Having a premature baby presents a lot of physical and emotional challenges, so it's natural -- if you're thinking of having another child -- to wonder (and perhaps worry) about your risk for a another premature birth.
Previous preterm birth is one of the biggest risk factors for having another premature infant. The risk goes up when mothers have had more than one premature birth, and goes down when mothers have a term pregnancy after a preterm birth. A mom of one preemie has about a 15% chance of having another; a mom who has had two preemies has about a 40% chance of having another; and a mom who has had three preemies has almost a 70% chance of having another premature birth.
It's important to note that these numbers only relate to moms who had a spontaneous preterm delivery. Mothers whose labors were induced early or who had a premature birth for health reasons were not included in the studies.
Of course, while it's good for you to know the realities, you may not be hinging your decision to have another child on the official data. Doing what you can to reduce the risk is what you should focus on.
What You Can do to Help Prevent a Subsequent Premature Birth
Although the risk of another preemie is significant, having one preemie doesn't mean that you will absolutely have another. Many risk factors can be reduced or eliminated before you decide to try again.
- Wait to conceive: If you've had a preemie, experts recommend waiting at least 18 months before trying to conceive again. The risk of having a second preemie is higher when pregnancies are closer together, and lower when they are farther apart.
- Stop smoking: Smoking cigarettes increases the risk of premature birth. Quitting smoking during pregnancy or before conception is one of the best ways to reduce your risk of having another premature birth.
- Treat infection early: Inflammation and infection 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.
- Avoid yo-yo dieting: Women who lose a large amount of weight between pregnancies have a greater risk for premature birth during the second pregnancy. Women with a body mass index of less than 19.8 kg/m2 are also at a higher risk of preterm delivery, so maintain a healthy weight.
- Manage other health conditions: Diabetes, high blood pressure, heart disease, and kidney disease all increase the risk of premature birth. Better management of these conditions can lower the risk.
Unfortunately, medical science has not found a sure way to prevent 100% of premature births. Over the past few years, though, much research has been done on how to detect, prevent, and stop preterm labor, and some reassuring findings have been reported.
- Detection: Recent discoveries have helped doctors' ability to tell whether a woman is at risk for an 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: Weekly shots of the hormone progesterone can help prevent premature birth in mothers who have had one preterm birth already. Injections are usually started between the 16th and 20th week of pregnancy, and continue until 37 weeks.
- 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 labor, research has not yet found that either does much to prevent premature birth. More studies are underway.
Centers for Disease Control and Prevention. "CDC Features: Premature Birth." Accessed: October 1, 2008. http://www.cdc.gov/Features/PrematureBirth
Esplin, MD, Michael S., O'Brien, PhD, Elizabeth, Fraser, MPH, Alison, Kerber, PhD, Richard A., Clark, MD, Erin, Simonsen, RN, MSPH, Sara Ellis, Holmgren, MD, Calla, Mineau, PhD, Geraldine P., Varner, MD, Michael. "Estimating Recurrence of Spontaneous Preterm Delivery." Obstetrics and Gynecology Sept 2008 112:516-523.
Medline Plus Medical Encyclopedia. "Premature Infant." Accessed: October 1, 2008. http://www.nlm.nih.gov/medlineplus/ency/article/001562.htm
Spong, MD, Catherine Y. "Prediction and Prevention of Recurrent Spontaneous Preterm Birth." Obstetrics and Gynecology August 2007 110:405-415.