Stillbirths Linked to Higher Postpartum Readmission Risk: Study Reveals

Stillbirth, a devastating event, not only impacts maternal health through physical complications but also poses a significant psychosocial hazard. Pregnant people with comorbid conditions and obstetrical complications are more prone to stillbirth, which in turn increases maternal morbidity and necessitates careful postpartum management. This study aimed to compare the risk of postpartum readmission between patients with stillbirths and live births, identifying key indications for readmission and associated risk factors.

This retrospective cohort study included patients with singleton stillbirths or live births delivered at or beyond 20 weeks’ gestation. The primary outcome measured was all-cause readmission within six weeks of discharge from the childbirth hospitalization. The study utilized multivariable regression models to adjust for maternal age, sociodemographic characteristics, maternal and obstetrical conditions, and delivery characteristics.

• Postpartum readmission occurred in 2.7% of 16,636 patients with stillbirths compared to 1.6% of 2,870,677 patients with live births (unadjusted risk ratio, 1.65; 95% confidence interval [CI], 1.47–1.86).

• The adjusted risk ratio for readmission after stillbirth versus live birth was 1.27 (95% CI, 1.11–1.46).

• 30.2% for stillbirths vs. 39.5% for live births (unadjusted risk ratio, 0.76; 95% CI, 0.63–0.93).

• 6.8% for stillbirths vs. 3.6% for live births (unadjusted risk ratio, 1.90; 95% CI, 1.15–3.16).

• 5.8% for stillbirths vs. 2.0% for live births (unadjusted risk ratio, 2.87; 95% CI, 1.60–5.17).

• Among patients with stillbirths, 56.0% of readmissions occurred within one week, 71.8% within two weeks, and 88.1% within four weeks. The timing did not significantly differ between the stillbirth and live birth cohorts.

Risk Factors for Readmission after Stillbirth:

• Pregestational Diabetes: Adjusted risk ratio, 1.87 (95% CI, 1.20–2.93).

• Gestational Diabetes: Adjusted risk ratio, 1.67 (95% CI, 1.03–2.71).

• Hypertensive Disorders of Pregnancy: Adjusted risk ratio, 1.80 (95% CI, 1.31–2.47).

• Obesity: Adjusted risk ratio, 1.46 (95% CI, 1.01–2.12).

• Primary Cesarean Delivery: Adjusted risk ratio, 1.74 (95% CI, 1.17–2.58).

• Higher Household Income: Associated with a lower risk for readmission (adjusted risk ratio for income ≥$82,000 vs. $1–$47,999, 0.48; 95% CI, 0.30–0.77).

The study underscores the higher risk for postpartum readmission among patients who experience stillbirths compared to those with live births, even after accounting for various maternal and obstetrical factors. This increased risk is particularly associated with mental health or substance use disorders and venous thromboembolism, highlighting the need for comprehensive postnatal care strategies that address both physical and psychological health.

The findings of this study emphasize the critical need for enhanced postpartum care for individuals who have experienced stillbirths. The higher risk of readmission, particularly due to mental health issues and venous thromboembolism, calls for targeted interventions and support systems to improve maternal health outcomes in this vulnerable group.

Reference:

Sweeney, L. C., Reddy, U. M., Campbell, K., & Xu, X. (2024). Postpartum readmission risk: a comparison between stillbirths and live births. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2024.02.017