Prevention of Recurrent Preterm Birth: Role of the Neonatal Follow-up Program

Abstract

OBJECTIVES Preterm birth (PTB) is a public health crisis in need of effective preventative strategies. Multi-disciplinary Neonatal Follow-up Programs (NFPs) provide health services to preterm infants at high risk for developmental problems after discharge from U.S. newborn intensive care units (NICUs). We aimed to determine whether NFPs are a potential effective venue for specialized maternal counseling and intervention aimed at reducing the high rate of recurrent PTB in this population. METHODS This prospective case series enrolled women with preterm children evaluated in the Utah Department of Health NFP, 2010-2012. Women were interviewed, received Maternal Fetal Medicine (MFM) counseling services, and maternal and neonatal records were abstracted. We assessed maternal demographics, medical history, and characteristics of the index pregnancy. We calculated the proportion of women with knowledge of PTB recurrence risk and available prevention strategies, and assessed current contraceptive use and reproductive plans. RESULTS Ninety-six women with a history of early PTB (≤26 weeks and/or birth weight <1250 gms) were evaluated. Nearly 1 in 5 women (19.8%) evaluated reported sexual activity, desire to avoid pregnancy, and no current contraceptive use, and were therefore at imminent risk of unintended pregnancy. Of women without permanent contraception, only 24.3% were aware of their individual PTB recurrence risk. Of women with a history of spontaneous PTB, only 4% were aware of effective pharmacologic preventative strategies. CONCLUSIONS Introduction of MFM consultation as part NFP multi-disciplinary services is a novel approach with the potential to reduce recurrent PTB in an exceptionally high-risk population.

Can We Predict Preterm Delivery Based on the Previous Pregnancy?

“…The main mechanisms that have been suggested are inflammation, infection, and vascular pathologies [ 29 , 30 ]. Usually multiple etiologies are involved, including: cervical insufficiency, decline in progesterone action and insufficiency or ischemic placental−uterine unit [ 29 , 31 , 32 ]. Impaired placental implantation processes and insufficient fetal nutrition and growth may cause deliveries of SGA newborns, preeclampsia, perinatal mortality, placental abruption and PTD [ 33 , 34 ].…”

Contraceptive Method Choices in Women With and Without Opioid Use Who Have Infants in the Neonatal Intensive Care Unit and Nursery

“…Previous studies in mothers with premature neonates in the NICU showed that a small percentage of women were aware of the major risk factors for recurrent preterm birth and had a lower uptake of effective contraception. 11 , 12 Another study reported disparities in postpartum contraceptive counseling and effective contraceptive uptake in women with preterm infants. 38 Since this is a high-risk group for repeat preterm deliveries, there should be a focus on their reproductive plans and perceptions about contraception.…”

“…We also wanted to learn about the contraceptive choices of women with infants in the neonatal intensive care unit (NICU) since low use of effective contraception in women with preterm infants puts them at high risk for unintended pregnancy and recurrent preterm birth. 11 , 12 To our knowledge, there are few studies looking specifically at postpartum contraceptive choices of these women.…”

Preterm birth : can we do better?

“…Most women are not aware of their own level of risk for PTB, and risky behaviors may continue as a result of inadequate knowledge. 33 Based on screening assessments, we should provide each patient with her own personal risk for PTB and engage her as a proactive partner in preventing PTB. 9 With better awareness of risk, physicians and patients are in a better position to target optimal weight management, and to tackle smoking cessation and avoidance of drugs and alcohol.…”