New data for counseling on pregnancy after stillbirth

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After miscarriage, an interpregnancy interval (IPI) of more than 7 months is sometimes recommended to reduce anxiety and depression in the subsequent pregnancy, but no guidelines exist for IPI following stillbirth. A recent study in The Lancet examined associations between IPI after stillbirth and risk of preterm birth (PTB), small-for-gestational-age (SGA), and stillbirth in the subsequent pregnancy. 

Using birth record data from three regions-Finland (1987-2016), Norway (1980-2015), and Western Australia (1980-2015)-the researchers looked at consecutive singleton pregnancies in women whose most recent pregnancy ended in stillbirth at least 22 weeks’ gestation. The cohort included 14,452 births. Median interpregnancy interval after stillbirth was 9 months and 9,109 women (63%) conceived within 12 months. Of the subsequent births, 228 (2%) were stillbirths, 2532 (18%) were preterm, and 1284 (9%) were SGA. 

Compared to pregnancies with a much longer interpregnancy interval (24-59 months), shorter-interval pregnancies were not associated with increased odds of a second stillbirth (odds ratio [OR] 1.09 [95% CI 0.63-1.91] for < 6 months; 0.90 [0.47-1.71] for 6-11 months). Odds of PTB and SGA also were no higher in the births with shorter interpregnancy intervals. The ORs were adjusted for maternal age, parity, decade of delivery, and gestation length of the previous pregnancy. No difference was seen in the association between interpregnancy interval and birth outcomes by gestational length of the previous stillbirth.

"Although WHO currently recommends waiting at least 24 months after a live birth until becoming pregnant again, currently, there is limited evidence to support guidelines for the recommended time to conceive after a stillbirth," study author, Dr. Annette Regan, Curtin University, Australia, told Contemporary OB/GYN. "We examined this in over 14,500 women in Australia, Finland and Norway who became pregnant again after experiencing a stillbirth, and we found no evidence for risk of preterm birth, stillbirth or small-for-gestational age birth for shorter time periods as compared to long intervals. And so, at least in our setting, this may suggest that if individuals or couples want to become pregnant quickly, which we found more than 60% did, there may not be harm in this. We are hopeful that this might help clinicians when they advise their patients who have experienced a stillbirth and are planning a future pregnancy."

The authors believe that their findings indicate that conception of another child within 12 months of a stillbirth is not associated with increased risk of subsequent stillbirth, PTB, or SGA. They said the results are important for ob/gyns counseling families planning future pregnancies and also can be used to provide reassurance to women who express a desire to become pregnant again following a stillbirth.