Quick Conception After Pregnancy Cuts Stillbirth Risk

New study flies in face of traditional thinking

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HealthDay Reporter

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TUESDAY, July 1, 2003 (HealthDayNews) -- New research offers hope -- and surprising advice -- for women who have suffered a stillbirth or have already had one child and want to become pregnant again.

The length of time between pregnancies may play an important role in predicting the risk of stillbirth and neonatal death -- the longer you wait, the higher the risk.

That's the finding of a Swedish study involving more than 400,000 women, reported in the July issue of Obstetrics and Gynecology. The research, which found that waiting three months or less between pregnancies reduces the risk of stillbirth and neonatal death, somewhat debunks traditional thinking.

"In the past, it was always believed that getting pregnant too soon after a stillbirth might increase the risk of another stillbirth -- and traditionally, women were always counseled to wait," says New York University obstetrician Dr. Andrei Rebarber.

"With this new information, however, it appears that getting pregnant right away is OK. In fact, the women who waited longest appeared to actually increase their risk, which is something brand new," Rebarber says.

The study, conducted by doctors from Karolinska Institute in Stockholm, continues to uphold the importance of finding the cause of a stillbirth, and, when possible, treating and eliminating it before a woman conceives again.

"I think this study may have a great deal of influence on how pregnant women are counseled in the future. It was such a large study and very well done, so I think its message is a vital one," Rebarber says.

Stillbirth is a situation in which a fetus of 20 weeks or more does not survive the pregnancy. This occurs in about one in every 200 conceptions, according to the March of Dimes. Neonatal death occurs when a baby dies within 28 days of delivery. Each year, some 19,000 babies succumb to neonatal death.

Although doctors can't pinpoint all the reasons why a stillbirth occurs, the March of Dimes says problems are often linked to a defective placenta (the sac that surrounds the baby in the womb), birth defects or maternal infection.

The most common cause of neonatal death is birth defects -- accounting for some 25 percent of this condition -- followed by premature delivery and pregnancy-related complications involving the placenta, the umbilical cord or uterine infection, according to the March of Dimes.

The 14-year Swedish study (1983-1997) looked at the first and second birthing outcomes of 410,021 women pregnant with just one fetus. The goal of the study was to analyze birth records for the occurrence of either stillbirth or neonatal death, particularly in regard to the amount of time that lapsed between these events and a subsequent pregnancy.

Statistically speaking, it first appeared as if traditional thinking would prevail: The women who became pregnant soon after a stillbirth or neonatal death seemed to be at greater risk for a similar problem.

However, after the researchers adjusted their findings to consider factors that could influence the outcome -- including the mother's age and previous history of stillbirth or neonatal death -- the new calculations revealed that timing alone could be an important factor.

"After adjusting for maternal characteristics and previous reproductive history, women with inter-pregnancy intervals of 0 to 3 months were not at increased risk for stillbirth or early neonatal death," the researchers write in their report.

Conversely, women who waited 72 months or more between pregnancies appeared to be at increased risk for both pregnancy complications, the study found.

Rebarber says that if you have experienced either a stillbirth pregnancy or neonatal death, it's imperative that you discover the reason and treat the problem before getting pregnant again.

"This is the best way to ensure the outcome of subsequent pregnancies, regardless of the time between conceptions," Rebarber says.

More information

The March of Dimes has more information on neonatal death and stillbirth. If you have experienced a stillbirth, Stillbirth.org may help.

SOURCES: Andrei Rebarber, M.D., assistant professor, obstetrics and gynecology, New York University School of Medicine, New York City; March of Dimes; July 2003 Obstetrics and Gynecology

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