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Stillbirth raises risk of its recurrence

Four times higher risk for women with previous stillbirth

Adrian O'Dowd

Friday, 26 June 2015

Women who have experienced a stillbirth have a four times higher risk of having another stillbirth in their second pregnancy as women who had an initial live birth, concludes a new meta-analysis* published in The BMJ.

Stillbirth rates have fallen across most of Europe, but the UK still has a significant public health problem and is ranked 33rd out of 35 for stillbirth rates among European countries.

The UK recorded 3,286 stillborn babies in 2013, meaning around one baby in every 200 is being stillborn every year.

Researchers from the University of Aberdeen carried out a systematic review and meta-analysis to examine the link between stillbirth in an initial pregnancy and risk of stillbirth in a subsequent pregnancy.

They analysed 13 cohort and three case-control studies from high-income countries including Australia, Scotland, the US, Denmark, Israel, the Netherlands, Norway and Sweden.

Data was collected for 3,412,079 women. Of these, 3,387,538 (99.3%) women had a previous live birth and 24,541 (0.7%) women had a stillbirth in an initial pregnancy.

The data showed that stillbirths occurred in the subsequent pregnancy for 14,283 women – 606 of 24,541 (2.5%) in women with a history of stillbirth and 13,677 of 3,387,538 (0.4%) in women with no history.

Twelve studies assessed the risk of stillbirth in second pregnancies.

Analyses showed that women who had a stillbirth in an initial pregnancy had a nearly fivefold increased risk of stillbirth in a second pregnancy.

After taking into account factors such as maternal age, maternal smoking and level of deprivation, the increased risk was up to fourfold higher.

Sohinee Bhattacharya and colleagues from the University of Aberdeen, said: “Stillbirth is one of the most common adverse obstetric outcomes and a traumatic experience for parents. Couples who have experienced a stillbirth need to understand why it happened and want to know the risk for future pregnancies.”

The authors cautioned that risks following an unexplained stillbirth might not be increased because there are few studies and the evidence remained inadequate.

Nevertheless, they argued that pre-pregnancy counselling services should be provided to women who had a stillbirth as well as advice on changing lifestyle factors such as smoking and obesity that were both linked to an increased risk of stillbirth.

“Pregnancies after a stillbirth should be closely monitored with a view to intervene at the first sign of foetal compromise,” they said.

In a linked editorial**, Dr Alexander Heazell, senior clinical lecturer in obstetrics and clinical director at St Mary's Hospital, University of Manchester, echoed the call for additional care in next pregnancy, and for more research on unexplained stillbirths, which can account for around 20% of stillbirths.

“The need for specialist care should also take into account the additional psychological needs of parents during pregnancies that follow a stillbirth,” said Dr Heazell.

* Kathleen Lamont, et al. Risk of recurrent stillbirth: systematic review and meta-analysis. The BMJ 2015;350:h3080 doi: 10.1136/bmj.h3080

** Alexander E P Heazell, Jane Clewlow. Protecting families from recurrent stillbirth. The BMJ 2015;350:h3262. doi: 10.1136/bmj.h3262

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