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Published on: January 12, 2018
Patterns of recurrent preterm birth: an individual patient data meta-analysis
Charlotte E van Dijk1, Annemijn A de Ruigh1, Benjamin Y Gravesteijn1
1Division of Maternal and Child Health, Department of Obstetrics and Gynecology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands (van Dijk, de Ruigh, Gravesteijn, Kazemier, Pajkrt, and Kleinrouweler); Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands (van Dijk, de Ruigh, Gravesteijn, Kazemier, and Pajkrt).
Pregnant patients with a history of spontaneous preterm birth (sPTB) face a higher risk of recurrence. Gestational age and cervical length can stratify risk, but even low-risk individuals require continued monitoring and counseling for preterm birth prevention.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatal Epidemiology
Background:
- Patients with a previous spontaneous preterm birth (sPTB) are at increased risk for recurrent sPTB.
- Risk stratification is crucial for identifying individuals who may benefit from targeted interventions.
Purpose of the Study:
- To investigate if the number of previous sPTBs, gestational age (GA) of previous birth, and cervical length (CL) can stratify patients into different risk groups for recurrent sPTB.
- To determine if a low-risk group exists that does not require additional interventions.
Main Methods:
- Systematic search of MEDLINE and EMBASE (1995-April 2025).
- Pooled analysis of individual patient data from prospective studies including asymptomatic pregnant individuals with at least one previous sPTB (<37 weeks) and measured CL (18-24 weeks).
- Assessment of associations between CL, obstetric history, and recurrent sPTB.
Main Results:
- Included data from 1,316 patients.
- CL and GA of previous sPTB independently stratified recurrence risk.
- High-risk group (previous sPTB <24 weeks, current CL <15mm) had PTB rates up to 50% before 32 weeks.
- Lowest-risk group (previous sPTB 32-36 weeks, current CL >30mm) had PTB rates of 3.9% before 32 weeks, still higher than reference groups.
Conclusions:
- All patients with a history of sPTB have an increased risk of recurrent PTB, irrespective of CL or GA of previous sPTB.
- Even the lowest-risk group exhibits a higher risk compared to women without a history of sPTB.
- Counseling and surveillance for preventative treatments remain essential for all patients with a history of sPTB.
