Risk of stillbirth, preterm delivery and fetal growth restriction following exposure in previous birth: systematic review and meta-analysis

Malacova, Eva; Regan, A.; Nassar, N.; Raynes-Greenow, C.; Leonard, H.; Srinivasjois, R.; Shand, A.; Lavin, T.; Pereira, Gavin

doi:10.1111/1471-0528.14906

254290.pdf (450.2Kb)

Access Status

Open access

Authors

Malacova, Eva

Regan, A.

Nassar, N.

Raynes-Greenow, C.

Leonard, H.

Srinivasjois, R.

Shand, A.

Lavin, T.

Pereira, Gavin

Date

2018

Type

Journal Article

Metadata

Show full item record

Citation

Malacova, E. and Regan, A. and Nassar, N. and Raynes-Greenow, C. and Leonard, H. and Srinivasjois, R. and Shand, A. et al. 2018. Risk of stillbirth, preterm delivery and fetal growth restriction following exposure in previous birth: systematic review and meta-analysis. BJOG. 125 (2): pp. 183-192.

Source Title

BJOG

DOI

10.1111/1471-0528.14906

ISSN

0306-5456

School

School of Public Health

Funding and Sponsorship

http://purl.org/au-research/grants/nhmrc/1099655

http://purl.org/au-research/grants/nhmrc/1067066

http://purl.org/au-research/grants/nhmrc/1087062

http://purl.org/au-research/grants/nhmrc/1117105

http://purl.org/au-research/grants/nhmrc/572742

http://purl.org/au-research/grants/nhmrc/1052236

Remarks

This is the peer reviewed version of the article cited above, which has been published in final form at https://doi.org/10.1111/1471-0528.14906. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving at http://olabout.wiley.com/WileyCDA/Section/id-828039.html

URI

http://hdl.handle.net/20.500.11937/56297

Collection

Curtin Research Publications

Abstract

Background: Little is known about the risk of non-recurrent adverse birth outcomes. Objectives: To evaluate the risk of stillbirth, preterm birth (PTB), and small for gestational age (SGA) as a proxy for fetal growth restriction (FGR) following exposure to one or more of these factors in a previous birth. Search strategy: We searched MEDLINE, EMBASE, Maternity and Infant Care, and Global Health from inception to 30 November 2016. Selection criteria: Studies were included if they investigated the association between stillbirth, PTB, or SGA (as a proxy for FGR) in two subsequent births. Data collection and analysis: Meta-analysis and pooled association presented as odds ratios (ORs) and adjusted odds ratios (aORs). Main results: Of the 3399 studies identified, 17 met the inclusion criteria. A PTB or SGA (as a proxy for FGR) infant increased the risk of subsequent stillbirth ((pooled OR 1.70; 95% confidence interval, 95% CI, 1.34–2.16) and (pooled OR 1.98; 95% CI 1.70–2.31), respectively). A combination of exposures, such as a preterm SGA (as a proxy for FGR) birth, doubled the risk of subsequent stillbirth (pooled OR 4.47; 95% CI 2.58–7.76). The risk of stillbirth also varied with prematurity, increasing three-fold following PTB <34 weeks of gestation (pooled OR 2.98; 95% CI 2.05–4.34) and six-fold following preterm SGA (as a proxy for FGR) <34 weeks of gestation (pooled OR 6.00; 95% CI 3.43–10.49). A previous stillbirth increased the risk of PTB (pooled OR 2.82; 95% CI 2.31–3.45), and subsequent SGA (as a proxy for FGR) (pooled OR 1.39; 95% CI 1.10–1.76). Conclusion: The risk of stillbirth, PTB, or SGA (as a proxy for FGR) was moderately elevated in women who previously experienced a single exposure, but increased between two- and three-fold when two prior adverse outcomes were combined. Clinical guidelines should consider the inter-relationship of stillbirth, PTB, and SGA, and that each condition is an independent risk factor for the other conditions.