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Preterm birth remains a major challenge in pregnancy care and can increase the risk of complications for newborns and families. Parents with a history of spontaneous preterm birth often want to know how likely it is to happen again in a future pregnancy. In this international individual patient data meta-analysis, researchers combined data from 1,316 pregnant individuals with at least one previous spontaneous preterm birth. The study explored whether factors such as cervical length and the timing of previous preterm births could help identify lower-risk groups. This study highlights how recurrence risks can vary between pregnancies. The researchers found that although some individuals had lower risks than others, all patients with a previous spontaneous preterm birth still remained at increased risk for another preterm birth.
Preterm birth can happen for many different reasons, and predicting which pregnancies are most at risk remains difficult. One commonly used tool is measuring cervical length during the middle of pregnancy. A shorter cervix is linked with a higher chance of preterm birth, especially in people who already experienced a previous preterm birth. This study examined whether cervical length together with pregnancy history could improve risk assessment for recurrent preterm birth.
The researchers analyzed data from seven prospective studies conducted in several countries. All participants had a singleton pregnancy and at least one previous spontaneous preterm birth. None of the participants received preventive treatments such as progesterone, cervical cerclage, or pessary placement during the studied pregnancy. The team compared cervical length measurements and details from previous pregnancies with later pregnancy outcomes.
The study found that cervical length and the timing of earlier preterm births both influenced the likelihood of another preterm birth. Patients with the highest risks were those with a very early previous spontaneous preterm birth and a very short cervix in the current pregnancy. In this group, up to 50% delivered before 32 weeks of pregnancy and 67% delivered before 37 weeks. Even among participants with a longer cervix, the timing of earlier preterm births still affected recurrence risk. Patients whose previous preterm birth occurred later in pregnancy generally had lower risks, but those risks still remained higher than in people without a history of spontaneous preterm birth. The number of previous term births did not clearly reduce the recurrence risk.
The researchers also found that no subgroup reached the same low risk seen in individuals without a previous spontaneous preterm birth. Even participants with a cervical length above 30 mm and a previous late preterm birth still had elevated risks for recurrent preterm birth. The findings suggest that cervical length alone cannot fully explain recurrence risk. Instead, previous pregnancy history and cervical length should both be considered when counseling families and planning monitoring during pregnancy.
For parents of preterm infants and healthcare professionals, the study shows that a previous spontaneous preterm birth remains an important risk factor in future pregnancies. A reassuring cervical length measurement may be a positive indicator, but it does not remove the need for continued follow-up and discussions about prevention. The findings support careful monitoring and individualized counseling throughout pregnancy.
The researchers emphasize that understanding patterns of recurrent preterm birth may help improve personalized care in the future. Families should feel encouraged to discuss their pregnancy history and available monitoring options with their healthcare team. Continued research may help identify better ways to predict and prevent recurrent preterm birth.
Paper available at: Patterns of recurrent preterm birth: an individual patient data meta-analysis - ScienceDirect
Full list of authors: van Dijk, C.E.; de Ruigh, A.A.; Gravesteijn, B.Y.; Kazemier, B.M.; Berghella, V.; Owen, J.; Bittar, R.E.; Bagga, R.; Crane, J.M.G.; Shennan, A.H.; Arabin, B.; Mol, B.W.; Pajkrt, E.; Kleinrouweler, C.E.
DOI: 10.1016/j.ajogmf.2026.101927
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