Department of Neonatal Medicine, Royal Prince Alfred Hospital, Sydney School of Public Health and Sydney Medical School, University of Sydney, New South Wales, Australia.
Obstet Gynecol. 2012 Mar;119(3):509-17. doi: 10.1097/AOG.0b013e31824781f8.
To estimate the risk of stillbirth in a second pregnancy when previous stillbirth, preterm, and small-for-gestational age (SGA) births occurred in the previous pregnancy.
This was a population-based cohort study in New South Wales Australia from 2002 to 2006. Singleton births in a first pregnancy were linked to a second pregnancy using data from the New South Wales Midwives Data Collection and the New South Wales Perinatal Death Database. Deaths were classified according to the Perinatal Mortality Classifications of the Perinatal Society of Australia and New Zealand. Crude and adjusted hazard ratios were estimated using a proportional hazards model.
Delivery of an SGA newborn in the first pregnancy was associated with increased risks of stillbirth in a second pregnancy (hazard ratio 1.73, 95% confidence interval [CI] 1.15-2.60) and risk was further increased with prematurity (hazard ratio 5.65, 95% CI 1.76-18.12). Stillbirth in a first pregnancy had a nonsignificant association with stillbirth in the second pregnancy (hazard ratio 2.03, 95% CI 0.60-6.90). For women aged 30-34 years, the absolute risk of stillbirth up to 40 completed weeks of gestation was 4.84 per 1,000 among women whose first pregnancy was a stillbirth and 7.19 per 1,000 among women whose first pregnancy was preterm and SGA.
Delivering an SGA and preterm neonate in a first pregnancy is associated with greater risks for stillbirth in a second pregnancy than delivering a previous stillbirth. All factors merit improved surveillance in a subsequent pregnancy, and research should address underlying factors common to all three outcomes.
评估既往死胎、早产和小于胎龄儿（SGA）分娩史对再次妊娠死胎风险的影响。
本研究为澳大利亚新南威尔士州 2002 年至 2006 年的基于人群的队列研究。利用新南威尔士州助产士数据收集和新南威尔士州围产儿死亡数据库中的数据，将首次妊娠中的单胎分娩与第二次妊娠相联系。根据澳大利亚和新西兰围产期学会的围产儿死亡分类，对死亡进行分类。使用比例风险模型估计粗风险比和调整风险比。
首次妊娠中 SGA 新生儿的分娩与再次妊娠中死胎的风险增加相关（风险比 1.73，95%置信区间 [CI] 1.15-2.60），且随着早产（风险比 5.65，95% CI 1.76-18.12）风险进一步增加。首次妊娠中死胎与再次妊娠中死胎的相关性无统计学意义（风险比 2.03，95% CI 0.60-6.90）。对于 30-34 岁的女性，在妊娠 40 周之前，首次妊娠为死胎的女性中死胎的绝对风险为每 1000 例中 4.84 例，首次妊娠为早产和 SGA 的女性中为每 1000 例中 7.19 例。
在首次妊娠中分娩 SGA 和早产儿与再次妊娠中死胎的风险增加相关，而首次妊娠中死胎的风险增加不明显。所有这些因素都需要在随后的妊娠中进行更好的监测，并且应该研究导致这三种结局的共同潜在因素。
