The Grapevine

Stillbirth Happens 4 Times As Often For Women With Prior Stillborn Pregnancy

stillborn statue
Women who have given birth to a stillborn child have a four times increased risk of doing so again compared to mothers whose first birth was live. Photo courtesy of Shutterstock.

Stillbirth is defined as a fetal death occurring after 20 weeks of pregnancy. A new University of Aberdeen study examines this tragic circumstance and arrives at a surprising conclusion: Women with a prior stillborn pregnancy are at greater risk of a second stillbirth — they are four times as likely — compared to mothers whose first birth was live, the researchers say.

Stillbirth happens all across the world, though the numbers differ from nation to nation. Every day more than 7,200 babies are stillborn, says the World Health Organization, and 98 percent of these deaths occur in low- and middle-income countries. Most stillbirths occur before labor begins. Often a mother will suspect something is wrong when she suddenly feels no movement and no kicking in her womb. Tragically, the grieving mother must go through the process of delivering her stillborn baby, as this moving account from Dr. Eleni Michailidis explains.

Though many high-income countries have a small number of stillbirths — Norway and the Netherlands have shown large reductions in their total figures of late — still some countries do not do so well in keeping their numbers low. For instance, the United Kingdomhas one of the highest stillbirth rates in Europe, with around one baby in every 200 being stillborn every year. Meanwhile, in the United States, stillbirth occurs in one out of every 160 pregnancies. Much too high, say public health officials.

Yet, behind every stillbirth "statistic" is a couple wanting to understand why it happened… and will it happen to them again?

A Study of Studies

To answer the question of recurrence, Dr. Sohinee Bhattacharya and her colleagues at University of Aberdeen in Scotland examined the link between stillbirth in a first pregnancy and risk of a second stillbirth. They analyzed 16 studies from high-income countries, including Australia, Scotland, the U.S., Denmark, Israel, the Netherlands, Norway, and Sweden.

Within the original studies, data had been collected from 3.4 million women. Of these women, 99.3 percent had a previous live birth, while 0.7 percent (or exactly 24,541) women had a stillbirth in an initial pregnancy.

Stillbirths occurred in the next pregnancy for a total of 14,283 women: 606 of the 24,541 who had originally had a stillbirth (2.5 percent) and 13,677 of the women with no history (0.4 percent).

While some of the root studies assessed the risk of a second stillbirth at a nearly fivefold increase, the current researchers factored out so-called confounding factors and decided the actual risk for a second stillbirth was about fourfold higher.

“Pregnancies after a stillbirth should be closely monitored with a view to intervene at the first sign of fetal compromise,” wrote the authors in their conclusion.

Source: Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis. BMJ. 2015.

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