Download PDF
Am J Perinatol
DOI: 10.1055/a-2053-8189
Original Article

Parental Perceptions of Counseling Regarding Interpregnancy Interval after Stillbirth or Neonatal Death

Karen J. Gibbins 
1   Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
2   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Cara C. Heuser
2   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
3   Department of Obstetrics and Gynecology, Intermountain Health, Murray, Utah
› Author Affiliations Funding K.J.G. is supported by National Institute of Child Health and Human Development–sponsored Women's Reproductive Health Research Award (grant number: 2K12HD085809-06).
› Further Information
    Permissions and Reprints

Abstract

Objective Although guidelines exist regarding optimal interpregnancy interval (IPI) after live birth, both optimal IPI and counseling regarding recommended IPI (rIPI) after stillbirth or neonatal death is not well established. Our goal was to describe the counseling bereaved parents receive regarding IPI, parents' reactions to that counseling, and actual IPI after loss.

Study Design Bereaved parents who had a previous pregnancy result in stillbirth or neonatal death participated in a web-based survey. Questions included demographics, details of stillbirth or neonatal death, IPI counseling, and pregnancy after loss. Demographic information, rIPI, and ac'tual IPI were reported using descriptive statistics. The Wilcoxon's rank sum test was used to test the association between rIPI and mode of delivery. The Spearman's correlation was used to test the association between rIPI and maternal age.

Results A total of 275 surveys were analyzed. Mean gestational age of stillbirth delivery was 33.1 (standard deviation: 6.6) weeks. A total of 29% delivered via cesarean. Median rIPI was 6 (interquartile ratio [IQR]: 2–9) months, with the primary reason for IPI reported as the need to heal (74%). Delivery via cesarean was associated with longer rIPI, 9 versus 4.2 months (p < 0.0001). Maternal age was not associated with rIPI. Of 144 people who pursued pregnancy again, median time until attempting conception was 3.5 (IQR: 2–6) months. Median actual IPI was 6 (IQR: 4–10) months.

Conclusion Bereaved parents receive a wide range of counseling regarding rIPI. The majority receive rIPI and pursue actual IPI shorter than current national and international recommendations for optimal IPI.

Key Points

  • There is variation in IPI recommendation after stillbirth/neonatal death.

  • Cesarean birth is associated with longer IPI recommendation, but maternal age is not.

  • Median IPI after stillbirth or neonatal death was short: 6 (IQR: 4–10) months.

Keywords

stillbirth - neonatal death - interpregnancy interval - patient centered

Note

This study was approved by the University of Utah Institutional Review Board (identifier: 00113313).


