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BJOG. 2014 Sep;121(10):1197-208; discussion 1209. doi: 10.1111/1471-0528.12896. Epub 2014 Jun 5.

Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: a systematic review.

Author information

1
Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.

Abstract

BACKGROUND:

Information about the recurrence of spontaneous preterm birth in subsequent twin/singleton pregnancies is scattered.

OBJECTIVES:

To quantify the risk of recurrence of spontaneous preterm birth in different subtypes of subsequent pregnancies.

SEARCH STRATEGY:

An electronic literature search in OVID MEDLINE and EMBASE, complemented by PubMed, to find recent studies.

SELECTION CRITERIA:

Studies comparing the risk of spontaneous preterm birth after a previous preterm and previous term pregnancy.

DATA COLLECTION AND ANALYSIS:

The absolute risk of recurrence with a 95% confidence interval and the absolute risk of preterm birth after a term delivery were calculated. Data from studies were pooled using the Mantel-Haenszel method.

MAIN RESULTS:

We detected 13 relevant studies. The risk of recurrence of preterm birth was significantly increased in all preterm pregnancy subtypes, compared with their term counterparts. Women pregnant with twins after a previous preterm singleton had the highest absolute risk of recurrence (57.0%, 95% CI 51.9-61.9%), and after a previous term singleton their absolute risk was 25% (95% CI 24.3-26.5%). Women pregnant with a singleton after a previous preterm twin pregnancy have an absolute recurrence risk of 10% (95% CI 8.2-12.3%), whereas a singleton pregnancy after delivering a previous twin up to term yields a low absolute risk of only 1.3% (95% CI 0.8-2.2). Women pregnant with a singleton after a previous preterm singleton have an absolute recurrence risk of 20% (95% CI 19.9-20.6).

AUTHOR'S CONCLUSIONS:

The risk of recurrence of preterm birth is influenced by the singleton/twin order in both pregnancies, and varies between 10% for a singleton after previous preterm twins to 57% for twins after a previous preterm singleton.

KEYWORDS:

Recurrence; singleton; spontaneous preterm birth; twin

PMID:
24899245
DOI:
10.1111/1471-0528.12896
[Indexed for MEDLINE]
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