Protecting families from recurrent stillbirth

Stillbirth is a tragedy for parents and has enduring medical, psychological, social, and economic consequences. It remains a major problem in the United Kingdom; in 2013, 3286 babies were stillborn after 24 weeks of pregnancy, equating to one in every 240 births.1 Since 2011, when the UK was ranked 33rd out of 35 high income countries for stillbirths, there has been a downward trend in the stillbirth rate, but this has not yet reached the lower levels seen in Scandinavia or the Netherlands.2

Identification of pregnancies at increased risk of stillbirth can help to prevent stillbirths by directing additional antenatal care and intervention to those most likely to benefit. Consequently, identification of risk factors is highly desirable.

In their meta-analysis of 16 studies of 3 412 079 women in this issue, Lamont and colleagues (doi:10.1136/bmj.h3080) identify an increased risk of stillbirth in subsequent pregnancies after a previous pregnancy ended in stillbirth.3 This approximately fivefold increase in risk is greater than that of stillbirth associated with pre-existing medical conditions, such as diabetes or hypertension.4 Heightened antenatal surveillance is recommended in both of these maternal conditions and …