title: Prepregnancy health status and the risk of preterm delivery.
abstract: BACKGROUND
  Despite extensive evaluation, our understanding of risk factors for premature delivery is incomplete.
  
  
  OBJECTIVE
  To examine whether a woman's health status and risk factors before pregnancy are associated with a woman's risk of preterm delivery, independent of risk factors that occur during pregnancy.
  
  
  METHODS
  Prospective cohort of pregnant women in the San Francisco Bay area who delivered a singleton infant (n = 1619).
  
  
  METHODS
  Preterm delivery (<37 weeks' gestational age).
  
  
  RESULTS
  Sociodemographic characteristics alone explained 13.0% of the risk of preterm delivery, whereas risk factors that occurred before pregnancy explained 39.8% and risk factors that occurred during pregnancy explained 47.1%. After we adjusted for sociodemographic characteristics, prepregnancy risk factors, and pregnancy risk factors, women who reported poor physical function during the month before conception were nearly twice as likely to experience a preterm delivery (odds ratio, 1.97; 95% confidence interval, 1.18-3.30) as women with better physical function.
  
  
  CONCLUSIONS
  A broader focus on the health of women prior to pregnancy may improve rates of preterm delivery.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120-1613, USA. jhaas@partners.org
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.forename: Elena
authors.initials: E
authors.lastname: Fuentes-Afflick
authors.forename: Anita L
authors.initials: AL
authors.lastname: Stewart
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Jackson
authors.forename: Mitzi L
authors.initials: ML
authors.lastname: Dean
authors.forename: Phyllis
authors.initials: P
authors.lastname: Brawarsky
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008875:Middle Aged; D010809:Physical Fitness; D016742:Preconception Care; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D001741:Black or African American