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Small-for-Gestational-Age or Preterm Birth Predicts Subsequent Stillbirth

And when the first infant is both preterm and small for gestational age, subsequent stillbirth risk is even higher.

Little is known about whether small-for-gestational-age or preterm birth increases risk for stillbirth in subsequent pregnancies. Using data from a national Swedish birth registry, investigators examined this risk among 410,021 women who delivered two successive singletons from 1983 through 1997.

Compared with women whose first child was born at term and was not small for gestational age, women whose first child was born at less than 32 weeks' gestation and was not small for gestational age had a 2.5-fold elevated risk for stillbirth in their next pregnancy. In addition, if the first infant was born at term but was small for gestational age, future risk for stillbirth was significantly increased, and this risk increased further as gestational age at first birth decreased. For example, when the first infant was born at less than 32 weeks' gestation and was small for gestational age, the future stillbirth risk was elevated eightfold.

Comment: In the U.S., the annual number of fetal deaths has decreased substantially and now approximates the number of infant deaths. Factors such as placental defects, congenital anomalies, and maternal vascular disease underlie both fetal growth problems and fetal deaths. Thus, it is not surprising that the current study documented an association between fetal growth restriction in initial pregnancies and stillbirth risk in subsequent pregnancies. Obstetric history can alert providers to elevated patient risks and guide decisions about more intensive monitoring in subsequent pregnancies. Nonetheless, as editorialists point out, clinicians can reassure pregnant women that even when a severely small-for-gestational-age infant is born at less than 32 weeks' gestation, the probability of late fetal death in a subsequent pregnancy is less than 2%.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health April 7, 2004

Citation(s):

Surkan PJ et al. Previous preterm and small-for-gestational-age births and the subsequent risk of stillbirth. N Engl J Med 2004 Feb 19; 350:777-85.

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Zhang J and Klebanoff MA. Small-for-gestational-age infants and risk of fetal death in subsequent pregnancies. N Engl J Med 2004 Feb 19; 350:754-6.

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• Medline abstract (Free)