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

    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
    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.

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