1085 Maternal and neonatal outcomes of a subsequent pregnancy after stillbirth

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Prior stillbirth is associated with increased risk of future stillbirth, but risks of adverse neonatal outcomes in a subsequent liveborn pregnancy are unknown. This is a secondary analysis of a large NIH-funded retrospective cohort study of women with diabetes, hypertensive disorders, and/or fetal growth restriction who delivered at a tertiary-care hospital from January 2002 to March 2013, excluding women with only severe preeclampsia or multifetal gestations. All women in the parent study were included in this analysis, comparing women with and without a history of stillbirth >20 weeks. The primary outcome is a neonatal morbidity composite: neonatal resuscitation (oxygen, CPAP, intubation, CPR), neonatal injury, RDS, TTN, hypoglycemia, sepsis. Secondary outcomes include a maternal morbidity composite (DVT/PE, ICU admission, DIC, sepsis, hysterectomy, pulmonary edema, renal failure, blood transfusion), neonatal death, and less severe neonatal and maternal outcomes. Log binomial and linear regression were performed controlling for maternal comorbidities. 191 women with and 11,725 women without prior stillbirth were included. Women with prior stillbirth were older (p<0.001), had higher BMI (p=0.001), and higher rates of chronic hypertension (p=0.007), autoimmune disease (p=0.02), and clotting disorder needing anticoagulation (p=0.03). After controlling for these factors, women with prior stillbirth had nearly 25% increased risk of composite neonatal morbidity (aRR 1.23; 95% CI 1.02-1.48), more than 50% increased risk of NICU admission (aRR 1.53; 95% CI 1.14-2.05), and nearly seven-fold increased risk of neonatal death (aRR 6.95; 95% CI 1.37-35.3), despite delivery at similar gestational age. Women with prior stillbirth were equally likely to have the maternal morbidity composite but nearly twice as likely to develop severe pre-eclampsia (aRR 1.88; 95% CI 1.09-3.31). Women with common obstetric comorbidities who have a prior stillbirth are at higher risk for severe neonatal complications, NICU admission and neonatal death when compared to women without prior stillbirth.