Preterm Labor in Pregnancy - Symptoms, Causes and Risk Factors

Preterm labor is defined as a premature labor between 20 - 37 weeks of gestation before full term. According to the statistic, 1 in 8 babies is born premature and 12% of all pregnancies are ended in preterm pregnancy, causing life longed health problem to some and one of the leading cause of infant death.
Signs and symptoms
1. Uterus Contraction
Pregnant women who are experience frequent uterus contraction for 5 minutes or more are at risk of preterm pregnancy.
2. Vagina discharge
It may be result of leaking fluid and bleeding from the womb.
3. Pain during urination
It can be caused by bladder or urinary track infection cause of preterm labor.
4. Intense pelvic pressure and low, dull backache
Symptoms of normal term labor.
5. Abnormal cramps and pain
It is not a usual sign of pregnancy.
6. Etc.
Causes and risk factors
1. Previous history
Women who have a previous incidence of preterm labor are at higher risk of preterm pregnancy again.

2. Pregnancy with multiple babies
According to the article of "Multiple birth" posted in the enote, the article indicated that Babies born from multiple-birth pregnancies are more likely to result in premature birth than those from single pregnancies. 51% of twins and 91% of triplets are born preterm, compared to 9.4% in singletons.

3. Uterine and Cervical structure abnormalities
Certain reproductive structure abnormalities can increase the risk of preterm labor, including
a duplicated or septate cervix, T-shaped uterus, etc.

4. Infection
Certain infections including bacterial vaginosis, bladder, urinary track, kidney infection can increase the risk of preterm labor and give birth early. According to the study of "Periodontal infection and preterm birth, Results of a prospective study by MARJORIE K. JEFFCOAT, D.M.D., NICO C. GEURS, D.M.D., MICHAEL S. REDDY, D.M.D., D.M.SC., SUZANNE P. CLIVER, B.S., ROBERT L. GOLDENBERG, M.D. and JOHN C. HAUTH, M.D., researchers found that Patients with severe or generalized periodontal disease had adjusted odds ratios (95 percent CI) of 4.45 (2.16–9.18) for preterm delivery (that is, before 37 weeks gestational age). The adjusted odds ratio increased with increasing prematurity to 5.28 (2.05–13.60) before 35 weeks’ gestational age and to 7.07 (1.70–27.4) before 32 weeks’ gestational age.

5. Chronic illness
Certain chronic illness such as high blood pressure, kidney disease and diabetes may increase the risk of preterm labor.

6. Maternal α-fetorrprotein levels in second trimester
Abnormally high plasma levels of α-fetoprotein in early pregnancy increases risk of preterm labor. According to the study of "PREDICTING THE RISK OF PRETERM LABOR BY SECOND TRIMESTER MEASUREMENT OF MATERNAL α-FETOPROTEIN LEVELS AND A RISK FACTOR SCORING SYSTEM" by FATEMEH DAVARI TANHA,* M.D., FARIBA SARDARI, M.D.,ZAHRA EFTEKHAR, M.D., MAHBOD KAVEH, M.D., AND NARGESSIZADY MOOD, M.D., researchers found that the combination of measurement of maternal serum AFP in the second trimester associated with a risk factor scoring system provides a more accurate indicator of the risk of preterm delivery and therefore may be of use in targeting prevention strategies.

7. Socio-economical and obstetric effects
Biopsychosocial risk factors for preterm birth and postpartum emotional well-being: a case–control study on Turkish women without chronic illnesses by Ilkay Gungor, Umran Oskay,Nezihe Kizilkaya Beji, researchers found that many of the socio-economical and obstetric causes of preterm births were similar to other countries with higher preterm birth rates. Preterm births were associated with lower social support along with more anxiety and depressive symptoms in early postpartum.

8. Overweight before pregnancy
Women who are overweight or obese are at great risk of giving birth to a preterm baby compared with normal weight women. According to the study of "Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and metaanalyses" by Sarah D McDonald, associate professor, Zhen Han, associate professor, Sohail Mulla, student, Joseph
Beyene,researchers found that Overweight or obese women have increased risks of preterm birth before 32 weeks and induced preterm birth before 37 weeks, and, accounting for publication bias, preterm birth before 37 weeks overall.

9. Underweight, smoking, uterine bleeding, blood pressure abnormalities and Inadequate Rate of Weight Gain
In a study of "Maternal Underweight Status and Inadequate Rate of Weight Gain During the Third Trimester of Pregnancy Increases the Risk of Preterm Delivery" by ANNA MARIA SIEGA-RIZ,*3 LINDA S. ADAIR* AND CALVIN J. HOBELf, researchers found that Women who delivered preterm were significantly lower in prepregnancy weight and as a result had a lower mean prepregnant BMI than women who delivered term (Table 2). In addition, mothers of preterm infants were less frequently married, more likely to smoke, to be African-Americans and had more occurrences of uterine bleeding and blood pressure abnormalities (chronic hypertension and/or pregnancy-induced hypertension) than mothers of term infants.
Researchers also found that Women who delivered preterm gained the same
amount of weight in the first trimester and had a similar rate of weight gain in the second trimester as women who delivered term (refer to Table 2). However, differences in rate of weight gain were seen in the third trimester. Women who delivered term gained, on average, 30 g more per week than women who delivered preterm. The weight gain curves for term vs. the types of preterm deliveries, preterm labor and preterm PROM are shown in Figure 1. Regression lines fitted to the data illustrate the similarities in the rate of weight gain among all three groups.

10. Singleton pregnancies after IVF-ET/GIFT
According to the study of "Increased risk of preterm birth in singleton pregnancies resulting from in vitro fertilization-embryo transfer or gamete intrafallopian transfer: a meta-analysis" by McGovern PG, Llorens AJ, Skurnick JH, Weiss G, Goldsmith LT., researchers found that The risk of preterm birth in singleton pregnancies resulting from IVF-ET/GIFT is twice that of natural conceived pregnancies.

11. Short time between pregnancies
Women who are pregnant again less than 6-9 months after giving birth are at higher risk of the preterm pregnancy. In a study of "Effect of the Interval between Pregnancies on Perinatal Outcomes" by Bao-Ping Zhu, M.D., Robert T. Rolfs, M.D., M.P.H., Barry E. Nangle, Ph.D., and John M. Horan, M.D., M.P.H. researchers suggested that the optimal interpregnancy interval for preventing adverse perinatal outcomes is 18 to 23 months.

12. Alcohol
Alcohol abuse increases the risk of preterm labor. According to the article of "Alcohol Use and Premature Birth" in 2006 Teresa Kellerman, the author wrote that Increased awareness about the risk of alcohol use during pregnancy can prevent many cases of premature birth, as well as the serious effects associated with Fetal Alcohol Spectrum Disorders.

13. Lack of prenatal care Lack of prenatal care increases the rate of recurrent preterm delivery and health care costs when compared to university hospital-based prenatal care by Serdar Ural MD, Cary Cox, Karin Blakemore MD, Eva Pressman MD and Jessica Bienstock MD, researchers concluded that Inner-city patients with a history of PTD who received even minimal prenatal care in a university HS clinic had a significantly lower incidence of recurrent PTD than those who had no prenatal care. Prenatal care also lowers total health care costs in women with a history of PTD. The coordinated multidisciplinary aspect of care provided at academic centers may have a positive impact on the problem of PTD.

14. Other causes, include
a. Poor nutrients
b. Physical and drug abuse
c. Etc. 

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