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- Title
Association between interpregnancy interval and the risk of recurrent loss after a midtrimester loss.
- Authors
Roberts, C. L.; Algert, C. S.; Ford, J. B.; Nippita, T. A.; Morris, J. M.
- Abstract
<bold>Study Question: </bold>After an initial midtrimester loss, is the interval to the next conception associated with the risk of a recurrent loss?<bold>Summary Answer: </bold>Among women who had a pregnancy loss at 14-19 weeks gestation, conception at least 3 months after this initial loss was associated with a reduced risk of a recurrent loss.<bold>What Is Known Already: </bold>A short interpregnancy interval (IPI) has been thought to increase risk but recent studies of pregnancy after a loss have found no effect; however, these studies have been based almost entirely on an initial first trimester (<14 weeks) loss.<bold>Study Design, Size, Duration: </bold>A retrospective cohort study drawing on over 997 000 linked birth and hospital records from New South Wales, Australia for 2003-2011. Index pregnancies were those of women who had a first recorded pregnancy loss of 14-23 weeks gestation (miscarriage, termination and perinatal death). The study population was 4290 women who conceived again within 2 years.<bold>Participants/materials, Setting, Methods: </bold>The index loss was categorized by subgroups: 14-19 weeks gestation versus 20-23 weeks, and by whether spontaneous or a termination. The primary outcome was any loss or perinatal death before 24 weeks in the subsequent pregnancy.<bold>Main Results and the Role Of Chance: </bold>After a 14-19 weeks index loss, an IPI of ≤3 months had an increased rate of recurrent loss compared with an IPI of >9-12 months: 21.9% versus 11.3% (adjusted relative risk (aRR) = 2.02, 95% CI 1.44-2.83). For women who had a spontaneous index loss of 20-23 weeks, there was no evidence that a short IPI increased or decreased the risk of recurrent loss. For any gestational age group of index losses, an IPI of >18-24 months increased the risk of a recurrent loss; the risk was highest after a 20-23 weeks index loss (aRR = 2.15, 95% CI 1.18-3.91).<bold>Limitations, Reasons For Caution: </bold>We do not know how many cycles were required to achieve conception. Pregnancies resulting in early first trimester losses are unlikely to have resulted in hospitalization so would not have been identified.<bold>Wider Implications Of the Findings: </bold>The risk of recurrent loss after an initial midtrimester loss may differ from the risk after an initial first trimester loss.<bold>Study Funding/competing Interests: </bold>This work was supported by an Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence Grant (1001066). C.L.R. is supported by an NHMRC Senior Research Fellowship (#APP1021025). J.B.F. is supported by an ARC Future Fellowship (#120100069). The authors have no conflicts of interest to declare.<bold>Trial Registration Number: </bold>N/A.
- Subjects
RISK factors in miscarriages; SECOND trimester of pregnancy; PREGNANCY complications; PERINATAL death; CONFLICT of interests; GESTATIONAL age; FIRST trimester of pregnancy; TIME; RELATIVE medical risk; RETROSPECTIVE studies; PARITY (Obstetrics); RECURRENT miscarriage
- Publication
Human Reproduction, 2016, Vol 31, Issue 12, p2834
- ISSN
0268-1161
- Publication type
journal article
- DOI
10.1093/humrep/dew251