Research
Obstetrics
National survey of obstetrician attitudes about timing the subsequent pregnancy after perinatal death

https://doi.org/10.1016/j.ajog.2009.11.039Get rights and content

Objective

After stillbirth or early infant death, parents often query when they can try for another pregnancy. We conducted a national survey of US obstetricians to assess attitudes about optimal timing of next pregnancy and advice given to parents.

Study Design

The study was an anonymous mail survey of 1500 randomly selected US obstetricians asking about physician experiences with perinatal death.

Results

In all, 804 of 1500 obstetricians completed the survey for a 54% usable response rate. Two-thirds of respondents endorsed a waiting time <6 months for parents bereaved by stillbirth who desired another pregnancy.

Conclusion

Physicians in this national survey supported very short interpregnancy intervals for parents bereaved by perinatal death. Responses may reflect efforts to support parents emotionally while recognizing individuals vary in coping and clinical circumstances. However, this is a provocative finding since short intervals may confer greater fetal risks for poor outcome.

Section snippets

Materials and Methods

The study was a national mail survey to 1500 US obstetricians, selected through simple random sampling from the American Medical Association (AMA) Physician Masterfile and confirmed to hold an active US medical license. The Physician Masterfile includes data on all US physicians, including both those who are AMA members and those who are not. It also includes data for graduates of foreign medical schools who live in the United States. Physicians were initially sent the 51-question survey along

Results

Of 1500 mailings, 19 subjects were replaced due to undeliverable envelopes and 15 mailings came back undeliverable after the study ended and these subjects were not replaced. Of the remaining 1485 subjects, 34 physicians returned a form declining to participate, 2 incompletely filled out the survey, and 804 completed the full survey for a usable response rate of 54%.

Respondents were nearly equally split between male and female, and median age was 46 years with 14 years of practice after

Comment

This study highlights physician recommendations for brief IPI after a stillbirth. The majority of studies that have examined IPIs have reported the best perinatal outcomes for pregnancies conceived at least 6 months and perhaps as much as ≥18 months after a previous pregnancy.1, 2, 3, 10 In this survey, less than a third of physicians recommended that parents bereaved by stillbirth wait ≥6 months prior to trying for conception. This is an important finding and warrants additional exploration of

References (45)

  • B.P. Zhu et al.

    Effect of interpregnancy interval on infant low birth weight: a retrospective cohort study using the Michigan maternally linked birth database

    Matern Child Health J

    (2003)
  • T. Bjerkdal et al.

    Association of birth outcome with subsequent fertility

    Am J Obstet Gynecol

    (1983)
  • U.M. Reddy

    Prediction and prevention of recurrent stillbirth

    Obstet Gynecol

    (2007)
  • P.P. Sharma et al.

    Stillbirth recurrence in a population of relatively low-risk mothers

    Paediatr Perinat Epidemiol

    (2007)
  • M. Black et al.

    Obstetric outcomes subsequent to intrauterine death in the first pregnancy

    BJOG

    (2008)
  • S.K. Nabukera et al.

    Interpregnancy interval and subsequent perinatal outcomes among women delaying initiation of childbearing

    J Obstet Gynaecol Res

    (2008)
  • B.P. Zhu et al.

    Effect of the interval between pregnancies on perinatal outcomes

    N Engl J Med

    (1999)
  • D.S. Armstrong

    Emotional distress and prenatal attachment in pregnancy after perinatal loss

    J Nurs Scholarsh

    (2002)
  • D. Cote-Arsenault et al.

    Women's voices reflecting changed expectations for pregnancy after perinatal loss

    J Nurs Scholarsh

    (2001)
  • R.L. Franche et al.

    The impact of a subsequent pregnancy on grief and emotional adjustment following a perinatal loss

    Infant Ment Health J

    (1999)
  • S. Phipps

    The subsequent pregnancy after stillbirth: anticipatory parenthood in the face of uncertainty

    Int J Psychiatry Med

    (1985)
  • D. Cote-Arsenault et al.

    Watching and worrying: early pregnancy after loss experiences

    MCN Am J Matern Child Nurs

    (2006)
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    Cite this article as: Gold KJ, Leon I, Chames MC. National survey of obstetrician attitudes about timing the subsequent pregnancy after perinatal death. Am J Obstet Gynecol 2010;202:357.e1-6.

    This study was supported by the Department of Obstetrics and Gynecology, University of Michigan Medical School, with salary support for Dr Gold provided by a National Institutes of Health K-12 Building Interdisciplinary Research Careers in Women's Health Grant.

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