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. 2014 Feb;210(2):131.e1-8.
doi: 10.1016/j.ajog.2013.09.014. Epub 2013 Sep 11.

The NICHD Consecutive Pregnancies Study: recurrent preterm delivery by subtype

S Katherine Laughon  1 , Paul S Albert  2 , Kira Leishear  3 , Pauline Mendola  1
Affiliations

The NICHD Consecutive Pregnancies Study: recurrent preterm delivery by subtype

S Katherine Laughon et al. Am J Obstet Gynecol. 2014 Feb.

Abstract

Objective: Attention for recurrent preterm delivery has primarily focused on spontaneous subtypes with less known about indicated preterm delivery.

Study design: In a retrospective cohort of consecutive pregnancies among 51,086 women in Utah (2002-2010), binary relative risk regression was performed to examine the risk of preterm delivery (PTD; <37 weeks) in the second observed delivery by PTD in the first, adjusting for maternal age, race/ethnicity, prepregnancy body mass index, insurance, smoking, alcohol and/or drug use, and chronic disease. Analyses were also performed stratified by prior preterm delivery subtype: spontaneous, indicated, or no recorded indication.

Results: There were 3836 women who delivered preterm in the first observed pregnancy (7.6%), of which 1160 repeated in the second (30.7%). Rate of recurrent PTD was 31.6% for prior spontaneous, 23.0% for prior indicated delivery, and 27.4% for prior elective delivery. Prior spontaneous PTD was associated with a relative risk (RR) of 5.64 (95% confidence interval [CI], 5.27-6.05) of subsequent spontaneous and RR of 1.61 (95% CI, 0.98-2.67) of subsequent indicated PTD. Prior indicated PTD was associated with an RR of 9.10 (95% CI, 4.68-17.71) of subsequent indicated and RR of 2.70 (95% CI, 2.00-3.65) of subsequent spontaneous PTD.

Conclusion: Prior indicated PTD was strongly associated with subsequent indicated PTD and with increased risk for subsequent spontaneous PTD. Spontaneous PTD had the highest rate of recurrence. Some common pathways for different etiologies of preterm delivery are likely, and indicated PTD merits additional attention for recurrence risk.

Keywords: indicated preterm birth; recurrent preterm birth; spontaneous preterm birth.

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Conflict of interest statement

Disclosure: The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Gestational age at delivery in the second delivery by gestational age in the first delivery for all women. Circles in the scatterplot represent each gestational age (weeks) of delivery with Loess smooth line.
Figure 2
Figure 2
Incidences of preterm delivery < 37 weeks in the 2nd pregnancy based on timing of preterm delivery in the 1st pregnancy. Cumulative incidence curves were estimated by prior delivery timing (20 to <24, 24 to <28, 28 to <34, 34 to <37, and >=37 weeks of gestation) using Kaplan-Meier estimation for the following three panels: a. any prior preterm delivery < 37 weeks; b. prior spontaneous preterm delivery < 37 weeks; c. prior indicated preterm delivery < 37 weeks.
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