Primiparity: an 'intermediate' risk group for spontaneous and medically indicated preterm birth.
OBJECTIVE
Most women in their first pregnancy are at 'unknown' risk for preterm birth. We hypothesized that such women may be at an increased risk for preterm birth in comparison to those with a prior term birth.


METHODS
We used Missouri's maternally-linked data (1989-97), comprised of women delivering their first singleton live birth (N = 259 431) and women delivering their first two consecutive singleton live births (N = 154 810). We compared preterm birth (<37 weeks) rates among women with a previous term birth, women with no reproductive history (primiparous women), and in those with a previous preterm birth. Risks of spontaneous and medically indicated preterm birth were also examined after adjustments for confounders through multivariate log-binomial regression models.


RESULTS
Preterm birth rates were 8.1%, 9.6%, and 23.3% among women with a previous term birth, among primiparous women, and among those with a previous preterm birth, respectively. In comparison to women with a prior term birth, risks of spontaneous preterm birth among primiparous women and among women with a prior preterm birth were 1.1-fold (95% confidence interval (CI) 1.0, 1.2) and 2.5-fold (95% CI 2.4, 2.6) higher, respectively. These risks were higher for medically indicated preterm birth among both primiparous women (RR 1.3, 95% CI 1.2, 1.4) and those with a prior preterm birth (RR 3.2, 95% CI 3.0, 3.5) than for spontaneous preterm births.


CONCLUSIONS
Primiparous women are at increased risk of both medically indicated and spontaneous preterm birth. The findings suggest that studies on preterm birth should consider a risk assignment to include three groups: low-risk (prior term birth), intermediate risk (primiparity), and high-risk (prior preterm birth). This strategy will be informative for the identification of women with impending risk of delivering preterm, and complications associated with prematurity.
Ananth
Cande V
CV
Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901-1977, USA.
Peltier
Morgan R
MR
Getahun
Darios
D
Kirby
Russell S
RS
Vintzileos
Anthony M
AM
D000328:Adult; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors