Association of previous stillbirth with subsequent perinatal outcomes: a systematic review and meta-analysis of cohort studies

Xiyuan Deng; Bei Pan; Honghao Lai; Qingmei Sun; Xiaojuan Lin; Jinwei Yang; Xin Han; Tingting Ge; Qiuyuan Li; Long Ge; Xiaowei Liu; Ning Ma; Xiaoman Wang; Dan Li; Yongxiu Yang; Kehu Yang

doi:10.1016/j.ajog.2024.02.304

Association of previous stillbirth with subsequent perinatal outcomes: a systematic review and meta-analysis of cohort studies

Am J Obstet Gynecol. 2024 Mar 2:S0002-9378(24)00418-6. doi: 10.1016/j.ajog.2024.02.304. Online ahead of print.

Authors

Xiyuan Deng¹, Bei Pan², Honghao Lai³, Qingmei Sun⁴, Xiaojuan Lin⁴, Jinwei Yang⁴, Xin Han⁴, Tingting Ge⁴, Qiuyuan Li⁵, Long Ge³, Xiaowei Liu⁶, Ning Ma⁷, Xiaoman Wang², Dan Li², Yongxiu Yang⁸, Kehu Yang⁹

Affiliations

¹ First School of Clinical Medicine, Lanzhou University, Lanzhou, China; Department of Obstetrics and Gynecology, First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology Gansu Province, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Gansu Province Prenatal Diagnosis Center, Key Laboratory of Prevention and Control of Birth Defects of Gansu Province, Gansu Provincial Maternity and Child-Care Hospital/Central Hospital of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
² Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
³ Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
⁴ Gansu Province Prenatal Diagnosis Center, Key Laboratory of Prevention and Control of Birth Defects of Gansu Province, Gansu Provincial Maternity and Child-Care Hospital/Central Hospital of Gansu Province, Lanzhou, China.
⁵ First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
⁶ First School of Clinical Medicine, Lanzhou University, Lanzhou, China; Department of Obstetrics and Gynecology, First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology Gansu Province, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
⁷ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
⁸ First School of Clinical Medicine, Lanzhou University, Lanzhou, China; Department of Obstetrics and Gynecology, First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology Gansu Province, Lanzhou, China. Electronic address: yongxiuyang@163.com.
⁹ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China. Electronic address: yangkh-ebm@lzu.edu.cn.

PMID: 38437893
DOI: 10.1016/j.ajog.2024.02.304

Abstract

Objective: We conducted a systematic review and meta-analysis to examine the relationship between stillbirth and various perinatal outcomes in subsequent pregnancy.

Data sources: PubMed, the Cochrane Library, Embase, Web of Science, and CNKI databases were searched up to July 2023.

Study eligibility criteria: Cohort studies that reported the association between stillbirth and perinatal outcomes in subsequent pregnancies were included.

Methods: We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. Statistical analysis was performed using R and Stata software. We used random-effects models to pool each outcome of interest. We performed a meta-regression analysis to explore the potential heterogeneity. The certainty (quality) of evidence assessment was performed using the GRADE approach.

Results: Nineteen cohort studies were included, involving 4,855,153 participants. From these studies, we identified 28,322 individuals with previous stillbirths who met the eligibility criteria. After adjusting for confounders, evidence of low to moderate certainty indicated that compared with women with previous live births, women with previous stillbirths had higher risks of recurrent stillbirth (odds ratio, 2.68; 95% confidence interval, 2.01-3.56), preterm birth (odds ratio, 3.15; 95% confidence interval, 2.07-4.80), neonatal death (odds ratio, 4.24; 95% confidence interval, 2.65-6.79), small for gestational age/intrauterine growth restriction (odds ratio, 1.3; 95% confidence interval, 1.0-1.8), low birthweight (odds ratio, 3.32; 95% confidence interval, 1.46-7.52), placental abruption (odds ratio, 3.01; 95% confidence interval, 1.01-8.98), instrumental delivery (odds ratio, 2.29; 95% confidence interval, 1.68-3.11), labor induction (odds ratio, 4.09; 95% confidence interval, 1.88-8.88), cesarean delivery (odds ratio, 2.38; 95% confidence interval, 1.20-4.73), elective cesarean delivery (odds ratio, 2.42; 95% confidence interval, 1.82-3.23), and emergency cesarean delivery (odds ratio, 2.35; 95% confidence interval, 1.81-3.06) in subsequent pregnancies, but had a lower rate of spontaneous labor (odds ratio, 0.22; 95% confidence interval, 0.13-0.36). However, there was no association between previous stillbirth and preeclampsia (odds ratio, 1.72; 95% confidence interval, 0.63-4.70) in subsequent pregnancies.

Conclusion: Our systematic review and meta-analysis provide a more comprehensive understanding of adverse pregnancy outcomes associated with previous stillbirth. These findings could be used to inform counseling for couples who are considering pregnancy after a previous stillbirth.

Keywords: adverse pregnancy outcomes; fetal death; perinatal outcomes; risk; stillbirth; subsequent pregnancies.

Publication types

Review