Objective
This study was undertaken to determine whether women with recurrent spontaneous preterm
births (rSPBs) have different clinical characteristics or systemic markers than those
with isolated preterm (iSPBs) or recurrent term births (rTBs), when assessed remote
from delivery.
Study design
We compared clinical characteristics and findings (including cervical ultrasound,
bacterial vaginosis, fetal fibronectin), maternal plasma markers obtained at 22 to
24 weeks' gestation (inflammatory cytokines, cortisol, and corticotrophin-releasing
hormone), between women with rSPBs (2 or 3 consecutive SPBs and no TBs), iSPBs (1
SPB and 1 or 2 TBs), and rTBs (2 or 3 consecutive TBs and no SPBs).
Results
A total of 1257 women met our inclusion criteria; 47 rSPBs, 241 iSPBs (80 current
and 161 prior iSPBs), and 969 rTBs. Before pregnancy, women with rSPBs had lower weights
(P < .0001) and body mass indexes (BMIs) (P < .001), and were more likely to be less than 100 lbs (P = .008) or less than 19.8 kg/m2 BMI (P = .001). At 22 to 24 weeks those with rSPBs remained lighter and leaner, and had
more advanced Bishop scores than iSPBs and rTBs. Ultrasound demonstrated progressive
decrease in cervical length for those with rTBs, prior iSPBs, current iSPBs, and rSPBs,
and also progressively more frequent short cervixes with worsening history (P < .001). Cervical length was shorter for women of lower pregravid weight and BMI,
but not with shorter height. At 22 to 24 weeks, women with rSPBs had more common uterine
contractions and tocolytic agents, but not more infections or antibiotic therapy.
Those with an SPB in the current gestation had higher fetal fibronectin levels and
more frequent vaginal bleeding, regardless of prior outcome. Maternal cortisol and
corticotrophin-releasing hormone were higher in women with iSPBs and rSPBs than in
rTB controls, (P = .001 and .0027), a finding more apparent with SPB in the current pregnancy. However,
maternal cytokines were not increased with either iSPBs or rSPBs.
Conclusion
Women with rSPBs are leaner, contract more, have shorter cervixes, and have more advanced
Bishop scores than women with iSPBs or rTBs.
Key words
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Article info
Publication history
Accepted:
January 20,
2006
Received in revised form:
December 16,
2005
Received:
November 9,
2005
Footnotes
Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD27860, HD27861, HD27869, HD27883, HD27889, HD27905, HD27915, HD27917, HD19897, HD36801, HD34208, and HD40544), and the Department of Reproductive Biology, Case Western Reserve University, MetroHealth Medical Center.
Presented at the Twenty-Fourth Annual Meeting of the American Gynecological and Obstetrical Society, September 29 through October 1, 2005, Victoria, British Columbia, Canada.
Reprints not available from the authors.
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
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