Rates of and factors associated with recurrence of preterm delivery

World Health Organization Collaborating Center in Perinatal Care and Health Services Research in Maternal Child Health, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 11/1999; 283(12):1591-6.
Source: PubMed


Information about risk of recurrent preterm delivery is useful to clinicians, researchers, and policy makers for counseling, generating etiologic leads, and measuring the related public health burden.
To identify the rate of recurrence of preterm delivery in second pregnancies, factors associated with recurrence, and the percentage of preterm deliveries in women with a history of preterm delivery.
Population-based cohort study of data from birth and fetal death certificates from the state of Georgia between 1980 and 1995.
A total of 122 722 white and 56174 black women with first and second singleton deliveries at 20 to 44 weeks' gestation.
Length of gestation (categorized as 20-31, 32-36, or > or =37 weeks) at second delivery compared with length of gestation at first delivery, by age and race.
Most women whose first delivery was preterm subsequently had term deliveries. Of 1023 white women whose first delivery occurred at 20 to 31 weeks, 8.2% (95% confidence interval [CI], 6.6%-10.1%) delivered their second birth at 20 to 31 weeks and 20.1% (95% CI, 17.7%-22.8%) at 32 to 36 weeks. Of 1084 comparable black women, 13.4% (95 % CI, 11.4%-15.6%) delivered at 20 to 31 weeks and 23.4% (95% CI, 20.9%-26.1%) delivered at 32 to 36 weeks. Among women whose first delivery occurred at 32 to 36 weeks, all corresponding rates were lower than those whose first birth was at 20 to 31 weeks; the rates of second birth at 20 to 31 weeks were substantially lower (for white women, 1.9% [95% CI, 1.7%-2.2%]; for black women, 3.8% [95% CI, 3.4%-4.2%]). Compared with women aged 20 to 49 years at their second delivery, women younger than 18 years had twice the risk of recurrence of delivery at 20 to 31 weeks. Of all second deliveries at 20 to 31 weeks, 29.4% for white women and 37.8% for black women were preceded by a preterm delivery.
Our data suggest that recurrence of preterm delivery contributes a notable portion of all preterm deliveries, especially at the shortest gestations.

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    • "Furthermore, of women who are considered at high risk of preterm birth (e.g. previous preterm birth and twin gestation), !50% will deliver prematurely (Adams et al. 2000). This emphasises the difficulty in recognising women that will deliver preterm. "
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    ABSTRACT: The ability to recognise women who are at-risk of preterm labour is often difficult. Over 50% of women who are identified with factors associated with an increased risk of preterm birth will ultimately deliver at term. The cervicovaginal fluid (CVF) comprises of a range of proteins secreted by gestational tissues, making it an ideal candidate for the screening of differentially expressed proteins associated with preterm labour. CVF samples were collected from at-risk asymptomatic women. Two-dimensional gel electrophoresis techniques were used to examine the CVF proteome of women who spontaneously delivered preterm 11-22 days later, compared to gestation-matched women who delivered at term. Five candidate biomarkers were selected for further validation in a larger independent cohort of asymptomatic women. Thioredoxin (TXN) and interleukin-1 receptor antagonist (IL1RN) expression in the CVF were found to be significantly reduced up to 90 days prior to spontaneous preterm labour compared to women who subsequently delivered at term. TXN was able to predict spontaneous preterm labour within 28 days after sampling with high positive and negative predictive values of 75.0% and 96.4%, respectively. IL1RN also showed comparable positive and negative predictive values of 72.7% and 95.7%, respectively. The discovery of these differentially expressed proteins may assist in the development of a new predictive bedside test in identifying asymptomatic women who have an increased risk of spontaneous preterm labour.
    Reproduction 07/2013; 146(4). DOI:10.1530/REP-13-0175 · 3.17 Impact Factor
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    • "The most salient maternal risk factor for PTB is a history of premature birth. Women with a previous preterm birth have anywhere between a two-to sixfold greater risk for a second, repeat preterm birth when compared to women with a previous full-term birth (Adams, Elam-Evans, Wilson, & Gilbert, 2000; Kistka et al. 2007). Unfortunately, relatively little is known about the specific health-related conditions and behaviors that account for this increased risk. "
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    ABSTRACT: To describe pregnancy intention and contraceptive use among women with a recent delivery that occurred at 35 weeks gestation or fewer and who were enrolled in a large-scale randomized control trial. In this descriptive study we used data from assessments conducted at 6 months postpartum as part of a randomized controlled clinical trial, the Philadelphia Collaborative Preterm Prevention Project (PCPPP). Participants were recruited following a preterm birth (PTB) in one of the 12 urban birth hospitals. All women enrolled in PCPPP, who completed their 6-month postpartum assessment, and who were sexually active at the time of that assessment (n = 566), were included in the analysis. Data were collected during face-to-face interviews. Study questionnaires included questions about participants' plans for the timing of subsequent pregnancies, contraceptive behaviors, and other health variables. Nearly all of the participants (90.1%, n = 509) reported they did not want to get pregnant within one year of the index PTB. However, more than one half of these women (54.6%) reported contraceptive practices of low or moderate effectiveness. Most predictive of intending another pregnancy within the year was the death of the index PTB infant (odds ratio [OR]= 18.2,95% confidence interval [CI] [8.9, 37.0]). Discordant pregnancy intention and contraceptive use were reported among this group of mothers of PTB infants who are at particularly high risk for a poor outcome of any subsequent pregnancy. The findings highlight the need for further investigation of the causes, correlates, and consequences of discordant pregnancy intentions and contraceptive practices.
    Journal of Obstetric Gynecologic & Neonatal Nursing 05/2012; 41(3):389-97. DOI:10.1111/j.1552-6909.2012.01351.x · 1.02 Impact Factor
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    • "Preterm birth (delivery prior to 37 weeks gestation) occurs in around 10% of all deliveries and is the most significant problem encountered in obstetrics including neonatal morbidity and mortality [1]. This disorder is a complex cluster of problems associated with socioeconomic, sociodemographic, sociobehavioral, environmental, medical, biological, and genetic risk factors [2, 3]. Infection and inflammation are important etiological factors in the development of preterm birth, since nearly 30% of preterm deliveries are associated with intrauterine infection [1, 4]. "
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    ABSTRACT: Individuals with inflammation have a myriad of pregnancy aberrations including increasing their preterm birth risk. Toll-like receptors (TLRs) and receptor for advanced glycation end products (RAGE) and their ligands were all found to play a key role in inflammation. In the present study, we reviewed TLR and RAGE expression, their ligands, and signaling in preterm birth. A systematic search was performed in the electronic databases PubMed and ScienceDirect up to July 2010, combining the keywords "preterm birth," "TLR", "RAGE", "danger signal", "alarmin", "genomewide," "microarray," and "proteomics" with specific expression profiles of genes and proteins. This paper provides data on TLR and RAGE levels and critical downstream signaling events including NF-kappaB-dependent proinflammatory cytokine expression in preterm birth. About half of the genes and proteins specifically present in preterm birth have the properties of endogenous ligands "alarmin" for receptor activation. The interactions between the TLR-mediated acute inflammation and RAGE-mediated chronic inflammation have clear implications for preterm birth via the TLR and RAGE system, which may be acting collectively. TLR and RAGE expression and their ligands, signaling, and functional activation are increased in preterm birth and may contribute to the proinflammatory state.
    Mediators of Inflammation 11/2010; 2010(0962-9351):490406. DOI:10.1155/2010/490406 · 3.24 Impact Factor
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