The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61225

Pamela Jean Surkan, MS¹, Olaf Stephansson, MD, PhD², Paul W Dickman, PhD², and Sven Cnattingius, MD, PhD². (1) Maternal and Child Health, Harvard School of Public Health, 677 Huntington Ave, Kresge Building 6th Floor, Boston, MA 02115, 617-423-1000, psurkan@hsph.harvard.edu, (2) Medical Epidemiology, Karolinska Institutet, PO Box 281/ Berzelius väg 8, SE-171 77 Stockholm, Sweden

This cohort study examined the relationship between intrauterine growth restriction in first pregnancy and stillbirth in a second pregnancy. Using the Swedish National Birth Register, it included approximately 410,000 women, 1061 of whom had a stillbirth in their second pregnancy between 1983 and 1997. Results showed that a small-for-gestational age (SGA) livebirth in first pregnancy increases the risk of subsequent stillbirth, especially when the birth is preterm. Compared with women with a previous non-SGA term birth, a history of a previous term SGA birth doubled the stillbirth risk in second pregnancy, whereas a previous moderately preterm SGA birth or a very preterm SGA birth were associated with a fourfold and over six-fold increase in risk, respectively.

Second pregnancy outcomes were stratified into preterm and term stillbirths as well as SGA and non-SGA stillbirths. The risks of preterm stillbirth associated with previous SGA livebirth increased with decreasing gestational age, the highest risk being for previous very preterm SGA birth which was associated with an almost nine-fold increase in risk. History of a preterm SGA delivery in first pregnancy was even a stronger risk factor for SGA stillbirth outcomes in second pregnancy. Moderately-preterm-SGA and very-preterm-SGA birth in first pregnancy were associated with a nine-fold risk and twenty-fold risk of SGA stillbirth in second pregnancy, respectively. Given that the causes of many stillbirths are unexplained, information about a woman’s risk based on pregnancy history can be used to help identify those at increased risk of stillbirth in subsequent pregnancy.

Learning Objectives:

• Define small-for-gestational age (SGA), preterm birth, and stillbirth
• Describe the study results regarding the relationship of SGA and preterm birth to stillbirth outcomes in subsequent pregnancy
• Discuss potential mechanisms explaining the associations adverse pregnancy outcomes in first pregnancy and subsequent stillbirth

Keywords: Pregnancy Outcomes, Epidemiology

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.