Th information presented here is not direct medical advice and is not meant to replace the medical care from your personal physician.
Delivering one premature baby can be traumatic enough, medically and emotionally. Many parents with one premature baby struggle with the idea of having a second child, knowing their risks of delivering prematurely are typically greater in a subsequent pregnancy. There are some strategies and interventions that can help reduce the risk of delivering prematurely in a second pregnancy.
The first measures apply to everyone:
- If you smoke, quit now. Only 50% of women who are smokers quit when they find out they are pregnant. The most complete data are from 2002, when 11.5% of women in the U.S. smoked during their pregnancy. Studies show that 5-8% of premature births are directly attributable to smoking. Smoking also causes 13-19% of low-birth weight babies and 23-31% of cases o sudden infant death syndrome (SIDS).
- Get screened for chlamydia and gonorrhea. These sexually transmitted diseases infect the cervix (the opening to the uterus) and can cause inflammation and infection in the uterus. This can cause premature labor and cause the membranes to rupture early. Almost 1/2 of all premature deliveries are related to infection (that includes all infections, not just gonorrhea and chlamydia), so getting screened early and treated in you are positive will help to lower that risk.
- Get tested for anemia (low blood count or hemoglobin). Women who have anemia before 20 weeks in their pregnancy have an increased risk of premature delivery. It takes a while to correct anemia, so you want to try and optimize your blood count before delivery.
- Start prenatal vitamins before you get pregnant. Not only will this help prevent anemia, but the extra folic acid will reduce your chance of having a baby with spina bifida, a serious birth defect that involves the spinal cord and brain.
- Calculate your body mass index. A normal BMI is 18.5-24.9 (check your BMI with a free on-line calculator). Studies show that women with a body mass index (BMI) > or = 30 (in the obese range) are at increased risk of premature delivery. Being obese increases your risk of high blood pressure and diabetes, which increase your risk of developing preeclampsia. Obese women are at higher risk of having a medically indicated premature delivery as well as a spontaneous premature delivery before 32 weeks. Women with a low BMI, less than 18.5 are also at increased risk for having a spontaneous premature delivery. As weight loss and excessive weight gain during pregnancy can also affect your risk of delivering prematurely, it is best to try and optimize your weight before your get pregnancy.
- Space out your pregnancy. Studies show that a premature delivery is more likely if the interval between pregnancies is less than a year. Even though you are probably not thinking about sex if your baby is in the NICU, remember, 50% of pregnancies in the Unites States are unplanned and every day women find out they are pregnant at their post-partum check up. Talk with your OB/GYN or nurse practitioner about contraception. One of the best options is an IUD. One IUS has the hormone levonorgesterel (a type of progesterone that is only minimally absorbed by your body and will not interfere with breastfeeding) and the other IUD is made of copper and has no hormones. Many moms are so busy taking after their preemie that they have little time to remember a birth control pill, pick up condoms from the store, or make appointments to go in for a shot of depo-provera. If you have a c-section, waiting 18 months before getting pregnant is recommended as this will reduce your chance of having a condition called placenta accreta, where the placenta grows into the uterus in an abnormal and overly aggressive way. Placenta accreta is not associated with prematurity, but it can cause very catastrophic bleeding during pregnancy that can lead to needing multiple blood transfusions, hysterectomy, and even death.
- Get regular prenatal care. This sounds so obvious, but countries with universal health care have dramatically lower rates of premature delivery than the United States. In the United States 12.5% of deliveries are premature, versus 8% for Canada and 6.2% for Europe (data from the World Health Organization, 2010). The incidence of premature delivery is on par with the least developed countries in the world. If you have health insurance, make sure you go to all your appointments (not everyone does). If you don’t have health insurance find out how you can qualify for Medicaid if you were to become pregnant. Remember, Medicaid is accepted at all University Hospitals, so you will have access to all the high-risk specialists. Women is Europe also have more liberal maternity leave and are often able to stop working in the third trimester, reducing both physical and emotional stress.
- Ask your OB about taking extra vitamin D. A recent study presented this year (not published yet) indicates that women who took 4,000 IU of vitaminD a year had lower rates of premature delivery with no adverse effects. You may also want to get your vitamin D level checked before you get pregnant, because if it is low you definitely want to talk with your doctor about taking a replacement before you get pregnant. Vitamin D has a big role in inflammation and the immune system so it makes sense that it could have an impact on premature labor and delivery.
- Find out why you delivered prematurely. Did you go into premature labor or have ruptured membranes? Did you have pre-eclampsia or problems with and underlying medical condition that required a premature delivery. There are specific interventions that are recommended for specific causes of premature delivery, so knowing why you delivered will help you and your OB plan the next time around.
- Do you have antiphospholipid antibody syndrome? This is a condition where the blood clots abnormally. During pregnancy, the blood can clot in the placenta and lead to preecplampsia, growth restriction (IUGR), and stillbirth. If you answer yes to any one of the following questions you should be tested for antiphospholipid antibody syndrome before you get pregnant:
- Did you deliver prematurely before 34 weeks because of severe preeclampsia or placental insufficiency (meaning an abruption, which is bleeding behind the placenta, fetal growth restriction, oligohydramnios, or lack of oxygen flow to your baby)?
- Did you have a miscarriage at 10 weeks or later or a stillbirth?
- Have you had 3 or more miscarriages before 10 weeks with no other cause identified (meaning no genetic causes or problems with the shape of your uterus).