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Pregnancy for several months from stillborn has good results


Stimulation within a year or even 6 months after the dead. | it did not increase the likelihood of a woman having another dead or premature or low gestational age (SGA) in the pores with an intervertebral interval of at least 2 years, according to a new study. online February 28 v Lancet.

The results were from the first large-scale observational study to explore the interval between stillbirths and subsequent pregnancies, including nearly 14,500 births in women from Australia, Finland and Norway who had had a stillborn in their previous pregnancy.

"Approximately 3.5 per 1000 births in high-income countries is stillborn, and there is limited guidance for planning future pregnancies. We hope that our findings will provide security for women who want to get pregnant or unexpectedly get pregnant shortly after stillbirth," she said chief author of Dr Annette K. Regan, from Curtin University, Perth, Australia, in a Lancet Press release.

At present, the World Health Organization recommends that women do not try to start at least 6 months after abortion or abortion and at least 2 years after live birth, but there are no recommendations for an optimal interval after the birth of the dead (defined as fetal) loss after a mid-pregnancy.

The new study has attempted to fill this lack of evidence by collecting data from population-based registries in three countries for nearly 40 years.

Data "consistently show that an interpregnant interval of less than 1 year is not associated with an increased risk of unintended outbreaks in the coming pregnancy. Our findings provide valuable evidence for the recommended distance between pregnancy after stillbirth," added Regan.

In the invited comment, Dr. Mark A. Klebanoff, from the Center for Perinatal Research at Columbia National Hospital, Ohio, says: "The results … suggest that the interpregnant interval [after stillbirth] may be less important than previously assumed, at least for women in high income regions.

"Instead of adhering to strict and rapid rules, clinical recommendations should take into account the current state of health of a woman, her present age in relation to her wishes regarding the space of the child and the final size of the family, especially after loss, her emotional readiness to re-conceal . "

In the year of stillbirth, 63% of women again became pregnant

Using data on 1987-2016 birth data in Finland, 1980-2015 in Norway and 1980-2015 in Western Australia, the researchers analyzed outcomes of births for women who started after single-born stillbirths in the period of 22 weeks or later. Among the subsequent 14,452 births, 2% are stillborn, 18% are premature, and 9% are SGA. Most of the still-born (88%) were premature; 12% were in office.

The median time between stillbirths and the beginning of her next pregnancy was 9 months, with 63% of women who started within 12 months (and 37% started within 6 months) after stillbirth.

Women who started less than 6 to 12 months after birth did not have a greater chance of stillbirth, premature birth or newborn babies than women who started 24 to 59 months after birth, after adjusting for a woman's country, age, parity for a decade delivery and duration of previous pregnancy.

Additional adjustment for the level of education and smoking of mothers during pregnancy, when these data were available, did not alter the findings, nor did the investigation of just birth after 1998.

Despite their statistical adjustments, the authors state that other problems may prove to play a role in the findings.

"Women who appear shortly after the previous pregnancy can be healthier and more fertile than women who are later dying and therefore may be less prone to adverse birth outcomes," they assume. They acknowledge that they lack information about women's chronic illnesses, their intention to think about, socioeconomic status, the cause of stillborn child, abortions, abortions or the use of assisted reproductive technology.

Results Informative, but require replication as a stillbirth are rare

The results come from high-income countries with universal health care, free antenatal care and a predominantly white population, which potentially excludes generalization of low or middle income countries, countries without access to universal health care, or ethnic minorities, added Regan and his colleagues.

Klebanoff agrees, pointing out that "the results can not refer to women in poorer conditions in which poor nutrition, untreated chronic medical conditions, and poor access to quality medical and family care are common."

Researchers also note that although this is the largest study of this type, only 228 women have had a recurrence of stillbirths, which means that the analyzes for this group are limited due to a small number. The study's replication in a larger group would be informative, they conclude.

The research was funded by Australia& # 39;The National Council for Health and Medical Research, the Norwegian Research Council and the Medical Research Council in the United Kingdom. The authors did not report relevant financial relationships.

Lancet. Posted on February 28, 2019.

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