Download PDF
Am J Perinatol 2018; 35(11): 1023-1030
DOI: 10.1055/s-0037-1617758
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obstetric History and Likelihood of Preterm Birth of Twins

Sarah Rae Easter
1   Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Sarah E. Little
1   Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Julian N. Robinson
1   Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Hector Mendez-Figueroa
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Suneet P. Chauhan
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
› Author Affiliations
Further Information

Publication History

10 April 2017

29 November 2017

Publication Date:
05 January 2018 (online)

    Permissions and Reprints

Abstract

Objective The objective of this study was to investigate the relationship between preterm birth in a prior pregnancy and preterm birth in a twin pregnancy.

Study Design We performed a secondary analysis of a randomized controlled trial evaluating 17-α-hydroxyprogesterone caproate in twins. Women were classified as nulliparous, multiparous with a prior term birth, or multiparous with a prior preterm birth. We used logistic regression to examine the odds of spontaneous preterm birth of twins before 35 weeks according to past obstetric history.

Results Of the 653 women analyzed, 294 were nulliparas, 310 had a prior term birth, and 49 had a prior preterm birth. Prior preterm birth increased the likelihood of spontaneous delivery before 35 weeks (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.28–4.66), whereas prior term delivery decreased these odds (aOR: 0.55, 95% CI: 0.38–0.78) in the current twin pregnancy compared with the nulliparous reference group. This translated into a lower odds of composite neonatal morbidity (aOR: 0.38, 95% CI: 0.27–0.53) for women with a prior term delivery.

Conclusion For women carrying twins, a history of preterm birth increases the odds of spontaneous preterm birth, whereas a prior term birth decreases odds of spontaneous preterm birth and neonatal morbidity for the current twin pregnancy. These results offer risk stratification and reassurance for clinicians.

