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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    ABSTRACT: Pelvic infections and sexually transmitted diseases place a burden on health resources and may be associated with premature birth. The mechanisms by which the female reproductive tract (FRT) combats these infections remain ill understood, but are likely to involve the pattern recognition Toll-like receptors (TLR). We sought to compare the expression of TLR-2 and -4 by human pregnant and non-pregnant ectocervical epithelium as a prelude to the investigation of the function of these receptors in this tissue during pregnancy. Using the techniques of reverse-transcriptase polymer chain reaction (RT-PCR) and immunohistochemistry, the gene and protein expression of TLR-2 and -4 were studied in the biopsies of ectocervix obtained from non-pregnant premenopausal women (n=21) undergoing hysterectomy, women in the first trimester of pregnancy undergoing non-medically indicated suction pregnancy termination (n=6), and women at term undergoing elective caesarean section (n=11). The expression of TLR2 and TLR4 genes and proteins were upregulated in early and late pregnant ectocervical epithelium, compared with non-pregnant tissue. These findings suggest that the upregulation of TLR2 and TLR4 in the lower FRT may play a key role in the modulation of the innate immune and inflammatory mechanisms of the ectocervix during pregnancy, interacting with other neuroendocrine factors. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Nov 2014 · Journal of Reproductive Immunology
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    Full-text · Article · Jul 2013 · Reproduction
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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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