Recommended Interpregnancy Interval After Stillbirth
There is no need to delay conception after a stillbirth, as conception within 12 months of a stillbirth is not associated with increased risk of adverse outcomes in subsequent pregnancies. 1
Evidence on Interpregnancy Interval After Stillbirth
- A large international cohort study analyzing data from Finland, Norway, and Western Australia found that 63% of women conceived within 12 months after a stillbirth, with a median interpregnancy interval of 9 months 1
- Compared to longer intervals (24-59 months), interpregnancy intervals shorter than 12 months were not associated with increased odds of subsequent stillbirth, preterm birth, or small-for-gestational-age birth 1
- Shorter intervals (<6 months) were actually associated with reduced odds of small-for-gestational-age birth compared to longer intervals 1
Clinical Approach to Counseling After Stillbirth
- When counseling patients after stillbirth, inform them that there is no medical reason to delay conception based on current evidence 1, 2
- The decision about when to attempt another pregnancy should be based on the mother's emotional readiness rather than arbitrary timing recommendations 3
- In a study of mothers who experienced stillbirth, most felt that the suitable time for a subsequent pregnancy was when the mother herself wanted, not based on a specific timeframe 3
Physiological Considerations
- Fertility typically returns within 1 month of pregnancy termination unless breastfeeding occurs 4
- The traditional recommendation to wait at least 3 months after pregnancy loss before attempting conception is not supported by current evidence 5
- A study examining very short interpregnancy intervals (<3 months) after pregnancy loss found no difference in live birth rates or adverse pregnancy outcomes compared to longer intervals 5
Important Considerations for the Next Pregnancy
- Stillbirth is defined as the death of a fetus prior to complete expulsion or extraction from the mother after 20 completed weeks of gestational age 6
- In subsequent pregnancies after stillbirth, appropriate antenatal surveillance should be implemented based on the cause of the previous stillbirth, if known 2
- For pregnancies with risk factors identified in previous stillbirths (such as fetal growth restriction), specialized monitoring with Doppler studies may be indicated 7
- Any woman who delivers a stillborn infant after 20 weeks' gestation should be tested for syphilis and other potential causes of stillbirth 6
Common Pitfalls in Management
- Advising arbitrary waiting periods (such as waiting 6-12 months) after stillbirth is not evidence-based and may cause unnecessary emotional distress 1, 3
- Failing to provide contraceptive counseling for those who wish to delay pregnancy can lead to unintended pregnancy 4
- Not addressing the psychological aspects of pregnancy after loss, which may include increased anxiety and need for additional support 2
In summary, the evidence does not support mandatory waiting periods after stillbirth before attempting another pregnancy. The decision should be individualized based on the mother's emotional readiness, with no medical contraindication to attempting conception as soon as desired.