A GUIDE TO HEALTHY PREGNANCY MANAGING AILMENTS AND FINDING SOLUTIONS

A_Guide_to_Healthy_Pregnancy

PROTECTING AGAINST PREMATURE DELIVERY AND MISCARRIAGE

Gizem Berfin Uluutku Bulutlar

İstanbul Haydarpaşa Numune Training and Research Hospital, Department of Gynecology and Obstetrics, İstanbul, Türkiye

Uluutku Bulutlar GB. Protecting Against Premature Delivery and Miscarriage. Çetin A, ed. A Guide To Healthy Pregnancy: Managing Ailments and Finding Solutions. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.71-82.

ABSTRACT

Pregnancy loss and preterm birth (PTB) represent significant challenges in maternal and neonatal health, requiring multifactorial approaches to prevention and management. Miscarriage is influenced by various risk factors, including maternal age, prior pregnancy loss, health conditions, and environmental exposures. Key preventive strategies include preconception counseling, chronic disease management, infection screening, lifestyle modifications, and surgical correction of anatomical anomalies. PTB, affecting 10% of global births, is driven by both spontaneous and medically indicated factors, with substantial variability based on gestational age and risk profiles. Primary risk factors include obstetric history, cervical insufficiency, multiple pregnancies, and chronic medical conditions. Evidence-based interventions to reduce PTB include optimizing maternal health, addressing behavioral factors, and employing cervical cerclage or progesterone supplementation in specific cases. However, certain traditional measures, such as bed rest and uterine contraction monitoring, lack efficacy and may pose additional risks. This chapter emphasizes the importance of individualized care, integrating clinical, behavioral, and environmental strategies to mitigate pregnancy loss and PTB, ultimately improving maternal and neonatal outcomes.

Keywords: Abortion spontaneous; Preterm birth; maternal health; Cervical measurement; Preconception care

