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No increased pregnancy loss risk for women conceiving soon after stillbirth

Key clinical point: Conceiving within 1 year of a stillbirth was not associated with adverse outcomes in the subsequent pregnancy.

Major finding: In adjusted analyses, there was no association between short interpregnancy intervals and subsequent stillbirths, compared with longer intervals (24-59 months), with odds ratios of 1.09 for an interval shorter than 6 months and 0.90 for 6 to 11 months.

Study details: An international observational study including data on 14,452 women who had stillbirths in Finland, Norway, or Australia.

Disclosures: Dr. Regan and colleagues declared no competing interests related to the study, which was funded the National Health and Medical Research Council of Australia, among other sources.

Citation:

Regan AK et al. Lancet. 2019 Feb 28. doi: 10.1016/S0140-6736(18)32266-9.

Commentary:

The interval between pregnancy loss and the next conception may be less important than previously assumed, based on the results of this and other recent studies, according to Mark A Klebanoff, MD, MPH.

“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,” he said in a commentary accompanying the article by Regan et al.

However, these results are specific to high-income countries, and might not extrapolate to women in “less favorable situations” where poor access to quality medical and obstetric care, malnutrition, and untreated chronic conditions are more common, Dr. Klebanoff added.

Another limitation of the study, acknowledged by Regan and coauthors, is the relatively small number of stillbirths in subsequent pregnancies (228) despite this being the largest study of its kind to date.

“The fairly small number of women included in this report dictates that replication, probably using other large, linked, population-level databases, is required,” Dr. Klebanoff said in his commentary.

Dr. Klebanoff is with the Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital; and the departments of pediatrics and obstetrics and gynecology at the College of Medicine, and division of epidemiology at the College of Public Health, at The Ohio State University, all in Columbus. This is a summarization of his commentary (Lancet. 2019 Feb 28. doi: 10.1016/S0140-6736(18)32430-9 ). Dr. Klebanoff said he had a pending grant application to the National Institutes of Health to study the association between interpregnancy interval and birth outcomes, and had no other competing interests.