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What are the risk factors for preterm labor and birth?

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There are several risk factors for preterm labor and premature birth, including ones that researchers have not yet identified. Some of these risk factors are “modifiable,” meaning they can be changed to help reduce the risk. Other factors cannot be changed.

Health care providers consider the following factors to put women at high risk for preterm labor or birth:

  • Women who have delivered preterm before, or who have experienced preterm labor before, are considered to be at high risk for preterm labor and birth.1
  • Being pregnant with twins, triplets, or more (called “multiple gestations”) or the use of assisted reproductive technology is associated with a higher risk of preterm labor and birth. One study showed that more than 50% of twin births occurred preterm, compared with only 10% of births of single infants.2
  • Women with certain abnormalities of the reproductive organs are at greater risk for preterm labor and birth than are women who do not have these abnormalities. For instance, women who have a short cervix (the lower part of the uterus) or whose cervix shortens in the second trimester (fourth through sixth months) of pregnancy instead of the third trimester are at high risk for preterm delivery.

Certain medical conditions, including some that occur only during pregnancy, also place a woman at higher risk for preterm labor and delivery. Some of these conditions include3:

  • Urinary tract infections
  • Sexually transmitted infections
  • Certain vaginal infections, such as bacterial vaginosis and trichomoniasis
  • High blood pressure
  • Bleeding from the vagina
  • Certain developmental abnormalities in the fetus
  • Pregnancy resulting from in vitro fertilization
  • Being underweight or obese before pregnancy
  • Short time period between pregnancies (less than 6 months between a birth and the beginning of the next pregnancy)
  • Placenta previa, a condition in which the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix
  • Being at risk for rupture of the uterus (when the wall of the uterus rips open). Rupture of the uterus is more likely if you have had a prior cesarean delivery or have had a uterine fibroid removed.
  • Diabetes (high blood sugar) and gestational diabetes (which occurs only during pregnancy)
  • Blood clotting problems

Other factors that may increase risk for preterm labor and premature birth include:

  • Ethnicity. Preterm labor and birth occur more often among certain racial and ethnic groups. Infants of African American mothers are 50% more likely to be born preterm than are infants of white mothers.4
  • Age of the mother.
    • Women younger than age 18 are more likely to have a preterm delivery.
    • Women older than age 35 are also at risk of having preterm infants because they are more likely to have other conditions (such as high blood pressure and diabetes) that can cause complications requiring preterm delivery.4
  • Certain lifestyle and environmental factors, including:3
  • Late or no health care during pregnancy
  • Smoking
  • Drinking alcohol
  • Using illegal drugs
  • Domestic violence, including physical, sexual, or emotional abuse
  • Lack of social support
  • Stress
  • Long working hours with long periods of standing
  • Exposure to certain environmental pollutants

  1. Ekwo, E. E., Gosselink, C. A., & Moawad, A. (1992). Unfavorable outcome in penultimate pregnancy and premature rupture of membranes in successive pregnancy. Obstetrics and Gynecology, 80, 166–172. [top]
  2. Gardner, M. O., Goldenberg, R. L., Cliver, S. P., Tucker, J. M., Nelson, K. G., & Copper, R. L. (1995). The origin and outcome of preterm twin pregnancies. Obstetrics and Gynecology, 85, 553–557. [top]
  3. March of Dimes. (2008, 2010). Preterm labor and birth: A serious pregnancy complication. Retrieved April 23, 2012, from http://www.marchofdimes.com/pregnancy/preterm_indepth.html External Web Site Policy [top]
  4. enters for Disease Control and Prevention. (2013). Preterm birth. Retrieved September 18, 2013, from http://www.cdc.gov/reproductivehealth/maternalinfanthealth/PretermBirth.htm [top]

Last Updated Date: 03/11/2014
Last Reviewed Date: 11/06/2013
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