Risk of recurrent stillbirth: Systematic review and meta-analysis

Kathleen Lamont, Neil W Scott, Gareth Jones, Sohinee Bhattacharya

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Abstract

Objective To determine the risk of recurrent stillbirth.

Design Systematic review and meta-analysis of cohort and case-control studies.

Data sources Embase, Medline, Cochrane Library, PubMed, CINAHL, and Scopus searched systematically with no restrictions on date, publication, or language to identify relevant studies. Supplementary efforts included searching relevant internet resources as well as hand searching the reference lists of included studies. Where published information was unclear or inadequate, corresponding authors were contacted for more information.

Study selection Cohort and case-control studies from high income countries were potentially eligible if they investigated the association between stillbirth in an initial pregnancy and risk of stillbirth in a subsequent pregnancy. Stillbirth was defined as fetal death occurring at more than 20 weeks’ gestation or a birth weight of at least 400 g. Two reviewers independently screened titles to identify eligible studies based on inclusion and exclusion criteria agreed a priori, extracted data, and assessed the methodological quality using scoring criteria from the critical appraisal skills programme. Random effects meta-analyses were used to combine the results of the included studies. Subgroup analysis was performed on studies that examined unexplained stillbirth.

Results 13 cohort studies and three case-control studies met the inclusion criteria and were included in the meta-analysis. Data were available on 3 412 079 women with pregnancies beyond 20 weeks duration, of who 3 387 538 (99.3%) had had a previous live birth and 24 541 (0.7%) a stillbirth. A total of 14 283 stillbirths occurred in subsequent pregnancies, 606/24 541 (2.5%) in women with a history of stillbirth and 13 677/3 387 538 (0.4%) among women with no such history (pooled odds ratio 4.83, 95% confidence interval 3.77 to 6.18). 12 studies specifically assessed the risk of stillbirth in second pregnancies. Compared with women who had a live birth in their first pregnancy, those who experienced a stillbirth were almost five times more likely to experience a stillbirth in their second pregnancy (odds ratio 4.77, 95% confidence interval 3.70 to 6.15). The pooled odds ratio using the adjusted effect measures from the primary studies was 3.38 (95% confidence interval 2.61 to 4.38). Four studies examined the risk of recurrent unexplained stillbirth. Methodological differences between these studies precluded pooling the results.

Conclusions The risk of stillbirth in subsequent pregnancies is higher in women who experience a stillbirth in their first pregnancy. This increased risk remained after adjusted analysis. Evidence surrounding the recurrence risk of unexplained stillbirth remains controversial.
Original languageEnglish
Article number3080
JournalBMJ
Volume350
Early online date24 Jun 2015
DOIs
Publication statusPublished - 2015

Bibliographical note

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Acknowledgements: We thank Melanie Bickerton for her guidance on the search strategy.

Contributors: KL conducted the searches, extracted the data, and wrote the first draft of the paper. NWS supervised and helped with the interpretation of the meta-analyses. GTJ assisted with data extraction and quality assessment and supervised KL. SB was responsible for formulating the review question, designing the study, conducting the literature searches independently, and supervising KL. All authors contributed intellectually to the writing or revising of the manuscript, and approved the final version. SB is the guarantor.

Funding: The University of Aberdeen acted as sponsors for this research project, but the findings and their interpretation in this study are the authors’ own.

Keywords

  • stillbirth
  • unexplained stillbirth
  • recurrence

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