First School of Clinical Medicine, Lanzhou University, Lanzhou, China; Department of Obstetrics and Gynecology, First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology Gansu Province, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Gansu Province Prenatal Diagnosis Center, Key Laboratory of Prevention and Control of Birth Defects of Gansu Province, Gansu Provincial Maternity and Child-Care Hospital/Central Hospital of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
Am J Obstet Gynecol. 2024 Aug;231(2):211-222. doi: 10.1016/j.ajog.2024.02.304. Epub 2024 Mar 2.
We conducted a systematic review and meta-analysis to examine the relationship between stillbirth and various perinatal outcomes in subsequent pregnancy.
PubMed, the Cochrane Library, Embase, Web of Science, and CNKI databases were searched up to July 2023.
Cohort studies that reported the association between stillbirth and perinatal outcomes in subsequent pregnancies were included.
We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. Statistical analysis was performed using R and Stata software. We used random-effects models to pool each outcome of interest. We performed a meta-regression analysis to explore the potential heterogeneity. The certainty (quality) of evidence assessment was performed using the GRADE approach.
Nineteen cohort studies were included, involving 4,855,153 participants. From these studies, we identified 28,322 individuals with previous stillbirths who met the eligibility criteria. After adjusting for confounders, evidence of low to moderate certainty indicated that compared with women with previous live births, women with previous stillbirths had higher risks of recurrent stillbirth (odds ratio, 2.68; 95% confidence interval, 2.01-3.56), preterm birth (odds ratio, 3.15; 95% confidence interval, 2.07-4.80), neonatal death (odds ratio, 4.24; 95% confidence interval, 2.65-6.79), small for gestational age/intrauterine growth restriction (odds ratio, 1.3; 95% confidence interval, 1.0-1.8), low birthweight (odds ratio, 3.32; 95% confidence interval, 1.46-7.52), placental abruption (odds ratio, 3.01; 95% confidence interval, 1.01-8.98), instrumental delivery (odds ratio, 2.29; 95% confidence interval, 1.68-3.11), labor induction (odds ratio, 4.09; 95% confidence interval, 1.88-8.88), cesarean delivery (odds ratio, 2.38; 95% confidence interval, 1.20-4.73), elective cesarean delivery (odds ratio, 2.42; 95% confidence interval, 1.82-3.23), and emergency cesarean delivery (odds ratio, 2.35; 95% confidence interval, 1.81-3.06) in subsequent pregnancies, but had a lower rate of spontaneous labor (odds ratio, 0.22; 95% confidence interval, 0.13-0.36). However, there was no association between previous stillbirth and preeclampsia (odds ratio, 1.72; 95% confidence interval, 0.63-4.70) in subsequent pregnancies.
Our systematic review and meta-analysis provide a more comprehensive understanding of adverse pregnancy outcomes associated with previous stillbirth. These findings could be used to inform counseling for couples who are considering pregnancy after a previous stillbirth.
我们进行了一项系统评价和荟萃分析，以研究死产与后续妊娠中各种围产结局之间的关系。
截至 2023 年 7 月，我们检索了 PubMed、Cochrane 图书馆、Embase、Web of Science 和中国知网数据库。
纳入了报告死产与后续妊娠中围产结局之间关联的队列研究。
我们根据 PRISMA 指南进行了这项系统评价和荟萃分析。使用 R 和 Stata 软件进行统计分析。我们使用随机效应模型汇总每个感兴趣的结局。我们进行了荟萃回归分析以探索潜在的异质性。使用 GRADE 方法评估证据的确定性（质量）。
纳入了 19 项队列研究，涉及 4855153 名参与者。从这些研究中，我们确定了 28322 名符合入选标准的既往死产者。在调整了混杂因素后，低到中度确定性的证据表明，与既往活产的女性相比，既往死产的女性再次发生死产的风险更高（比值比，2.68；95%置信区间，2.01-3.56）、早产（比值比，3.15；95%置信区间，2.07-4.80）、新生儿死亡（比值比，4.24；95%置信区间，2.65-6.79）、小于胎龄/宫内生长受限（比值比，1.3；95%置信区间，1.0-1.8）、低出生体重（比值比，3.32；95%置信区间，1.46-7.52）、胎盘早剥（比值比，3.01；95%置信区间，1.01-8.98）、器械分娩（比值比，2.29；95%置信区间，1.68-3.11）、引产（比值比，4.09；95%置信区间，1.88-8.88）、剖宫产（比值比，2.38；95%置信区间，1.20-4.73）、选择性剖宫产（比值比，2.42；95%置信区间，1.82-3.23）和急诊剖宫产（比值比，2.35；95%置信区间，1.81-3.06），但自发性分娩的比例较低（比值比，0.22；95%置信区间，0.13-0.36）。然而，既往死产与后续妊娠中的子痫前期（比值比，1.72；95%置信区间，0.63-4.70）之间没有关联。
我们的系统评价和荟萃分析提供了对与既往死产相关的不良妊娠结局的更全面理解。这些发现可用于为考虑再次妊娠的夫妇提供咨询。
