • 12 Black M, Shetty A, Bhattacharya S. Obstetric outcomes subsequent to intrauterine death in the first pregnancy. BJOG 2008; 115 (02) 269-274
    CrossrefPubMedGoogle Scholar
  • 13 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 (04) 378.e1-378.e6
    CrossrefPubMedGoogle Scholar
  • 14 Graham N, Stephens L, Johnstone ED, Heazell AEP. Can information regarding the index stillbirth determine risk of adverse outcome in a subsequent pregnancy? Findings from a single-center cohort study. Acta Obstet Gynecol Scand 2021; 100 (07) 1326-1335
    CrossrefPubMedGoogle Scholar
  • 15 Pekkola M, Tikkanen M, Gissler M, Paavonen J, Stefanovic V. Stillbirth and subsequent pregnancy outcome - a cohort from a large tertiary referral hospital. J Perinat Med 2020; 48 (08) 765-770
    CrossrefPubMedGoogle Scholar
  • 16 Ofir K, Kalter A, Moran O, Sivan E, Schiff E, Simchen MJ. Subsequent pregnancy after stillbirth: obstetrical and medical risks. J Perinat Med 2013; 41 (05) 543-548
    CrossrefPubMedGoogle Scholar
  • 17 Monari F, Pedrielli G, Vergani P. et al. Adverse perinatal outcome in subsequent pregnancy after stillbirth by placental vascular disorders. PLoS ONE 2016; 11 (05) e0155761
    CrossrefPubMedGoogle Scholar
  • 18 Lurie S, Eldar I, Glezerman M, Sadan O. Pregnancy outcome after stillbirth. J Reprod Med 2007; 52 (04) 289-292
    PubMedGoogle Scholar
  • 19 Savitz DA, Danilack VA, Cochancela J, Hughes BL, Rouse DJ, Gutmann R. Health outcomes associated with clinician-initiated delivery for hypertensive disorders at 34-38 weeks' gestation. Epidemiology 2022; 33 (02) 260-268
    CrossrefPubMedGoogle Scholar
  • 20 Mills TA, Ricklesford C, Heazell AE, Cooke A, Lavender T. Marvellous to mediocre: findings of national survey of UK practice and provision of care in pregnancies after stillbirth or neonatal death. BMC Pregnancy Childbirth 2016; 16 (01) 101
    CrossrefPubMedGoogle Scholar
  • 21 Wojcieszek AM, Boyle FM, Belizán JM. et al. Care in subsequent pregnancies following stillbirth: an international survey of parents. BJOG 2018; 125 (02) 193-201
    CrossrefPubMedGoogle Scholar
  • 22 Robson SJ, Leader LR. Management of subsequent pregnancy after an unexplained stillbirth. J Perinatol 2010; 30 (05) 305-310
    CrossrefPubMedGoogle Scholar