Preconceptual care reduces risk of spontaneous preterm birth for select high-risk populations: A prospective study

Prevention of preterm birth (PTB) is an urgent unmet clinical need. Preconceptual counseling for women at high-risk of PTB offers a unique opportunity to mitigate risk of preterm birth for subsequent pregnancy. The present study aimed to examine the impact of preconceptual counseling on rates of PTB in a high-risk population.

This was a prospective study at a tertiary referral PTB Clinic of all preconceptual consultations over a 5-year period (2018-2023, n = 97). Consultation data were collected. Subsequent pregnancy outcomes for women who attended for preconceptual counseling were compared to a women attending the PTB Clinic who did not attend for preconception counseling, with sensitivity analysis based on PTB risk factor.

A total of 97 women attended for preconception care with 47 subsequent pregnancies, of which 62/97 (63.9%) had a prior PTB or mid trimester loss (MTL). A total of 35/97 (36.0%) had cervical surgery. After consultation, 34/97 (35.0%) patients chose abdominal cerclage, 15/97 (15.5%) chose elective cervical cerclage in pregnancy and 48/97 (49.5%) opted for reassessment in early pregnancy. Pregnancy outcomes were recorded for 165 women attending the PTB Clinic; this included 47 women who had received preconceptual counseling and 118 who did not receive preconceptual counseling. Women with preconceptual care were significantly more likely to have an abdominal cerclage (17/47, 36.2% vs. 4/118, 3.4%, P < 0.001). There was no difference in preterm birth <37 or <34 weeks or mid-trimester loss with preconceptual counseling for any risk factor criteria. However, for high-risk patients (history of extreme PTB [<28 week], mid-trimester loss [14-23 weeks] or recurrent sPTB) preconceptual counseling was associated with a significant reduction in early PTB <32 weeks (0/19, 0.0% vs. 6/32, 18.8%, P = 0.044), associated with significantly higher rate of abdominal cerclage (5/19, 26.3% vs. 0/0, 0.0%, P = 0.003).

Preconceptual counseling is an effective intervention to reduce risk of early preterm birth for select high-risk populations.