Research
Obstetrics
Risk for postterm delivery after previous postterm delivery

https://doi.org/10.1016/j.ajog.2006.10.873Get rights and content

Objective

We examined the hypothesis that the risk for subsequent postterm birth is increased in women with an initial postterm birth.

Study design

We performed a population-based cohort study of Missouri births (1989-1997) to assess the recurrence of postterm birth using the Missouri Department of Health’s maternally linked database.

Results

A total of 368,633 births were evaluated, of which 7.6% were postterm (>42 weeks of gestation). Black mothers had a lower risk for all (adjusted odds ratio [OR], 0.70; 95% CI, 0.67-0.73) or recurrent (adjusted OR, 0.73; 95% CI, 0.67-0.79) postterm birth. Maternal education of <12 years (adjusted OR, 1.51; 95% CI, 1.41-1.62), indices of low socioeconomic status, and maternal body mass index >35 kg/m2 (adjusted OR, 1.23; 95% CI, 1.11-1.37) were associated with increased risk for recurrent postterm birth. Mothers with an initial postterm birth were at increased risk for postterm birth (OR, 1.88; 95% CI, 1.79-1.97) in subsequent pregnancies, independent of race.

Conclusion

Among mothers who deliver postterm, there is a significant risk for subsequent postterm births. This increased risk suggests that common factors (genetic or other) influence the likelihood of abnormal parturition timing.

Section snippets

Study design

The Washington University School of Medicine Human Studies Committee approved a protocol for the analysis of the Missouri Department of Health’s maternally linked birth-death certificate database. All protected health information was removed before distribution. This database includes 1,577,082 live births or fetal deaths that occurred between 1978 and 1997, which include 257,064 (16.3%) black births and 1,297,938 (82.3%) white births. Analysis of a maternally linked database that contains live

Population demographics

The Missouri Department of Health maternally linked birth-death certificate database included 711,015 births between 1989 and 1997. The database was subdivided into 3 clinically defined gestational age categories: preterm (20-366/7 weeks of gestation), full-term (37-416/7 weeks of gestation), and postterm (42-456/7 weeks of gestation). The birth rates for each of these categories were 11.4%, 80.8%, and 7.4%, respectively. The relative risks between black and white births in each category were

Comment

In this study, we use epidemiologic methods to identify contributors to the timing for birth. Several studies have evaluated the likelihood of recurrence of preterm birth, but little evaluation has been reported on the recurrence of postterm birth.9, 19, 20, 25, 26 As with preterm birth, we found that a woman is more likely to experience postterm gestation if she has had a previous postterm birth. The quantification that we provided likely underestimates the incidence of recurrent postterm

Acknowledgment

We thank the Missouri Department of Health and Senior Services, Section of Public Health Practice and Administrative Support for allowing us to analyze this database. All of the analysis, interpretations, and conclusions derived from the database are those of the authors and not the Missouri Department of Health and Senior Services.

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    Supported by grants from the March of Dimes (Dr Muglia), Doris Duke Clinical Research Fellowship (Mr Kistka), and Howard Hughes Medical Institute (Ms Palomar).

    Cite this article as: Kistka ZA-F, Palomar L, Boslaugh SE, DeBaun MR, DeFranco EA, Muglis LJ. Risk for postterm delivery after previous postterm delivery. Am J Obstet Gynecol 2007;196:241.e1-241.e6.

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