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Short interpregnancy interval after stillbirth: no effect on adverse birth outcomes

By Nicole MacKee
Conceiving within a year of stillbirth does not increase the risk of adverse birth outcomes, international researchers have reported in The Lancet.

The researchers analysed birth record data from Finland, Norway and Western Australia, identifying 14,452 births in women who had had a stillbirth (of at least 22 weeks’ gestation) in their previous pregnancy. They found that the median pregnancy interval after stillbirth was 9 months, with 63% of women conceiving within 12 months of the stillbirth.

Compared with longer interpregnancy intervals (24 to 59 months), intervals of less than a year were not associated with increased risks of subsequent stillbirth, preterm birth or small-for-gestational-age births, the researchers reported.

Although the WHO recommends that women wait at least two years after a livebirth and at least six months after a miscarriage or induced abortion before conceiving again, no recommendation has been made for pregnancy intervals after stillbirth.

Lead author Dr Annette Regan, Public Health Researcher at Curtin University, Perth, told Medicine Today that the findings should provide some reassurance to families looking to conceive again after stillbirth.

‘In a lot of cases, the first question that a parent will ask [after stillbirth] is, ‘how long do I have to wait before I become pregnant again?’ Dr Regan said. ‘We do need more research in this area, but at least based on this study ... clinicians could advise women that they may not need to delay conception.’

An accompanying editorial noted that interpregnancy interval might be less important for birth outcomes than previously assumed.

‘Rather than adhering to hard and fast rules, clinical recommendations should consider a woman’s current health status, her current age in conjunction with her desires regarding child spacing and ultimate family size, and particularly following a loss, her emotional readiness to become pregnant again,’ wrote Dr Mark Klebanoff of the US’ Nationwide Children’s Hospital in Columbus.

Dr Regan said these points were valid. ‘It’s an interesting area of research,’ she said, noting the many challenges in relying on large registry studies. ‘Until about five years ago, we were fairly convinced that there was a two- to threefold increase in the risk of preterm birth if [a woman] conceived within six months of [her] last pregnancy, but more recent epidemiological studies have [suggested that the association] may not be as strong as previously thought.’
Lancet 2019; http://dx.doi.org/10.1016/S0140-6736(18)32266-9.
Lancet 2019; http://dx.doi.org/10.1016/S0140-6736(18)32430-9.