American Journal of Epidemiology Advance Access originally published online on October 25, 2006
American Journal of Epidemiology 2007 165(2):194-202; doi:10.1093/aje/kwj354
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ORIGINAL CONTRIBUTIONS |
Previous Preeclampsia, Preterm Delivery, and Delivery of a Small for Gestational Age Infant and the Risk of Unexplained Stillbirth in the Second Pregnancy: A Retrospective Cohort Study, Scotland, 1992–2001
1 Department of Obstetrics and Gynaecology, Cambridge University, The Rosie Hospital, Cambridge, United Kingdom
2 Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, United Kingdom
3 Department of Public Health, Greater Glasgow National Health Service Board, Glasgow, United Kingdom
4 Information and Statistics Division, Common Services Agency, Edinburgh, United Kingdom
Correspondence to Dr. Gordon C. S. Smith, Department of Obstetrics and Gynaecology, Cambridge University, Box 223, The Rosie Hospital, Robinson Way, Cambridge CB2 2SW, United Kingdom (e-mail: gcss2{at}cam.ac.uk).
Women with a previous stillbirth are known to be at increased risk of stillbirth in subsequent pregnancies. However, few studies have addressed the association between other complications of pregnancy and the future risk of stillbirth. Using linkage of national pregnancy and perinatal death registries, the authors performed a retrospective cohort study of 133,163 women having a second birth in Scotland between 1992 and 2001 whose first infant was liveborn. The risk of unexplained stillbirth was increased among women with a previous preterm birth (adjusted hazard ratio (HR) = 2.04, 95% confidence interval (CI): 1.34, 3.11), previous delivery of a small for gestational age (SGA) infant (HR = 2.14, 95% CI: 1.59, 2.87), and previous preeclampsia (HR = 1.68, 95% CI: 1.07, 2.62). The associations were similar after adjustment for maternal age, height, marital and smoking status, and interpregnancy interval. There was a statistically significant positive interaction between previous delivery of a SGA infant and previous preeclampsia (p = 0.01): Women with this combination in their first pregnancy had an approximately fivefold risk of unexplained stillbirth in the second pregnancy (HR = 4.95, 95% CI: 2.63, 9.32). Associations were stronger with SGA unexplained stillbirths. The authors conclude that complicated first births of liveborn infants are associated with an increased risk of unexplained stillbirth in the next pregnancy.
pregnancy complications; risk; stillbirth
Abbreviations: CI, confidence interval; HR, hazard ratio; ICD, International Classification of Diseases; OR, odds ratio; SGA, small for gestational age