Mothers of very preterm infants and their partners
User group
Healthcare professionals, perinatal and neonatal units, hospitals, health services, and follow-up teams
Statement of standard
Mothers of infants born very preterm or after pregnancy complications and their partners are counselled on the risk of recurrence in future pregnancies, and offered strategies to prevent recurrence, both before conception and during a subsequent pregnancy.
Rationale
The goal is to assess and evaluate the risk of recurrence of preterm birth or other severe pregnancy complications after birth of a high-risk infant. Compared to the general population, women with a previous preterm delivery have an increased risk of preterm delivery in future pregnancies. (1,2) This increased risk applies to spontaneous as well as iatrogenic preterm delivery.
With regards to spontaneous preterm delivery, a number of preconception interventions may reduce the risk of recurrence: cessation of smoking and recreational drugs, appropriate management of maternal comorbidities, including treatment of genital tract infection, and attainment of a normal body mass index. (1,3,4) In a subsequent pregnancy, treatment of asymptomatic bacteriuria, progesterone administration and cervical cerclage have proven useful in reducing the risk of recurrence in women with a short cervix. (1,3,5,6)
In terms of iatrogenic preterm delivery, a substantial proportion of these cases are related to vascular placental conditions, such as pre-eclampsia and fetal growth restriction. The risk of recurrence of these conditions is higher than in the general population, and can be decreased by low-dose aspirin, calcium supplements, and diet and lifestyle interventions. (2,7,8)
Benefits
Short-term benefits
N/A
Long-term benefits
Better informed parents (consensus)
Appropriate preconception or early pregnancy intervention or management (1,3,4)
Reduced risk of recurrent preterm delivery (1,3–6)
Reduced risk of recurrent pre-eclampsia and fetal growth restriction (2,7–9)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
Mothers and their partners are informed by healthcare professionals on strategies to prevent recurrence of preterm delivery or pregnancy complications, before hospital discharge or at a follow-up visit. (see Birth & transfer)
B (High quality)
Patient information sheet1
Mothers and their partners are supported to help them to cope with uncertainties in outcomes in future pregnancies.
B (High quality)
Parent feedback
For healthcare professionals
A unit guideline on reproductive counselling of women with a previous complicated pregnancy at risk of recurrence, including pathways of integrated antenatal care, is adhered to by all healthcare professionals. (1–8)
A (High quality) B (High quality)
Guideline
Training on reproductive counselling of women with a previous complicated pregnancy at risk of recurrence is attended by all responsible healthcare professionals.
B (High quality)
Training documentation
For perinatal and neonatal unit, hospital, and follow-up team
A unit guideline on reproductive counselling of women with a previous complicated pregnancy at risk of recurrence, including pathways of integrated antenatal care is available and regularly updated. (1–8)
A (High quality) B (High quality)
Guideline
Communication about maternal health issues that may affect newborn care is maintained.
B (High quality)
Clinical records
Training on reproductive counselling of women with a previous complicated pregnancy at risk of recurrence is ensured.
B (High quality)
Training documentation
For health service
A national guideline on reproductive counselling of women with a previous complicated pregnancy at risk of recurrence, including pathways of integrated antenatal care is available and regularly updated. (1–8)
A (High quality) B (High quality)
Guideline
Funding for follow-up care of mothers and for targeted antenatal care in future pregnancies is provided, or included in insurance packages.
B (Moderate quality)
Audit report2
1The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator ‘audit report” can also be defined as a benchmarking report.
Where to go
Further development
Grading of evidence
For parents and family
N/A
For healthcare professionals
N/A
For neonatal unit, hospital, and follow-up team
N/A
For health service
N/A
Getting started
Initial steps
For parents and family
Mothers and their partners are informed by healthcare professionals about pregnancy complications and about the availability of targeted care in future pregnancies.
For healthcare professionals
Attend training on reproductive counselling of women with a previous complicated pregnancy at risk of recurrence.
Establish a structure of communication with other healthcare institutions providing antenatal care.
For perinatal and neonatal unit, hospital, and follow-up team
A service for providing antenatal care for women at risk of recurrent pregnancy complication is available.
Develop and implement a unit guideline on reproductive counselling.
Develop information material on the follow-up that is available for women at risk of recurrent pregnancy complication.
Support healthcare professionals to participate in trainings on reproductive counselling of women with a previous complicated pregnancy at risk of recurrence.
Provide funding and resources for targeted antenatal care in future pregnancies.
For health service
Develop and implement a national guideline on pathways of care, integrating routine antenatal care for women with a previous complicated pregnancy at risk of recurrence.
Iams JD, Berghella V. Care for women with prior preterm birth. Am J Obstet Gynecol. 2010 Aug;203(2):89–100.
Friedman AM, Cleary KL. Prediction and prevention of ischemic placental disease. Semin Perinatol. 2014 Apr;38(3):177–82.
Colicchia LC, Simhan HN. Optimizing Subsequent Pregnancy Outcomes for Women with a Prior Preterm Birth. Am J Perinatol. 2016 Feb;33(3):267–75.
Stang J, Huffman LG. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes. J Acad Nutr Diet. 2016 Apr;116(4):677–91.
Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstet Gynecol. 2011 Mar;117(3):663–71.
Norman JE, Marlow N, Messow C-M, Shennan A, Bennett PR, Thornton S, et al. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. The Lancet. 2016 May 21;387(10033):2106–16.
Costa ML. Preeclampsia: Reflections on How to Counsel About Preventing Recurrence. J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2015 Oct;37(10):887–93.
Mol BWJ, Roberts CT, Thangaratinam S, Magee LA, de Groot CJM, Hofmeyr GJ. Pre-eclampsia. The Lancet. 2016 Mar;387(10022):999–1011.
Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017 Aug 17;377(7):613–22.
November 2018 / 1st edition / next revision: 2023
Recommended citation
EFCNI, Prefumo F, Johnson MR et al., European Standards of Care for Newborn Health: Reproductive counselling. 2018.
