Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: a systematic review.

BACKGROUND Information about the recurrence of spontaneous preterm birth in subsequent twin/singleton pregnancies is scattered. OBJECTIVES To quantify the risk of recurrence of spontaneous preterm birth in different subtypes of subsequent pregnancies. SEARCH STRATEGY An electronic literature search in OVID MEDLINE and EMBASE, complemented by PubMed, to find recent studies. SELECTION CRITERIA Studies comparing the risk of spontaneous preterm birth after a previous preterm and previous term pregnancy. DATA COLLECTION AND ANALYSIS The absolute risk of recurrence with a 95% confidence interval and the absolute risk of preterm birth after a term delivery were calculated. Data from studies were pooled using the Mantel-Haenszel method. MAIN RESULTS We detected 13 relevant studies. The risk of recurrence of preterm birth was significantly increased in all preterm pregnancy subtypes, compared with their term counterparts. Women pregnant with twins after a previous preterm singleton had the highest absolute risk of recurrence (57.0%, 95% CI 51.9-61.9%), and after a previous term singleton their absolute risk was 25% (95% CI 24.3-26.5%). Women pregnant with a singleton after a previous preterm twin pregnancy have an absolute recurrence risk of 10% (95% CI 8.2-12.3%), whereas a singleton pregnancy after delivering a previous twin up to term yields a low absolute risk of only 1.3% (95% CI 0.8-2.2). Women pregnant with a singleton after a previous preterm singleton have an absolute recurrence risk of 20% (95% CI 19.9-20.6). AUTHOR'S CONCLUSIONS The risk of recurrence of preterm birth is influenced by the singleton/twin order in both pregnancies, and varies between 10% for a singleton after previous preterm twins to 57% for twins after a previous preterm singleton.