Referanslar

  1. Ohuma EO, Moller AB, Bradley E, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023;402(10409):1261-1271. [Crossref]  [PubMed]
  2. Wang X, Chen C, Wang L, Chen D, Guang W, French J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril. 2003;79(3):577-584. [Crossref]  [PubMed]
  3. Magnus MC, Wilcox AJ, Morken NH, Weinberg CR, Håberg SE. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study. BMJ. 2019;364:l869. [Crossref]  [PubMed]  [PMC]
  4. Slama R, Bouyer J, Windham G, Fenster L, Werwatz A, Swan SH. Influence of paternal age on the risk of spontaneous abortion. Am J Epidemiol. 2005;161(9):816-823. [Crossref]  [PubMed]
  5. Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SEM, Horne AW. The role of infection in miscarriage. Hum Reprod Update. 2016;22(1):116-133. [Crossref]  [PubMed]  [PMC]
  6. Xiong YQ, Tan J, Liu YM, et al. The risk of maternal parvovirus B19 infection during pregnancy on fetal loss and fetal hydrops: A systematic review and meta-analysis. J Clin Virol. 2019;114:12-20. [Crossref]  [PubMed]
  7. Gurses G, Doni NY, Simsek Z, Aksoy M, Hilali NG, Özek B. Evaluation of T. gondii, rubella, and cytomegalovirus seroprevalences among female Syrian refugees in Sanliurfa, Turkiye. J. Infect Dev. Ctries. 2024; 18(6): 964-971. [Crossref]  [PubMed]
  8. Ludvigsson JF, Neovius M, Söderling J, et al. Maternal Glycemic Control in Type 1 Diabetes and the Risk for Preterm Birth: A Population-Based Cohort Study. Ann Intern Med. 2019;170(10):691-701. [Crossref]  [PubMed]
  9. Metwally M, Ong KJ, Ledger WL, Li TC. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril. 2008;90(3):714-726. [Crossref]  [PubMed]
  10. Maraka S, Ospina NMS, O'Keeffe DT, et al. Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid. 2016;26(4):580-590. [Crossref]  [PubMed]  [PMC]
  11. Li Y, Margerison-Zilko C, Strutz KL, Holzman C. Life Course Adversity and Prior Miscarriage in a Pregnancy Cohort. Womens Health Issues. 2018;28(3):232-238. [Crossref]  [PubMed]
  12. Qu F, Wu Y, Zhu YH, et al. The association between psychological stress and miscarriage: A systematic review and meta-analysis. Sci Rep. 2017;7(1):1731. [Crossref]  [PubMed]  [PMC]
  13. Ozgu-Erdinc AS, Tasdemir UG, Uygur D, Aktulay A, Tasdemir N, Gulerman HC. Outcome of intrauterine pregnancies with intrauterine device in place and effects of device location on prognosis. Contraception. 2014;89(5):426-430. [Crossref]  [PubMed]
  14. Kasman AM, Zhang CA, Li S, et al. Association between preconception paternal health and pregnancy loss in the USA: an analysis of US claims data. Hum Reprod. 2021;36(3):785-793. [Crossref]  [PubMed]  [PMC]
  15. Li DK, Ferber JR, Odouli R, Quesenberry C. Use of nonsteroidal antiinflammatory drugs during pregnancy and the risk of miscarriage. Am J Obstet Gynecol. 2018;219(3):275.e1-275.e8. [Crossref]  [PubMed]
  16. Lee SW, Han YJ, Cho DH, et al. Smoking Exposure in Early Pregnancy and Adverse Pregnancy Outcomes: Usefulness of Urinary Tobacco-Specific Nitrosamine Metabolite 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol Levels. Gynecol Obstet Invest. 2018;83(4):365-374. [Crossref]  [PubMed]
  17. Sundermann AC, Zhao S, Young CL, et al. Alcohol Use in Pregnancy and Miscarriage: A Systematic Review and Meta-Analysis. Alcohol Clin Exp Res. 2019;43(8):1606-1616. [Crossref]  [PubMed]  [PMC]
  18. Young BK. A multidisciplinary approach to pregnancy loss: the pregnancy loss prevention center. J Perinat Med.2018;47(1):41-44. [Crossref]  [PubMed]
  19. Dagklis T, Akolekar R, Villalain C, et al. Management of preterm labor: Clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation. Eur J Obstet Gynecol Reprod Biol. 2023;291:196-205. [Crossref]  [PubMed]
  20. Mercer BM, Goldenberg RL, Moawad AH, et al. The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 1999;181(5 Pt 1):1216-1221. [Crossref]  [PubMed]
  21. Kiely JL. What is the population-based risk of preterm birth among twins and other multiples? Clin Obstet Gynecol.1998;41(1):3-11. [Crossref]  [PubMed]
  22. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, Society for Maternal-Fetal Medicine. Medically Indicated Late-Preterm and Early-Term Deliveries: ACOG Committee Opinion, Number831. Obstet Gynecol. 2021;138(1):e35-e39. [Crossref]  [PubMed]
  23. Saccone G, Perriera L, Berghella V. Prior uterine evacuationof pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016;214(5):572-591. [Crossref]  [PubMed]
  24. Braveman P, Dominguez TP, Burke W, et al. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. Front Reprod Health. 2021;3:684207. [Crossref]  [PubMed]  [PMC]
  25. CDC Grand Rounds: Public Health Strategies to Prevent Preterm Birth - PubMed. Accessed November 28, 2024. [PubMed]
  26. Newman RB, Goldenberg RL, Iams JD, et al. Preterm prediction study: comparison of the cervical score and Bishop score for prediction of spontaneous preterm delivery. Obstet Gynecol. 2008;112(3):508-515. [Crossref]  [PubMed]  [PMC]
  27. Wakimoto T, Hayashi S, Koh I, Yamamoto R, Ishii K. Relationship between unremoved cervical polyp in pregnancy and spontaneous preterm birth. Am J Obstet Gynecol. 2022;227(6):899.e1-899.e6. [Crossref]  [PubMed]
  28. Riemma G, Della Corte L, Vitale SG, et al. Surgical management of endocervical and decidual polyps during pregnancy: systematic review and meta-analysis. Arch Gynecol Obstet.2023;307(3):673-680. [Crossref]  [PubMed]  [PMC]
  29. Szymusik I, Bartnik P, Wypych K, Kolaczkowska H, Kosinska-Kaczynska K, Wielgos M. The association of first trimester bleeding with preterm delivery. Journal of Perinatal Medicine. 2015;43(5):525-529. [Crossref]  [PubMed]
