Mothers must heal physically and psychologically from the first stillbirth before conceiving again

Women who experience a stillbirth in their first pregnancy may be at higher risk for complications or adverse outcomes in their next pregnancy, according to a Kaiser Permanente study that appears online in the October issue of the American Journal of Obstetrics and Gynecology.

The study examined 71,315 Kaiser Permanente Southern California female members from diverse racial and ethnic backgrounds who delivered one child at 20-44 weeks’ gestation from 1991 to 2008 and found that women whose first pregnancy resulted in stillbirth tended to be younger, African American, and had started prenatal care later in the pregnancy, as well as having a shorter interval between the first two pregnancies.

Each year in the United States, there are about 25,000 stillbirths, defined as the death of a fetus at greater than or equal to 20 weeks of gestation. Despite technological advances in obstetric and neonatal care, it remains one of the major causes of perinatal mortality in developed countries and even more so in developing countries.

The study used data linking three medical records referencing birth certificates, hospitalization, and outpatient health care encounter files using each member’s unique medical record number. The researchers evaluated the relationship between stillbirth and ischemic placental diseases (IPDs) defined as the occurrence of any one or more of the following closely related conditions: pre-eclampsia, small-for-gestational age, and placental abruption, as well as other adverse perinatal and neonatal outcomes such as fetal distress, chorioamnionitis, spontaneous preterm birth (SPTB) and neonatal mortality in subsequent pregnancies. Their findings show that a first pregnancy which resulted in stillbirth was associated with increased risk of IPD, fetal distress, chorioamnionitis, and neonatal mortality in the second pregnancy, compared to a pregnancy that resulted in live birth. A stillbirth in the first pregnancy was also associated with an increased risk of SPTB and stillbirth in the second pregnancy, an observation that is consistent with the findings of previous studies.

“When it comes to healthy pregnancies, it appears that early initiation of prenatal care is the key to lowering the risk of adverse outcomes in pregnancies,” said the study’s lead author Darios Getahun, MD, MPH, and researcher at the Kaiser Permanente Department of Research and Evaluation in Pasadena, CA. He explained that early initiation and consistent treatment of hypertension, diabetes, malnutrition, bacterial infections and other pre-existing health problems before conception and during the pregnancy may help reduce stillbirth incidences. “It is also critical for the mother to take time to physically and psychologically heal from the first stillbirth before conceiving again,” said Getahun who plans to continue this study.