Interpregnancy interval and risk of stillbirth: a population-based case control study

Priya M. Gupta; Alexa A. Freedman; Michael R. Kramer; Robert L. Goldenberg; Marian Willinger; Barbara J. Stoll; Robert M. Silver; Donald J. Dudley; Corette B. Parker; Carol J.R. Hogue

doi:10.1016/j.annepidem.2019.05.001

Interpregnancy interval and risk of stillbirth: a population-based case control study

Priya M. Gupta^*, Alexa A. Freedman, Michael R. Kramer, Robert L. Goldenberg, Marian Willinger, Barbara J. Stoll, Robert M. Silver, Donald J. Dudley, Corette B. Parker, Carol J.R. Hogue

^*Corresponding author for this work

Preventive Medicine

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Purpose: We examined the association between interpregnancy intervals (IPIs) and stillbirth (defined as fetal death ≥20 weeks), as both short and long IPIs have been associated with adverse perinatal outcomes. Prior pregnancy loss is also a known risk factor for stillbirth, and women who suffer a prior loss often have shorter IPIs. For these reasons, we also sought to quantify the proportion of the association between prior pregnancy loss and subsequent stillbirth risk that may be attributed to a short IPI. Methods: We used data from the Stillbirth Collaborative Research Network, a multisite case-control study conducted in 2006–2008, restricted to singleton pregnancies among multiparous or multigravid women (985 controls and 291 cases). We accounted for complex sample design and nonparticipation with weighted multivariable logistic regression. Results: In the adjusted models, IPIs <6 months, as compared with a reference of 18–23 months, were associated with increased odds of stillbirth (aOR 1.6, 95% CI: 0.8, 3.4). Long IPIs (60–100 months) were also associated with an increased odds of stillbirth (aOR 2.4, 95% CI: 1.2, 4.5). After control for covariates, about one-fifth (21.2%) of the association of prior pregnancy loss (stillbirth, ectopic pregnancy, molar pregnancy, or spontaneous abortion) and stillbirth may be attributable to a short IPI. Conclusions: Our results suggest that women who experience a prior pregnancy loss may benefit from additional counseling on adequate birth spacing to reduce subsequent stillbirth risk.

Original language	English (US)
Pages (from-to)	35-41
Number of pages	7
Journal	Annals of Epidemiology
Volume	35
DOIs	https://doi.org/10.1016/j.annepidem.2019.05.001
State	Published - Jul 2019

Funding

The authors' responsibilities were as follows: P.M.G., A.A., and C.J.H. had full access to all data in this study and were responsible for the integrity of the data and accuracy of the data analysis. A.A., M.R.K., and C.J.H. were responsible for critical revision of the manuscript; P.M.G. and A.A. for drafting the manuscript and statistical analyses. The Stillbirth Collaborative Research Network was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (Grants U10-HD045953 (Brown University) , U10-HD045925 (Emory University) , U10-HD045952 (University of Texas Medical Branch at Galveston) , U10- HD045955 (University of Texas Health Sciences Center at San Antonio) , UK10-HD045944 (University of Utah Health Sciences Center) , U10-HD045954 (RTI International)). None of the authors had a financial or personal interest in any company or organization connected with the research represented in the article.

Keywords

Birth spacing
Inter-pregnancy interval
Maternal and child health
Stillbirth

ASJC Scopus subject areas

Epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.annepidem.2019.05.001

Cite this

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title = "Interpregnancy interval and risk of stillbirth: a population-based case control study",

abstract = "Purpose: We examined the association between interpregnancy intervals (IPIs) and stillbirth (defined as fetal death ≥20 weeks), as both short and long IPIs have been associated with adverse perinatal outcomes. Prior pregnancy loss is also a known risk factor for stillbirth, and women who suffer a prior loss often have shorter IPIs. For these reasons, we also sought to quantify the proportion of the association between prior pregnancy loss and subsequent stillbirth risk that may be attributed to a short IPI. Methods: We used data from the Stillbirth Collaborative Research Network, a multisite case-control study conducted in 2006–2008, restricted to singleton pregnancies among multiparous or multigravid women (985 controls and 291 cases). We accounted for complex sample design and nonparticipation with weighted multivariable logistic regression. Results: In the adjusted models, IPIs <6 months, as compared with a reference of 18–23 months, were associated with increased odds of stillbirth (aOR 1.6, 95% CI: 0.8, 3.4). Long IPIs (60–100 months) were also associated with an increased odds of stillbirth (aOR 2.4, 95% CI: 1.2, 4.5). After control for covariates, about one-fifth (21.2%) of the association of prior pregnancy loss (stillbirth, ectopic pregnancy, molar pregnancy, or spontaneous abortion) and stillbirth may be attributable to a short IPI. Conclusions: Our results suggest that women who experience a prior pregnancy loss may benefit from additional counseling on adequate birth spacing to reduce subsequent stillbirth risk.",

