The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes.

Abstract

We sought to examine the association between first-pregnancy stillbirth and subsequent adverse perinatal outcomes. 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. 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 > or =4 years after stillbirth increased the risk of ischemic placental disease and spontaneous preterm birth. Risks varied by stillbirth subtype. A first-pregnancy stillbirth may increase adverse perinatal outcomes in subsequent pregnancy.