We conducted a systematic review and meta-analysis to examine the relationship between stillbirth and various perinatal outcomes in subsequent pregnancy. PubMed, the Cochrane Library, Embase, Web of Science, and CNKI databases were searched up to July 2023. Cohort studies that reported the association between stillbirth and perinatal outcomes in subsequent pregnancies were included. We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. Statistical analysis was performed using R and Stata software. We used random-effects models to pool each outcome of interest. We performed a meta-regression analysis to explore the potential heterogeneity. The certainty (quality) of evidence assessment was performed using the GRADE approach. Nineteen cohort studies were included, involving 4,855,153 participants. From these studies, we identified 28,322 individuals with previous stillbirths who met the eligibility criteria. After adjusting for confounders, evidence of low to moderate certainty indicated that compared with women with previous live births, women with previous stillbirths had higher risks of recurrent stillbirth (odds ratio, 2.68; 95% confidence interval, 2.01–3.56), preterm birth (odds ratio, 3.15; 95% confidence interval, 2.07–4.80), neonatal death (odds ratio, 4.24; 95% confidence interval, 2.65–6.79), small for gestational age/intrauterine growth restriction (odds ratio, 1.3; 95% confidence interval, 1.0–1.8), low birthweight (odds ratio, 3.32; 95% confidence interval, 1.46–7.52), placental abruption (odds ratio, 3.01; 95% confidence interval, 1.01–8.98), instrumental delivery (odds ratio, 2.29; 95% confidence interval, 1.68–3.11), labor induction (odds ratio, 4.09; 95% confidence interval, 1.88–8.88), cesarean delivery (odds ratio, 2.38; 95% confidence interval, 1.20–4.73), elective cesarean delivery (odds ratio, 2.42; 95% confidence interval, 1.82–3.23), and emergency cesarean delivery (odds ratio, 2.35; 95% confidence interval, 1.81–3.06) in subsequent pregnancies, but had a lower rate of spontaneous labor (odds ratio, 0.22; 95% confidence interval, 0.13–0.36). However, there was no association between previous stillbirth and preeclampsia (odds ratio, 1.72; 95% confidence interval, 0.63–4.70) in subsequent pregnancies. Our systematic review and meta-analysis provide a more comprehensive understanding of adverse pregnancy outcomes associated with previous stillbirth. These findings could be used to inform counseling for couples who are considering pregnancy after a previous stillbirth.

中文翻译：

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既往死产与随后围产期结局的关联：队列研究的系统回顾和荟萃分析

我们进行了系统回顾和荟萃分析，以研究死产与随后妊娠的各种围产期结局之间的关系。检索了截至 2023 年 7 月的 PubMed、Cochrane 图书馆、Embase、Web of Science 和 CNKI 数据库。纳入了报告死产与随后妊娠的围产期结局之间关系的队列研究。我们根据 PRISMA 指南进行了系统评价和荟萃分析。使用R和Stata软件进行统计分析。我们使用随机效应模型来汇集每个感兴趣的结果。我们进行了荟萃回归分析来探索潜在的异质性。证据的确定性（质量）评估是使用 GRADE 方法进行的。纳入 19 项队列研究，涉及 4,855,153 名参与者。从这些研究中，我们确定了 28,322 名曾有过死产且符合资格标准的个体。调整混杂因素后，低到中等确定性的证据表明，与以前有过活产的妇女相比，以前有过死产的妇女复发死产的风险更高（比值比，2.68；95%置信区间，2.01-3.56）、早产（比值比，3.15；95% 置信区间，2.07–4.80）、新生儿死亡（比值比，4.24；95% 置信区间，2.65–6.79）、小胎龄/宫内生长受限（比值比，1.3；95% 置信度）区间，1.0–1.8）、低出生体重（比值比，3.32；95% 置信区间，1.46–7.52）、胎盘早剥（比值比，3.01；95% 置信区间，1.01–8.98）、器械助产（比值比，2.29） ；95% 置信区间，1.68–3.11）、引产（比值比，4.09；95% 置信区间，1.88–8.88）、剖宫产（比值比，2.38；95% 置信区间，1.20–4.73）、选择性剖宫产（优势比，2.42；95% 置信区间，1.82-3.23）和紧急剖腹产（优势比，2.35；95% 置信区间，1.82-3.23）随后怀孕的 95% 置信区间，1.81–3.06），但自然分娩率较低（比值比，0.22；95% 置信区间，0.13–0.36）。然而，先前的死产与随后怀孕中的先兆子痫之间没有关联（比值比，1.72；95% 置信区间，0.63-4.70）。我们的系统回顾和荟萃分析可以更全面地了解与既往死产相关的不良妊娠结局。这些发现可用于为那些在之前死产后考虑怀孕的夫妇提供咨询。