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Grand Rounds

Can Obstetric History Predict Preterm Birth Risk in Twins?

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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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

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

Learn More – Primary Sources:

Obstetric History and Likelihood of Preterm Birth of Twins

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Related ObG Topics:

SMFM Statement: Choice of Progestogen for Preterm Birth Prevention
Preventing Preterm Birth in Twins – What works?
Vaginal Progesterone to Prevent Preterm Birth in Twins
Antenatal Corticosteroids – When to Administer?
Does the Timing of a Loss of One Twin Affect the Risk for Preterm Birth?

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