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Can We Predict Preterm Delivery Based on the Previous Pregnancy?
Tamar Wainstock1, Ruslan Sergienko1, Eyal Sheiner2
1Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8489325, Israel.
Insights
Complications during a first pregnancy, even if it ends at term, increase the risk of preterm delivery (PTD) in a subsequent pregnancy. Identifying these early pregnancy complications can help predict future PTD risk.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Reproductive Health
Background:
- Preterm delivery (PTD) affects 5-18% of global births, causing significant offspring morbidity and healthcare costs.
- Identifying risk factors for subsequent PTD is crucial for improving perinatal outcomes.
- Previous PTD or early PTD (<34 weeks) are known risk factors, but factors from a prior term delivery are less understood.
Purpose of the Study:
- To identify risk factors during a first pregnancy, ending at term, for preterm delivery (PTD) in the subsequent pregnancy.
- To assess the association between specific first pregnancy complications and the risk of PTD in the second pregnancy.
- To determine if early pregnancy complications can serve as a predictive window for future PTD.
Main Methods:
- Retrospective population-based nested case-control study of women with two consecutive singleton deliveries.
- Exclusion of women with PTD in the first pregnancy.
- Multivariable logistic regression analysis adjusting for maternal age, interpregnancy interval, and comorbidities.
Main Results:
- Of 39,780 women, 5.2% experienced PTD in their second pregnancy.
- First pregnancy complications like perinatal mortality, small for gestational age, and preeclampsia were more common in women with subsequent PTD.
- Any of these first pregnancy complications independently increased PTD risk (aOR=1.44), with two or more complications significantly elevating risk (aOR=2.09).
Conclusions:
- Complications in a first pregnancy, even if delivered at term, are associated with an increased risk of preterm delivery in the subsequent pregnancy.
- The first pregnancy serves as a critical window for identifying women at risk for future PTD.
- Early identification and management of first pregnancy complications may help mitigate the risk of subsequent preterm deliveries.
Abstract:
(1) Background: Preterm deliveries (PTD, <37 gestational weeks) which occur in 5-18% of deliveries across the world, are associated with immediate and long-term offspring morbidity, as well as high costs to health systems. Our aim was to identify risk factors during the first pregnancy ending at term for PTD in the subsequent pregnancy. (2) Methods: A retrospective population- based nested case-control study was conducted, including all women with two first singleton consecutive deliveries. Women with PTD in the first pregnancy were excluded. Characteristics and complications of the first pregnancy were compared among cases, defined as women with PTD in their second pregnancy, and the controls, defined as women delivering at term in their second pregnancy. A multivariable logistic regression model was used to study the association between pregnancy complications (in the first pregnancy) and PTD (in the subsequent pregnancy), while adjusting for maternal age and the interpregnancy interval. (3) Results: A total of 39,780 women were included in the study, 5.2% (n = 2088) had PTD in their second pregnancy. Women with PTD, as compared to controls (i.e., delivered at term in second pregnancy), were more likely to have the following complications in their first pregnancy: perinatal mortality (0.4% vs. 1.0%), small for gestational age (12.4% vs. 8.1%), and preeclampsia (7.6% vs. 5.7%). In the multivariable model, after adjusting for maternal age, interpregnancy interval and co-morbidities, having any one of these first pregnancy complications was independently associated with an increased risk for PTD (adjusted OR = 1.44; 95%CI 1.28-1.62), and the risk was greater if two or more complications were diagnosed (adjusted OR = 2.09; 95%CI 1.47-3.00). These complications were also risk factors for early PTD (<34 gestational weeks), PTD with a systematic infectious disease in the background, and possibly with spontaneous PTD. (4) Conclusions: First pregnancy complications are associated with an increased risk for PTD in the subsequent pregnancy. First pregnancy, although ending at term, may serve as a window of opportunity to identify women at risk for future PTD.
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