Term complications and subsequent risk of preterm birth: registry based study.

Journal Article (Journal Article)

OBJECTIVE: To explore conditions and outcomes of a first delivery at term that might predict later preterm birth. DESIGN: Population based, prospective register based study. SETTING: Medical Birth Registry of Norway, 1999-2015. PARTICIPANTS: 302 192 women giving birth (live or stillbirth) to a second singleton child between 1999 and 2015. MAIN OUTCOME MEASURES: Main outcome was the relative risk of preterm delivery (<37 gestational weeks) in the birth after a term first birth with pregnancy complications: pre-eclampsia, placental abruption, stillbirth, neonatal death, and small for gestational age. RESULTS: Women with any of the five complications at term showed a substantially increased risk of preterm delivery in the next pregnancy. The absolute risks for preterm delivery in a second pregnancy were 3.1% with none of the five term complications (8202/265 043), 6.1% after term pre-eclampsia (688/11 225), 7.3% after term placental abruption (41/562), 13.1% after term stillbirth (72/551), 10.0% after term neonatal death (22/219), and 6.7% after term small for gestational age (463/6939). The unadjusted relative risk for preterm birth after term pre-eclampsia was 2.0 (95% confidence interval 1.8 to 2.1), after term placental abruption was 2.3 (1.7 to 3.1), after term stillbirth was 4.2 (3.4 to 5.2), after term neonatal death was 3.2 (2.2 to 4.8), and after term small for gestational age was 2.2 (2.0 to 2.4). On average, the risk of preterm birth was increased 2.0-fold (1.9-fold to 2.1-fold) with one term complication in the first pregnancy, and 3.5-fold (2.9-fold to 4.2-fold) with two or more complications. The associations persisted after excluding recurrence of the specific complication in the second pregnancy. These links between term complications and preterm delivery were also seen in the reverse direction: preterm birth in the first pregnancy predicted complications in second pregnancies delivered at term. CONCLUSIONS: Pre-eclampsia, placental abruption, stillbirth, neonatal death, or small for gestational age experienced in a first term pregnancy are associated with a substantially increased risk of subsequent preterm delivery. Term complications seem to share important underlying causes with preterm delivery that persist from pregnancy to pregnancy, perhaps related to a mother's predisposition to disorders of placental function.

Full Text

Duke Authors

Cited Authors

  • Kvalvik, LG; Wilcox, AJ; Skjærven, R; Østbye, T; Harmon, QE

Published Date

  • April 29, 2020

Published In

Volume / Issue

  • 369 /

Start / End Page

  • m1007 -

PubMed ID

  • 32349968

Pubmed Central ID

  • PMC7188013

Electronic International Standard Serial Number (EISSN)

  • 1756-1833

Digital Object Identifier (DOI)

  • 10.1136/bmj.m1007

Language

  • eng

Conference Location

  • England