Care for women with prior preterm birth

Abstract

Iams and Berghella's recent article in the August 2010 issue on the care of women with prior preterm birth was comprehensive and helpful.1Iams J.D. Berghella V. Care for women with prior preterm birth.Am J Obstet Gynecol. 2010; 203: 89-100Abstract Full Text Full Text PDF PubMed Scopus (133) Google Scholar They comment on the association of preterm birth with a prior history of elective abortion. “Contrary to common belief, population-based studies,34-36 have found that elective pregnancy terminations in the first and second trimesters are associated with a very small but apparently real increase in the risk of subsequent spontaneous preterm birth (PTB).37” Contrary to the description of a “very small” increase, the 2009 systematic review and metaanalysis referred to in reference 37 actually concluded that a single elective termination was associated with a subsequent preterm birth odds ratio of 1.36 and more than 1 termination was associated with an odds ratio of 1.93.2Shah P.S. Zao J. Knowledge Synthesis Group of Determinants of Preterm/LBW BirthsInduced termination of pregnancy and low birth weight and preterm birth: a systematic review and meta-analysis.BJOG. 2009; 116: 1425-1442Crossref PubMed Scopus (115) Google Scholar These increases are significant. In light of this information, could the authors comment on whether: (1) the troubling doubled preterm birth risk for African American women might plausibly be related to the increased rate of pregnancy termination in African American women, and (2) since the abortion/preterm birth link has now been acknowledged, should this information be included in informed consent for abortion? The choice for or against an initial or repeat abortion is certainly a prospectively modifiable risk factor for preterm birth. Care for women with prior preterm birthAmerican Journal of Obstetrics & GynecologyVol. 203Issue 2PreviewWomen who have delivered an infant between 16 and 36 weeks' gestation have an increased risk of preterm birth in subsequent pregnancies. The risk increases with more than 1 preterm birth and is inversely proportional to the gestational age of the previous preterm birth. African American women have rates of recurrent preterm birth that are nearly twice that of women of other backgrounds. An approximate risk of recurrent preterm birth can be estimated by a comprehensive reproductive history, with emphasis on maternal race, the number and gestational age of prior births, and the sequence of events preceding the index preterm birth. Full-Text PDF ReplyAmerican Journal of Obstetrics & GynecologyVol. 204Issue 3PreviewWe thank Dr Calvin for calling our article on “Care of women with prior preterm birth”1 “comprehensive and helpful.” He brings up the issue of the association of induced termination of pregnancy and preterm birth, and quotes a recent metaanalysis.2 We are both delighted that Dr Calvin has read it carefully. As Editor at the journal (BJOG) where this manuscript was published, I (V.B.) was directly involved in reviewing this study and ultimately getting it approved for publication. I thought it was such an important study that I proposed it for a BJOG podcast, which the Editor-in-chief (Dr Steer) approved. Full-Text PDF