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

Am J Obstet Gynecol. 2009 Oct;201(4):378.e1-6. doi: 10.1016/j.ajog.2009.06.071. Epub 2009 Aug 18.


Objective: We sought to examine the association between first-pregnancy stillbirth and subsequent adverse perinatal outcomes.

Study design: 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.

Results: 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.

Conclusion: A first-pregnancy stillbirth may increase adverse perinatal outcomes in subsequent pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chorioamnionitis / epidemiology
  • Female
  • Fetal Distress / epidemiology
  • Gestational Age
  • Humans
  • Logistic Models
  • Pregnancy
  • Pregnancy Outcome*
  • Stillbirth / epidemiology*
  • Young Adult