  30. Klein LL, Gibbs RS. Use of microbial cultures and antibiotics in the prevention of infection-associated preterm birth. Am J Obstet Gynecol. 2004;190(6):1493-1502. [Crossref]  [PubMed]
  31. Kazemier BM, Koningstein FN, Schneeberger C, et al. Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial. Lancet Infect Dis. 2015;15(11):1324-1333. [Crossref]  [PubMed]
  32. Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG. 2006;113(2):135-143. [Crossref]  [PubMed]
  33. Valkenburg-van den Berg AW, Sprij AJ, Dekker FW, Dörr PJ, Kanhai HHH. Association between colonization with Group B Streptococcus and preterm delivery: a systematic review. Acta Obstet Gynecol Scand. 2009;88(9):958-967. [Crossref]  [PubMed]
  34. Kenfack-Zanguim J, Kenmoe S, Bowo-Ngandji A, et al. Systematic review and meta-analysis of maternal and fetal outcomes among pregnant women with bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol. 2023;289:9-18. [Crossref]  [PubMed]
  35. Van Gerwen OT, Craig-Kuhn MC, Jones AT, et al. Trichomoniasis and adverse birth outcomes: a systematic review and meta-analysis. BJOG. 2021;128(12):1907-1915. [Crossref]  [PubMed]  [PMC]
  36. Sweeney EL, Kallapur SG, Gisslen T, et al. Placental Infection With Ureaplasma species Is Associated With Histologic Chorioamnionitis and Adverse Outcomes in Moderately Preterm and Late-Preterm Infants. J Infect Dis.2016;213(8):1340-1347. [Crossref]  [PubMed]  [PMC]
  37. Kovács D, Szabó A, Hegyi P, et al. Association between human papillomavirus and preterm delivery: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2024;103(10):1933-1942. [Crossref]  [PubMed]  [PMC]
  38. Schuster HJ, de Jonghe BA, Limpens J, Budding AE, Painter RC. Asymptomatic vaginal Candida colonization and adverse pregnancy outcomes including preterm birth: a systematic review and meta-analysis. Am J Obstet Gynecol MFM.2020;2(3):100163. [Crossref]  [PubMed]
  39. Derraik JGB, Lundgren M, Cutfield WS, Ahlsson F. Maternal Height and Preterm Birth: A Study on 192,432 Swedish Women. PLoS One. 2016;11(4):e0154304. [Crossref]  [PubMed]  [PMC]
  40. Ward K, Argyle V, Meade M, Nelson L. The heritability of preterm delivery. Obstet Gynecol. 2005;106(6):1235-1239. [Crossref]  [PubMed]
  41. Bhattacharya S, Amalraj Raja E, Ruiz Mirazo E, et al. Inherited predisposition to spontaneous preterm delivery. Obstet Gynecol. 2010;115(6):1125-1133. [Crossref]  [PubMed]
  42. Rayco-Solon P, Fulford AJ, Prentice AM. Maternal preconceptional weight and gestational length. Am J Obstet Gynecol. 2005;192(4):1133-1136. [Crossref]  [PubMed]
  43. Kumarasamy V, Mitchell MD, Bloomfield FH, et al. Effects of periconceptional undernutrition on the initiation of parturition in sheep. Am J Physiol Regul Integr Comp Physiol. 2005;288(1):R67-72. [Crossref]  [PubMed]
  44. Cai C, Vandermeer B, Khurana R, et al. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019;221(6):563-576. [Crossref]  [PubMed]
  45. Cai C, Vandermeer B, Khurana R, et al. The impact of occupational activities during pregnancy on pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol. 2020;222(3):224-238. [Crossref]  [PubMed]
  46. Armson BA. Physical activity and preterm birth: risk factor or benefit? BJOG. 2017;124(12):1827. [Crossref]  [PubMed]
  47. Berghella V, Klebanoff M, McPherson C, et al. Sexual intercourse association with asymptomatic bacterial vaginosis and Trichomonas vaginalis treatment in relationship to preterm birth. Am J Obstet Gynecol. 2002;187(5):1277-1282. [Crossref]  [PubMed]
  48. Orr ST, Miller CA, James SA, Babones S. Unintended pregnancy and preterm birth. Paediatr Perinat Epidemiol. 2000;14(4):309-313. [Crossref]  [PubMed]
  49. McIntosh J, Feltovich H, Berghella V, Manuck T. The role of routine cervical length screening in selected high- and lowrisk women for preterm birth prevention. Am J Obstet Gynecol. 2016;215(3):B2-7. [Crossref]  [PubMed]
  50. Updated Clinical Guidance for the Use of Progesterone Supplementation for the Prevention of Recurrent Preterm Birth. Accessed December 1, 2024. [Link]
  51. Fried I, Beam AL, Kohane IS, Palmer NP. Utilization, Cost, and Outcome of Branded vs Compounded 17-Alpha Hydroxyprogesterone Caproate in Prevention of Preterm Birth. JAMA Intern Med. 2017;177(11):1689-1690. [Crossref]  [PubMed]  [PMC]
  52. Urquhart C, Currell R, Harlow F, Callow L. Home uterine monitoring for detecting preterm labour. Cochrane Database Syst Rev. 2017;2(2):CD006172. [Crossref]  [PubMed]  [PMC]
  53. Khanprakob T, Laopaiboon M, Lumbiganon P, Sangkomkamhang US. Cyclo-oxygenase (COX) inhibitors for preventing preterm labour. Cochrane Database Syst Rev. 2012;10(10):CD007748. [Crossref]  [PubMed]  [PMC]
  54. Whitworth M, Quenby S. Prophylactic oral betamimetics for preventing preterm labour in singleton pregnancies. Cochrane Database Syst Rev. 2008;2008(1):CD006395. [Crossref]  [PubMed]  [PMC]
  55. Sosa CG, Althabe F, Belizán JM, Bergel E. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database Syst Rev. 2015;2015(3):CD003581. [Crossref]  [PubMed]  [PMC]
  56. Grobman WA, Gilbert SA, Iams JD, et al. Activity restriction among women with a short cervix. Obstet Gynecol. 2013;121(6):1181-1186. [Crossref]  [PubMed]  [PMC]
  57. Zemet R, Schiff E, Manovitch Z, et al. Quantitative assessment of physical activity in pregnant women with sonographic short cervix and the risk for preterm delivery: A prospective pilot study. PLoS One. 2018;13(6):e0198949. [Crossref]  [PubMed]  [PMC]
  58. Ribeiro MC, de Tubino Scanavino M, do Amaral MLS, de Moraes Horta AL, Torloni MR. Beliefs About Sexual Activity During Pregnancy: A Systematic Review of the Literature. J Sex Marital Ther. 2017;43(8):822-832. [Crossref]  [PubMed]