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Recurrence Risk of Preterm Birth in Successive Pregnancies Based on Its Subtypes

Iris T Smith1, Michael J Fassett2,3, David A Sacks4

  • 1Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.

American Journal of Perinatology
|March 7, 2025
PubMed

Insights

A prior preterm birth (PTB) significantly increases recurrence risk, especially for the same subtype. Non-Hispanic Black and Asian/Pacific Islander women face higher risks, highlighting disparities and the need for targeted interventions.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Health
  • Public Health

Background:

  • Preterm birth (PTB) is a major public health concern with significant obstetric and perinatal consequences.
  • A history of PTB is a known risk factor for recurrence, but influences of race/ethnicity, gestational age, PTB subtypes, and interpregnancy intervals (IPI) require further investigation.

Purpose of the Study:

  • To evaluate how factors including race/ethnicity, gestational age, PTB subtypes (spontaneous/indicated), and IPI modify the risk of PTB recurrence.
  • To identify specific risk factors and disparities associated with PTB recurrence in a large, diverse population.

Main Methods:

  • Retrospective cohort study of singleton pregnancies (2009-2022) using electronic health record data from Kaiser Permanente Southern California.
  • Inclusion of women with two (82,610) and three (14,925) pregnancies.
  • Natural language processing for PTB subtype identification (sPTB, iPTB); logistic regression for risk assessment (aOR, 95% CI).

Main Results:

  • A first PTB increased the risk of a second PTB sixfold (23.29% vs. 4.98%).
  • Recurrence risk was higher for the same PTB subtype (sPTB: aOR 5.32; iPTB: aOR 8.26).
  • Higher recurrence risks observed in Non-Hispanic Black and Asian/Pacific Islander women compared to Non-Hispanic Whites; risk increased substantially with PTB in both prior pregnancies (aOR 14.59).

Conclusions:

  • PTB recurrence risk is significantly elevated, particularly for the same subtype and across racial/ethnic groups, indicating persistent disparities.
  • Early gestational age deliveries (20-33 weeks) showed substantially higher recurrence.
  • Findings underscore the necessity for subtype-specific analyses and targeted interventions to address PTB recurrence disparities.

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