Grand Rounds

Can Obstetric History Predict Preterm Birth Risk in Twins?

BACKGROUND:

Data to help counsel patients with twins about risk for preterm birth are limited
Easter et al. (American Journal of Perinatology, 2018) assessed the relationship between preterm birth in a prior pregnancy and preterm birth in a twin pregnancy

Secondary analysis of MFMU Network randomized controlled trial (RCT)
- Primary study was designed to evaluate 17-α-hydroxyprogesterone caproate in twins
Participant eligibility
- Twin gestations between 16w0d to 20w6d
Participant exclusion
- For this study, only exclusion was selective reduction
Obstetric history was classified as follows
- Nulliparous: 0 prior deliveries <20 weeks
- Multiparous with a prior term birth: Delivery ≥37 weeks without prior preterm delivery
- Multiparous with a prior preterm birth: Any delivery between 20w0d and 36w6d
Primary outcome
- Rate of spontaneous preterm birth <35 weeks in the current twin pregnancy
Secondary outcomes
- Rates of spontaneous and any preterm birth <28 and <35 weeks
- Spontaneous delivery <24 and <22 weeks’ gestation

653 women analyzed
- 294 nulliparas | 310 prior term birth | 49 prior preterm birth
Absolute rates of spontaneous preterm birth >35 weeks
- 28.23% in nulliparous vs 55.10% in those women with prior preterm birth (p < 0.01)
Prior preterm birth increased the likelihood of spontaneous delivery before 35 weeks
- Adjusted odds ratio (aOR): 2.44; 95% CI, 1.28–4.66
Prior term delivery decreased likelihood of spontaneous delivery before 35 weeks
- aOR: 0.55; 95% CI, 0.38–0.78 compared with the nulliparous reference group
Women with a prior term delivery had lower odds of composite neonatal morbidity
- aOR: 0.38; 95% CI, 0.27–0.53

For women with twin pregnancies, previous preterm birth increased risk of spontaneous preterm birth while previous term delivery decreased the likelihood

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