Supplementary Material



Publication History

Received: 19 October 2022

Accepted: 06 March 2023

Accepted Manuscript online:
14 March 2023

Article published online:
18 April 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Flenady V, Boyle F, Koopmans L, Wilson T, Stones W, Cacciatore J. Meeting the needs of parents after a stillbirth or neonatal death. BJOG 2014; 121 (suppl 4): 137-140
    CrossrefPubMedGoogle Scholar
  • 2 Heazell AE, Leisher S, Cregan M. et al. Sharing experiences to improve bereavement support and clinical care after stillbirth: report of the 7th annual meeting of the International Stillbirth Alliance. Acta Obstet Gynecol Scand 2013; 92 (03) 352-361
    CrossrefPubMedGoogle Scholar
  • 3 Stephansson O, Dickman PW, Cnattingius S. The influence of interpregnancy interval on the subsequent risk of stillbirth and early neonatal death. Obstet Gynecol 2003; 102 (01) 101-108
    PubMedGoogle Scholar
  • 4 DeFranco EA, Stamilio DM, Boslaugh SE, Gross GA, Muglia LJ. A short interpregnancy interval is a risk factor for preterm birth and its recurrence. Am J Obstet Gynecol 2007; 197 (03) 264.e1-264.e6
    CrossrefPubMedGoogle Scholar
  • 5 Chen I, Jhangri GS, Lacasse M, Kumar M, Chandra S. Relationship between interpregnancy interval and adverse perinatal and neonatal outcomes in Northern Alberta. J Obstet Gynaecol Can 2015; 37 (07) 598-605
    CrossrefPubMedGoogle Scholar
  • 6 Koullali B, Kamphuis EI, Hof MH. et al. The effect of interpregnancy interval on the recurrence rate of spontaneous preterm birth: a retrospective cohort study. Am J Perinatol 2017; 34 (02) 174-182
    PubMedGoogle Scholar
  • 7 Cofer FG, Fridman M, Lawton E, Korst LM, Nicholas L, Gregory KD. Interpregnancy interval and childbirth outcomes in California, 2007-2009. Matern Child Health J 2016; 20 (suppl 1): 43-51
    CrossrefPubMedGoogle Scholar
  • 8 Getahun D, Lawrence JM, Fassett MJ. et al. The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes. Am J Obstet Gynecol 2009; 201 (04) 378.e1-378.e6
    CrossrefPubMedGoogle Scholar
  • 9 Dimes Mo. . Spacing pregnancies can help prevent preterm birth among both non-Hispanic Black and non-Hispanic white women, research shows. Accessed June 2, 2022 at: https://www.marchofdimes.org/news/spacing-pregnancies-can-help-prevent-preterm-birth-among-both-non-hispanic-black-and-non-hispanic-white-women-research-shows.aspx#:~:text=March%20of%20Dimes%20advises%20that,birth%20and%20getting%20pregnant%20again
    PubMed
  • 10 American College of Obstetricians and Gynecologists ; Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 8: interpregnancy care. Obstet Gynecol 2019; 133 (01) e51-e72
    CrossrefPubMedGoogle Scholar
  • 11 Regan AK, Ball SJ, Warren JL. et al. A population-based matched-sibling analysis estimating the associations between first interpregnancy interval and birth outcomes. Am J Epidemiol 2019; 188 (01) 9-16
    CrossrefPubMedGoogle Scholar
  • 12 Erickson JD, Bjerkedal T. Interpregnancy interval. Association with birth weight, stillbirth, and neonatal death. J Epidemiol Community Health 1978; 32 (02) 124-130
    CrossrefPubMedGoogle Scholar
  • 13 Hanley GE, Hutcheon JA, Kinniburgh BA, Lee L. Interpregnancy interval and adverse pregnancy outcomes: an analysis of successive pregnancies. Obstet Gynecol 2017; 129 (03) 408-415
    CrossrefPubMedGoogle Scholar
  • 14 Ball SJ, Pereira G, Jacoby P, de Klerk N, Stanley FJ. Re-evaluation of link between interpregnancy interval and adverse birth outcomes: retrospective cohort study matching two intervals per mother. BMJ 2014; 349: g4333
    CrossrefPubMedGoogle Scholar
  • 15 Wong LF, Schliep KC, Silver RM. et al. The effect of a very short interpregnancy interval and pregnancy outcomes following a previous pregnancy loss. Am J Obstet Gynecol 2015; 212 (03) 375.e1-375.e11
    CrossrefPubMedGoogle Scholar
  • 16 Sundermann AC, Hartmann KE, Jones SH, Torstenson ES, Velez Edwards DR. Interpregnancy interval after pregnancy loss and risk of repeat miscarriage. Obstet Gynecol 2017; 130 (06) 1312-1318
    CrossrefPubMedGoogle Scholar
  • 17 Love ER, Bhattacharya S, Smith NC, Bhattacharya S. Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland. BMJ 2010; 341: c3967
    CrossrefPubMedGoogle Scholar
  • 18 Kangatharan C, Labram S, Bhattacharya S. Interpregnancy interval following miscarriage and adverse pregnancy outcomes: systematic review and meta-analysis. Hum Reprod Update 2017; 23 (02) 221-231
    PubMedGoogle Scholar
  • 19 Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis. BMJ 2015; 350: h3080
    CrossrefPubMedGoogle Scholar
  • 20 Regan AK, Gissler M, Magnus MC. et al. Association between interpregnancy interval and adverse birth outcomes in women with a previous stillbirth: an international cohort study. Lancet 2019; 393 10180 1527-1535
    CrossrefPubMedGoogle Scholar
  • 21 Rådestad I, Hutti M, Säflund K, Onelöv E, Wredling R. Advice given by health-care professionals to mothers concerning subsequent pregnancy after stillbirth. Acta Obstet Gynecol Scand 2010; 89 (08) 1084-1086
    CrossrefPubMedGoogle Scholar
  • 22 Wojcieszek AM, Boyle FM, Belizán JM. et al. Care in subsequent pregnancies following stillbirth: an international survey of parents. BJOG 2018; 125 (02) 193-201
    CrossrefPubMedGoogle Scholar
  • 23 American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine in collaboration with. et al. Obstetric Care Consensus #10: management of stillbirth: (replaces Practice Bulletin Number 102, March 2009). Am J Obstet Gynecol 2020; 222 (03) B2-B20
    CrossrefPubMedGoogle Scholar
  • 24 Hollins Martin CJ, Reid K. A scoping review of therapies used to treat psychological trauma post perinatal bereavement. J Reprod Infant Psychol 2022; 6: 1-17
    CrossrefPubMedGoogle Scholar
  • 25 Obst KL, Oxlad M, Due C, Middleton P. Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample. BMC Pregnancy Childbirth 2021; 21 (01) 29
    CrossrefPubMedGoogle Scholar
  • 26 Matthews K, Morgan I, Davis K, Estriplet T, Perez S, Crear-Perry JA. Pathways to equitable and antiracist maternal mental health care: insights from Black women stakeholders. Health Aff (Millwood) 2021; 40 (10) 1597-1604
    CrossrefPubMedGoogle Scholar
  • 27 Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol 2010; 202 (04) 335-343
    CrossrefPubMedGoogle Scholar