Katherine Laughon, Paul S. Albert, Kira Leishear, and Pauline Mendola
Pregnancy complications and adverse pregnancy outcomes often recur in subsequent pregnancies. Preterm delivery before 37 weeks of gestation is one common adverse outcome that repeats, where women with a history of preterm birth have a 22% risk of preterm birth in a following pregnancy compared to 9% risk in women without a history of prior preterm delivery. Even though women with a history of preterm birth have a 2.5-fold increase in spontaneous preterm delivery in the next pregnancy, the vast majority of women will still deliver at term. The tendency to recur increases with the number of prior preterm deliveries, earlier gestational age at prior delivery, and the order, with higher risk of subsequent preterm delivery if the immediately preceding birth was preterm. Our understanding of recurrence risk has primarily focused on spontaneous preterm deliveries or has not taken the subtype of preterm birth into consideration.
A mother who has already had one premature baby has a 22% chance of having another premature birth. It is the biggest risk factor for having another premature baby.
To try and prevent another premature birth, it’s best to wait at least 18 months between giving birth and getting pregnant again. This means your baby is 1½ years old before you get pregnant with your next baby. This time lets your body recover from one pregnancy so it’s ready for your next pregnancy. The time between giving birth and getting pregnant again is called birth spacing or interpregnancy interval (also called IPI).
What you can do: Use birth control, like an intrauterine device (also called IUD) or an implant, to prevent pregnancy so you don’t get pregnant again too soon. IUDs and implants work well and are low maintenance. This means that once you have one, you don’t have to do anything to make it work. If you’re pregnant, talk to your provider before you give birth about getting an IUD or implant right after you have your baby. If you don’t get an IUD or implant right after giving birth, talk to your provider about getting one at your postpartum checkup. This is a medical check up you get about 6 weeks after you have your baby.
Previous Conditions that caused your preterm labour
If you are at risk for preeclampsia, your provider may recommend that you take low-dose aspirin (baby aspirin) to help prevent it. Preeclampsia is a particular type of high blood pressure some women get after the 20th week of pregnancy or after giving birth. If not treated, it can cause serious problems during pregnancy, including premature birth. If you have risk factors for preeclampsia, like you have had it before, your provider may want you to take low-dose aspirin during pregnancy. It is important to manage other health conditions like diabetes, high blood pressure, heart disease, and kidney disease as they all increase the risk of premature birth. Better management of these conditions can lower the risk.
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Treating any infections as early as possible with antibiotics as inflammation and infection can play a role in premature birth. The exact relationship is unclear, but experts agree that any bacterial infections during pregnancy should be treated early. Antibiotics for non-symptomatic infections, though, are not recommended.
Looking after your diet and managing health conditions can lower the risk as well.
Your Mental Health
A preterm birth can impact on how you and your partner feel during a next pregnancy. Be kind to yourself. It is natural to feel some anxiety about how this pregnancy will progress.
If you are struggling with negative feelings, you may need help. Tell your GP and midwife how you feel. You can also talk to another parent who has had a premature birth on our Nurture Line which is a free 24hr family support helpline for families of a premature or sick newborn on 1300 622 243.
Although science has not found a way to prevent premature births there has been a lot of research done on how to detect and prevent preterm labour.
Detection: Recent discoveries have helped doctors' ability to tell whether a woman is at risk for imminent preterm delivery. Cervical ultrasound has great success in detecting early signs of preterm labor, and it can be used as early as 16 weeks. Other studies of the mother's blood and vaginal secretions can help predict the risk more accurately.
Prevention with progesterone: Vaginal progesterone pessaries taken every night from 16 until 37 weeks gestation can be used to help prevent premature birth in mothers who have had one preterm birth already. This treatment is strongly recommended in women who have had a previous preterm birth and also have a short cervix on ultrasound assessment.
Prevention with cerclage: A cerclage, or a stitch in the cervix, has been used for many years to prevent premature birth in women who have had one preterm delivery. Studies show that cerclage may be helpful, and more studies are underway.
Prevention with bed rest and medication: Although doctors commonly prescribe bed rest and medications to women who show signs of preterm labour, research has not yet found that either does much to prevent premature birth. More studies are underway.
Knowing exactly what the risks of premature birth are and how doctors can prevent or stop premature can make the choice to get pregnant again a little easier.
Your health care team will be able to provide treatment, advice and support for any ongoing concerns relating to future pregnancies.
The Australian Preterm Birth Prevention Alliance (APBPA)
COPE – Centre for Perinatal Excellence
Panda - Perinatal Mental Health
Beyond Blue - Mental Health Support
Disclaimer: This publication by Miracle Babies Foundation is intended solely for general education and assistance and it is it is not medical advice or a healthcare recommendation. It should not be used for the purpose of medical diagnosis or treatment for any individual condition. This publication has been developed by our Parent Advisory Team (all who are parents of premature and sick babies) and has been reviewed and approved by a Clinical Advisory Team. This publication is not a substitute for professional medical advice. Miracle Babies Foundation recommends that professional medical advice and services be sought out from a qualified healthcare provider familiar with your personal circumstances. To the extent permitted by law, Miracle Babies Foundation excludes and disclaims any liability of any kind (directly or indirectly arising) to any reader of this publication who acts or does not act in reliance wholly or partly on the content of this general publication. If you would like to provide any feedback on the information please email [email protected].