TOPLINE

A prior stillbirth was associated with an increased risk for stillbirth in the subsequent pregnancy, with the risk for recurrence further elevated when the prior stillbirth was attributed to placental insufficiency.

METHODOLOGY

• Researchers conducted a retrospective cohort study including 77,689 individuals with two consecutive singleton deliveries at a single academic institution between 2000 and 2023, of whom 508 experienced stillbirth in the index pregnancy.
• Stillbirth was defined as birth weight ≥ 500 g prior to January 1, 2020, and as either a gestational age of at least 20 weeks or a birth weight ≥ 350 g on or after January 1, 2020.
• A multidisciplinary review committee evaluated all stillbirth cases through a standardized assessment of maternal clinical history, laboratory data, imaging results, placental pathology (completed in 87.0% of cases), autopsy findings (performed in 45.3% of cases), and genetic testing to assign the primary etiology.
• Placental insufficiency was identified by a perinatal pathologist using the Amsterdam criteria, on the basis of features of maternal vascular malperfusion such as accelerated villous maturation, villous infarction, perivillous fibrin deposition, decidual arteriopathy, and distal villous hypoplasia.
• Investigators compared rates of stillbirth in subsequent pregnancies between those with and without prior stillbirths; a subgroup analysis evaluated the risk for recurrence among those whose index stillbirth was attributed to placental insufficiency.

TAKEAWAY

• Individuals with a prior stillbirth had higher rates of recurrence than those with a prior live birth (relative risk [RR], 2.44; P < .02).
• The risk for recurrence was elevated among individuals whose index stillbirth was attributed to placental insufficiency vs among those without a prior stillbirth (RR, 6.00; P < .01).
• The absolute risk difference for subsequent stillbirth was 0.7% between individuals with and without a prior stillbirth and 2.4% among those with an index stillbirth attributed to placental insufficiency.

IN PRACTICE

“[The] findings suggest that the etiologic determination of stillbirth is an important determinant of recurrence risk and underscores the value of comprehensive evaluation following stillbirth, including placental pathology and multidisciplinary review,” the authors of the study wrote.

SOURCE

The study was led by Christine Henricks, DO, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas. It was published online on June 22, 2026, as a research letter in the American Journal of Obstetrics & Gynecology.

LIMITATIONS

The study did not consider changes in clinical practice, such as the use of routine antenatal ultrasounds and improvements in genetic evaluation, over the 23 years.

DISCLOSURES

The study did not receive any specific funding. Two authors disclosed receiving royalties from McGraw Hill Publishing for Williams Obstetrics, of whom one author also disclosed receiving royalties from Wolters Kluwer for UpToDate, and the other author disclosed serving as an editor for the American Journal of Obstetrics & Gynecology.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.