Repeat stillbirth risk highlighted
Women who have had a stillbirth have up to a fourfold increased risk of another in a later pregnancy, a study of millions of pregnant women has found.
Stillbirth rates have declined across most of Europe over recent years but there were 3,286 stillborn babies in the UK in 2013, and experts say it remains a "common and traumatic" experience for many parents.
Researchers from the University of Aberdeen collected data from a number of studies conducted in "high-income countries" including Australia, Scotland, the US, Denmark, Israel and the Netherlands to examine the link between stillbirth in an initial pregnancy and risk of stillbirth in a subsequent pregnancy.
Data was collected from around 3.4 million women who had previously given birth and were pregnant again, of which 24,541 had experienced a stillbirth in an initial pregnancy.
Stillbirths occurred in a subsequent pregnancy for 14,283 women in total - 606 of whom had had an initial stillbirth, giving a 2.5% risk of a repeat stillbirth.
There were 13,677 stillbirths in total among the almost 3.4 million other women with no history of stillbirth, giving a 0.4% risk.
The researchers adjusted the figures for factors such as maternal age, maternal smoking and level of deprivation, and the increased risk of a repeat stillbirth was found to be fourfold higher.
In a report published in the British Medical Journal, the research team argue that p re-pregnancy counselling services should be provided to women who had a stillbirth, as well as advice on changing lifestyle factors such as smoking and obesity that are both linked to an increased risk of stillbirth.
Pregnancies should also be closely monitored, and antenatal interventions and care be offered at the first sign of increased risk of distress or danger, the report adds.
Dr Sohinee Bhattacharya, from the University of Aberdeen, said: "Stillbirth is one of the most common adverse obstetric outcomes and a traumatic experience for parents.
"Couples who have experienced a stillbirth need to understand why it happened and want to know the risk for future pregnancies."
Experts from St Mary's Hospital in Manchester echoed calls for additional care.
Clinical director Alexander Heazell said: " The death of a child is a life-changing event that may occur with no warning signs or symptoms. Women can believe their body has let them down, and also feel guilty that they had not protected their child, or given their family another child.
"Parents recognise that the support they need in a subsequent pregnancy differs from that needed and received previously. Continuity of care by the same provider, and additional ultrasound scans, provide parents with reassurance that their concerns will be heard and deviations from a healthy pregnancy detected.
"However, even these interventions do not remove the anxiety associated with a late stillbirth because there are no thresholds to reach, no point at which a stillbirth can be ruled out.
"Rather than trying to prevent or hide anxiety, care in a service dedicated to parents with a history of stillbirth exposes parents to other families with similar experiences and emotions, avoids awkward questions, and helps reduce feelings of isolation."