Recurrence Risk of Preterm Birth in Successive Pregnancies Based on Its Subtypes

Iris T. Smith; Michael J. Fassett; David A. Sacks; Nehaa Khadka; Nana A. Mensah; Morgan R. Peltier; Vicki Y. Chiu; Fagen Xie; Jiaxiao Shi; Darios Getahun

doi:10.1055/a-2552-9058

American Journal of Perinatology, Table of Contents

Am J Perinatol
DOI: 10.1055/a-2552-9058

Original Article

Recurrence Risk of Preterm Birth in Successive Pregnancies Based on Its Subtypes

Iris T. Smith

¹Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California

,

Michael J. Fassett

²Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, California

³Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California

,

David A. Sacks

⁴Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California

,

Nehaa Khadka

⁵Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California

,

Nana A. Mensah

⁵Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California

,

Morgan R. Peltier

⁶Department of Psychiatry and Behavioral Health, Jersey Shore University Medical Center, Neptune, NJ

⁷Department of Psychiatry and Behavioral Health, Hackensack-Meridian School of Medicine, Nutley, NJ

,

Vicki Y. Chiu

⁵Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California

,

Fagen Xie

⁵Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California

,

Jiaxiao Shi

⁵Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California

,

Darios Getahun

⁵Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California

⁸Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California

› Author Affiliations

Abstract

Objective

Preterm birth (PTB) remains one of the biggest public health challenges with both obstetric and perinatal implications. While a prior PTB is a known risk factor for recurrence, the understanding of the influence of factors such as race/ethnicity, gestational age, PTB subtypes, and interpregnancy intervals (IPI) remains limited. This study aimed to assess whether these factors modify PTB recurrence risk.

Study Design

We conducted a retrospective cohort study of singleton pregnancies in Kaiser Permanente Southern California (2009–2022) using electronic health record data from 82,610 women with two pregnancies and 14,925 women with three. PTB subtypes, spontaneous (sPTB) and indicated (iPTB), were identified through natural language processing. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results

A first PTB was associated with a sixfold increased risk of PTB in the second pregnancy compared with an uncomplicated pregnancy (23.29% vs. 4.98%, respectively; aOR: 5.60; 95% CI: 5.23–5.99). Those with a history of sPTB (aOR: 5.32; 95% CI: 4.87, 5.81) and iPTB (aOR: 8.26; 95% CI: 7.18, 9.50) had increased risk for the same respective subtype at their second pregnancy. PTB recurrence risk persisted across race/ethnicity categories. In women with PTB in both prior pregnancies, the risk for PTB in a third pregnancy was significantly higher (aOR: 14.59; 95% CI: 11.28–18.88). The recurrence of PTB between first and second pregnancy was substantially higher for those who delivered at 20 to 33 weeks of gestation, regardless of PTB subtype. Non-Hispanic Black and Asian/Pacific Islander women had higher recurrence risk compared with non-Hispanic Whites.

Conclusion

These findings highlight disparities in PTB recurrence by race/ethnicity and PTB subtype among a large integrated healthcare system in Southern California, underscoring the need for targeted interventions, particularly for sPTB.

Key Points

PTB recurrence risk is higher for the same subtype (spontaneous or indicated) in successive pregnancies.
Non-Hispanic Black and Asian/Pacific Islander women have higher PTB recurrence risks than non-Hispanic Whites.
Subtype-specific analysis is essential for understanding PTB recurrence, especially considering maternal race/ethnicity.

Keywords

preterm birth - successive pregnancies - pregnancy interval - population-based study - pregnancy complication - retrospective study

Full Text

References

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Supplementary Material

Supplementary Material