Department of Medical Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Department of OB/GYN, Boston Medical Center, Boston, Massachusetts.
Am J Perinatol. 2024 May;41(S 01):e3018-e3024. doi: 10.1055/s-0043-1776349. Epub 2023 Oct 31.
Prior stillbirth increases risk of subsequent stillbirth but has unclear effect on subsequent liveborn pregnancies. We examined associations between prior stillbirth, adverse neonatal outcomes, and maternal morbidity in subsequent liveborn pregnancies.
This is a secondary analysis of a large, National Institutes of Health-funded retrospective cohort study of parturients who delivered a singleton infant at a tertiary-care hospital from January 2002 to March 2013 and had a past medical/obstetric history of diabetic, and/or hypertensive disorders, and/or pregnancy with fetal growth restriction. Our analysis included all multiparous patients from the parent study. The primary outcome was a neonatal morbidity composite (neonatal resuscitation, neonatal birth injury, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis). Secondary outcomes included a maternal morbidity composite (venous thromboembolism, intensive care unit admission, disseminated intravascular coagulation, sepsis, hysterectomy, pulmonary edema, renal failure, blood transfusion), other maternal/delivery complications, and neonatal intensive care unit (NICU) admission. Outcomes were compared between those with versus without prior stillbirth. Negative binomial regression controlled for maternal comorbidities and delivery year.
Among 171 and 5,245 multiparous parturients with versus without prior stillbirth, respectively, those with prior stillbirth had higher rates of pregestational diabetes, autoimmune disease, and clotting disorders. After controlling for these differences and delivery year, infants of parturients with prior stillbirth had similar risk of composite neonatal morbidity (adjusted relative ratio [aRR] 1.19; 95% confidence interval [CI] 0.99-1.45) but higher risk of NICU admission (aRR 1.42; 95% CI 1.06-1.91) compared with infants of parturients without prior stillbirth, despite delivering at similar gestational ages. Multiparous patients with prior stillbirth had equal maternal morbidity risk but higher risk of developing preeclampsia with severe features (aRR 2.11; 95% CI 1.19-3.72).
Compared with high-risk multiparous patients without prior stillbirth, those with prior stillbirth have higher risk of NICU admission and preeclampsia with severe features.
· Prior stillbirth increases risk in subsequent livebirth for NICU admission and neonatal morbidity.. · Prior stillbirth increased the risk of severe preeclampsia for mothers in subsequent livebirth.. · Additional monitoring of pregnancies of patients with prior history of demise may be warranted..
先前的死胎会增加后续死胎的风险，但对后续活产妊娠的影响尚不清楚。我们研究了先前的死胎、不良新生儿结局和随后活产妊娠产妇发病率之间的关系。
这是一项对 2002 年 1 月至 2013 年 3 月在三级保健医院分娩单胎婴儿且有糖尿病和/或高血压疾病及/或胎儿生长受限病史的患者进行的大型 NIH 资助的回顾性队列研究的二次分析。我们的分析包括来自母研究的所有多产妇。主要结局是新生儿发病率综合指标（新生儿复苏、新生儿出生损伤、呼吸窘迫综合征、新生儿短暂性呼吸急促、低血糖、败血症）。次要结局包括产妇发病率综合指标（静脉血栓栓塞、入住重症监护病房、弥散性血管内凝血、败血症、子宫切除术、肺水肿、肾衰竭、输血）、其他产妇/分娩并发症和新生儿重症监护病房（NICU）入住。将有和无先前死胎的患者的结局进行比较。负二项回归控制了产妇合并症和分娩年份。
在分别有和无先前死胎的 171 名和 5245 名多产妇中，有先前死胎的患者孕前糖尿病、自身免疫性疾病和凝血障碍的发生率更高。在控制这些差异和分娩年份后，有先前死胎的产妇所生孩子的复合新生儿发病率风险相似（调整后相对比[aRR]1.19；95%置信区间[CI]0.99-1.45），但与无先前死胎的产妇所生孩子相比，NICU 入住的风险更高（aRR 1.42；95%CI 1.06-1.91），尽管他们的分娩孕周相似。有先前死胎的多产妇产妇发病率风险相同，但发生严重特征子痫前期的风险更高（aRR 2.11；95%CI 1.19-3.72）。
与无先前死胎的高危多产妇相比，有先前死胎的患者 NICU 入住和新生儿发病率风险更高。
·先前的死胎增加了随后活产中 NICU 入住和新生儿发病率的风险。·先前的死胎增加了随后活产中母亲发生严重特征子痫前期的风险。·可能需要对有先前死亡史的患者的妊娠进行额外监测。
