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