keywords = "Birth spacing, Inter-pregnancy interval, Maternal and child health, Stillbirth",

author = "Gupta, {Priya M.} and Freedman, {Alexa A.} and Kramer, {Michael R.} and Goldenberg, {Robert L.} and Marian Willinger and Stoll, {Barbara J.} and Silver, {Robert M.} and Dudley, {Donald J.} and Parker, {Corette B.} and Hogue, {Carol J.R.}",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2019",

month = jul,

doi = "10.1016/j.annepidem.2019.05.001",

language = "English (US)",

volume = "35",

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T1 - Interpregnancy interval and risk of stillbirth

T2 - a population-based case control study

AU - Gupta, Priya M.

AU - Freedman, Alexa A.

AU - Kramer, Michael R.

AU - Goldenberg, Robert L.

AU - Willinger, Marian

AU - Stoll, Barbara J.

AU - Silver, Robert M.

AU - Dudley, Donald J.

AU - Parker, Corette B.

AU - Hogue, Carol J.R.

PY - 2019/7

Y1 - 2019/7

N2 - Purpose: We examined the association between interpregnancy intervals (IPIs) and stillbirth (defined as fetal death ≥20 weeks), as both short and long IPIs have been associated with adverse perinatal outcomes. Prior pregnancy loss is also a known risk factor for stillbirth, and women who suffer a prior loss often have shorter IPIs. For these reasons, we also sought to quantify the proportion of the association between prior pregnancy loss and subsequent stillbirth risk that may be attributed to a short IPI. Methods: We used data from the Stillbirth Collaborative Research Network, a multisite case-control study conducted in 2006–2008, restricted to singleton pregnancies among multiparous or multigravid women (985 controls and 291 cases). We accounted for complex sample design and nonparticipation with weighted multivariable logistic regression. Results: In the adjusted models, IPIs <6 months, as compared with a reference of 18–23 months, were associated with increased odds of stillbirth (aOR 1.6, 95% CI: 0.8, 3.4). Long IPIs (60–100 months) were also associated with an increased odds of stillbirth (aOR 2.4, 95% CI: 1.2, 4.5). After control for covariates, about one-fifth (21.2%) of the association of prior pregnancy loss (stillbirth, ectopic pregnancy, molar pregnancy, or spontaneous abortion) and stillbirth may be attributable to a short IPI. Conclusions: Our results suggest that women who experience a prior pregnancy loss may benefit from additional counseling on adequate birth spacing to reduce subsequent stillbirth risk.

AB - Purpose: We examined the association between interpregnancy intervals (IPIs) and stillbirth (defined as fetal death ≥20 weeks), as both short and long IPIs have been associated with adverse perinatal outcomes. Prior pregnancy loss is also a known risk factor for stillbirth, and women who suffer a prior loss often have shorter IPIs. For these reasons, we also sought to quantify the proportion of the association between prior pregnancy loss and subsequent stillbirth risk that may be attributed to a short IPI. Methods: We used data from the Stillbirth Collaborative Research Network, a multisite case-control study conducted in 2006–2008, restricted to singleton pregnancies among multiparous or multigravid women (985 controls and 291 cases). We accounted for complex sample design and nonparticipation with weighted multivariable logistic regression. Results: In the adjusted models, IPIs <6 months, as compared with a reference of 18–23 months, were associated with increased odds of stillbirth (aOR 1.6, 95% CI: 0.8, 3.4). Long IPIs (60–100 months) were also associated with an increased odds of stillbirth (aOR 2.4, 95% CI: 1.2, 4.5). After control for covariates, about one-fifth (21.2%) of the association of prior pregnancy loss (stillbirth, ectopic pregnancy, molar pregnancy, or spontaneous abortion) and stillbirth may be attributable to a short IPI. Conclusions: Our results suggest that women who experience a prior pregnancy loss may benefit from additional counseling on adequate birth spacing to reduce subsequent stillbirth risk.

KW - Birth spacing

KW - Inter-pregnancy interval

KW - Maternal and child health

KW - Stillbirth

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SN - 1047-2797

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JO - Annals of Epidemiology

JF - Annals of Epidemiology

ER -

Interpregnancy interval and risk of stillbirth: a population-based case control study

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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