Keywords

twins - preterm birth - multiple pregnancy - neonatal morbidity
 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep 2015; 64 (01) 1-65
    PubMedGoogle Scholar
  • 2 Kiely JL. The epidemiology of perinatal mortality in multiple births. Bull N Y Acad Med 1990; 66 (06) 618-637
    PubMedGoogle Scholar
  • 3 Chauhan SP, Scardo JA, Hayes E, Abuhamad AZ, Berghella V. Twins: prevalence, problems, and preterm births. Am J Obstet Gynecol 2010; 203 (04) 305-315
    CrossrefPubMedGoogle Scholar
  • 4 Ananth CV, Joseph KS, Demissie K, Vintzileos AM. Trends in twin preterm birth subtypes in the United States, 1989 through 2000: impact on perinatal mortality. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 1076-1082
    PubMedGoogle Scholar
  • 5 Ananth CV, Vintzileos AM. Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth. Am J Obstet Gynecol 2006; 195 (06) 1557-1563
    CrossrefPubMedGoogle Scholar
  • 6 Goldenberg RL, Iams JD, Miodovnik M. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The preterm prediction study: risk factors in twin gestations. Am J Obstet Gynecol 1996; 175 (4 Pt 1): 1047-1053
    CrossrefPubMedGoogle Scholar
  • 7 Adams MM, Elam-Evans LD, Wilson HG, Gilbertz DA. Rates of and factors associated with recurrence of preterm delivery. JAMA 2000; 283 (12) 1591-1596
    CrossrefPubMedGoogle Scholar
  • 8 Fox NS, Saltzman DH, Klauser CK, Peress D, Gutierrez CV, Rebarber A. Prediction of spontaneous preterm birth in asymptomatic twin pregnancies with the use of combined fetal fibronectin and cervical length. Am J Obstet Gynecol 2009; 201 (03) 313.e1-313.e5
    CrossrefPubMedGoogle Scholar
  • 9 Singer E, Pilpel S, Bsat F, Plevyak M, Healy A, Markenson G. Accuracy of fetal fibronectin to predict preterm birth in twin gestations with symptoms of labor. Obstet Gynecol 2007; 109 (05) 1083-1087
    CrossrefPubMedGoogle Scholar
  • 10 Fuchs I, Tsoi E, Henrich W, Dudenhausen JW, Nicolaides KH. Sonographic measurement of cervical length in twin pregnancies in threatened preterm labor. Ultrasound Obstet Gynecol 2004; 23 (01) 42-45
    CrossrefPubMedGoogle Scholar
  • 11 Gyamfi C, Lerner V, Holzman I, Stone JL. Routine cervical length in twins and perinatal outcomes. Am J Perinatol 2007; 24 (01) 65-69
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Rafael TJ, Hoffman MK, Leiby BE, Berghella V. Gestational age of previous twin preterm birth as a predictor for subsequent singleton preterm birth. Am J Obstet Gynecol 2012; 206 (02) 156.e1-156.e6
    CrossrefPubMedGoogle Scholar
  • 13 Menard MK, Newman RB, Keenan A, Ebeling M. Prognostic significance of prior preterm twin delivery on subsequent singleton pregnancy. Am J Obstet Gynecol 1996; 174 (05) 1429-1432
    CrossrefPubMedGoogle Scholar
  • 14 Rydhstroem H. Gestational duration in the pregnancy after a preterm twin delivery. Am J Obstet Gynecol 1998; 178 (1 Pt 1): 136-139
    CrossrefPubMedGoogle Scholar
  • 15 Bloom SL, Yost NP, McIntire DD, Leveno KJ. Recurrence of preterm birth in singleton and twin pregnancies. Obstet Gynecol 2001; 98 (03) 379-385
    PubMedGoogle Scholar
  • 16 Schaaf JM, Hof MH, Mol BW, Abu-Hanna A, Ravelli AC. Recurrence risk of preterm birth in subsequent singleton pregnancy after preterm twin delivery. Am J Obstet Gynecol 2012; 207 (04) 279.e1-279.e7
    CrossrefPubMedGoogle Scholar
  • 17 Facco FL, Nash K, Grobman WA. Are women who have had a preterm singleton delivery at increased risk of preterm birth in a subsequent twin pregnancy?. Am J Perinatol 2008; 25 (10) 657-659
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Ananth CV, Kirby RS, Vintzileos AM. Recurrence of preterm birth in twin pregnancies in the presence of a prior singleton preterm birth. J Matern Fetal Neonatal Med 2008; 21 (05) 289-295
    CrossrefPubMedGoogle Scholar
  • 19 Schaaf JM, Hof MH, Mol BWH, Abu-Hanna A, Ravelli AC. Recurrence risk of preterm birth in subsequent twin pregnancy after preterm singleton delivery. BJOG 2012; 119 (13) 1624-1629
    CrossrefPubMedGoogle Scholar
  • 20 Kazemier BM, Buijs PE, Mignini L, Limpens J, de Groot CJ, Mol BW. ; EBM CONNECT. Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: a systematic review. BJOG 2014; 121 (10) 1197-1208 , discussion 1209
    CrossrefPubMedGoogle Scholar
  • 21 Fox NS, Stern E, Gupta S, Saltzman DH, Klauser CK, Rebarber A. Preterm birth or small for gestational age in a singleton pregnancy and risk of recurrence in a subsequent twin pregnancy. Obstet Gynecol 2015; 125 (04) 870-875
    CrossrefPubMedGoogle Scholar
  • 22 Rouse DJ, Caritis SN, Peaceman AM. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A trial of 17 alpha-hydroxyprogesterone caproate to prevent prematurity in twins. N Engl J Med 2007; 357 (05) 454-461
    CrossrefPubMedGoogle Scholar
  • 23 van ʼt Hooft J, Duffy JM, Daly M. , et al; Global Obstetrics Network (GONet). A core outcome set for evaluation of interventions to prevent preterm birth. Obstet Gynecol 2016; 127 (01) 49-58
    CrossrefPubMedGoogle Scholar
  • 24 Ananth CV, Peltier MR, Getahun D, Kirby RS, Vintzileos AM. Primiparity: an ‘intermediate’ risk group for spontaneous and medically indicated preterm birth. J Matern Fetal Neonatal Med 2007; 20 (08) 605-611
    CrossrefPubMedGoogle Scholar
  • 25 Ananth CV, Getahun D, Peltier MR, Salihu HM, Vintzileos AM. Recurrence of spontaneous versus medically indicated preterm birth. Am J Obstet Gynecol 2006; 195 (03) 643-650
    CrossrefPubMedGoogle Scholar
  • 26 Pagani G, Stagnati V, Fichera A, Prefumo F. Cervical length at mid-gestation in screening for preterm birth in twin pregnancy. Ultrasound Obstet Gynecol 2016; 48 (01) 56-60
    CrossrefPubMedGoogle Scholar
  • 27 Easter SR, Lieberman E, Carusi D. Fetal presentation and successful twin vaginal delivery. Am J Obstet Gynecol 2016; 214 (01) 116.e1-116.e10
    PubMedGoogle Scholar