title: The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes.
abstract: OBJECTIVE
  We sought to examine the association between first-pregnancy stillbirth and subsequent adverse perinatal outcomes.
  
  
  METHODS
  This cohort study examined the first 2 singleton deliveries at 20-44 weeks' gestation from 1991-2008 (n = 71,315) using birth certificate, hospitalization, and outpatient encounter files. Multivariable logistic regression models were used to assess the association.
  
  
  RESULTS
  Stillbirth was observed in 5.3 of 1000 first deliveries. There was an increased risk of ischemic placental disease (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1), fetal distress (OR, 2.8; 95% CI, 1.7-4.5), chorioamnionitis (OR, 2.3; 95% CI 1.5-4.3), extreme preterm birth (OR, 4.2; 95% CI, 1.8-9.9), and early neonatal mortality (OR, 8.3; 95% CI, 3.7-18.6) in pregnancies after stillbirth vs pregnancies after live birth. Interpregnancy intervals <2 and > or =4 years after stillbirth increased the risk of ischemic placental disease and spontaneous preterm birth. Risks varied by stillbirth subtype.
  
  
  CONCLUSIONS
  A first-pregnancy stillbirth may increase adverse perinatal outcomes in subsequent pregnancy.
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group, Pasadena, CA 91101, USA. Darios.T.Getahun@kp.org
authors.forename: Darios
authors.initials: D
authors.lastname: Getahun
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fassett
authors.forename: Daniel
authors.initials: D
authors.lastname: Strickland
authors.forename: Corinna
authors.initials: C
authors.lastname: Koebnick
authors.forename: Wansu
authors.initials: W
authors.lastname: Chen
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D002821:Chorioamnionitis / Q000453:epidemiology; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult