HPQ Risk: Pregnancy History

HPQ Risk Factors: Pregnancy History

A number of factors related to pregnancy history have close ties to an increased risk of preterm birth and other related complications and are included in HPQ.

This includes:

More detail regarding each of these factors is included below.

The HPQ does not include all known risk factors for preterm birth and other pregnancy complications. It is critical to be working with a health provider to create a personalized care plan for your own pregnancy that considers factors in and not considered by the HPQ.

If you have note read our note about Social Determinants of Health and "Mother/Mommy Blaming" please do so.

All of the factors listed and associated risk for preterm birth and other outcomes have potent links to social determinants of health. In no instance should these factors be considered as existing independently of social context. Guilt or shaming plays no role in what we do or in the information we share. We are about strength and empowerment of pregnant people and parents through information sharing.

Previous preterm birth

Previous Preterm Birth

Having a previous preterm birth is a significant risk factor for preterm birth in a current pregnancy. Studies have shown that people who have had a previous preterm birth are at a higher risk of delivering prematurely in subsequent pregnancies. The risk is even higher if the previous preterm birth occurred before 34 weeks of gestation.

In addition to the increased risk of preterm birth, individuals with a history of preterm birth may also be at higher risk for other pregnancy complications such as gestational diabetes, preeclampsia, and placental abruption.

Disparities exist in the relationship between previous preterm birth and current pregnancy outcomes. Pregnant individuals who are Black, Hispanic, or from low-income backgrounds are at higher risk of experiencing preterm birth and other pregnancy complications, even when controlling for other factors. The reasons for these disparities are multifactorial and include differences in access to healthcare, environmental factors, and social determinants of health. For example, pregnant people from low-income backgrounds may have limited access to prenatal care, which can lead to undiagnosed and untreated pregnancy complications.

Individuals with a history of preterm birth should be working closely with their healthcare provider to closely monitor their pregnancy.

Low-dose aspirin use may be an especially effective intervention for preventing preterm birth and preeclampsia in those with a previous preterm birth who have other risk factors present (see overview of factors associated with increased risk here). It is important to be working with a prenatal provider to determine if the use of low-dose aspirin may be helpful to you.

If present, having had a previous preterm birth will be included in your overall HPQ score. This and other factors affecting your preterm birth risk should be discussed with your prenatal provider.

If you are completing a HELLO EGG Healthy Pregnancy Plan and have a previous preterm birth it will be important to note how you plan to manage and address this risk with your provider.

Short or Long Time Since Last Pregnancy (less than 18-months or 5 or more years)

When a person becomes pregnant again soon after a previous pregnancy (less than 18 months) or after a long time (5 or more years), they may be at risk for preterm birth. It's not clear why this happens, but it may be because the body hasn't had enough time to recover or because the uterus isn't functioning well.

It's important to talk to your prenatal provider about how your own pregnancy may be affected by the time between your pregnancies. Other risk factors, like your age and health, can also affect your overall risk.

If you have a long interval (10 or more years) between pregnancies, low-dose aspirin may help reduce your risk of preeclampsia and preterm birth. You can read about the use of low-dose aspirin here.

If you have a short or long interpregnancy interval and this is associated with an increased risk of preterm birth in your race/ethnicity by insurance grouping (based on HPQ models of more than 5 million California births), then this factor will be included in your overall HPQ score. This and other factors affecting your preterm birth risk should be discussed with your prenatal provider.

If you are completing a HELLO EGG Healthy Pregnancy Plan and have either a short or long interpregnancy interval, it will be important to note how you plan to manage and address this risk with your provider.

Previous Cesarean Section

Having a previous cesarean section (c-section) can increase the risk of preterm birth and other pregnancy complications in a current pregnancy.

Studies have shown that individuals who have had a previous c-section may be at a higher risk for preterm birth, placental problems, and uterine rupture. The risk of preterm birth is higher if the previous c-section was performed before 34 weeks of gestation.

Disparities exist in the relationship between previous c-section and pregnancy outcomes. Those from low-income backgrounds and certain racial and ethnic groups, such as Black and Hispanic pregnant people, are more likely to have a previous c-section and to experience preterm birth and other pregnancy complications. The reasons for these disparities are multifactorial and include differences in access to healthcare, environmental factors, and social determinants of health. Those from low-income backgrounds may have limited access to prenatal care and may be more likely to have chronic health conditions that increase the risk of pregnancy complications.

To address the increased risk of preterm birth and other pregnancy complications in women with a previous c-section, it is important to be seeing a prenatal provider regularly so they can closely monitor the pregnancy. Those with a previous c-section may require additional monitoring and interventions, such as ultrasound and fetal monitoring, to reduce their risk of preterm birth.

Vaginal birth after cesarean (VBAC) may also be an option for some women, as it has been shown to be a safe and effective alternative to repeat c-sections for certain patients. However, not all women are candidates for VBAC, and the decision should be made in consultation with a healthcare provider.

Improving access to prenatal care, addressing social determinants of health, and reducing disparities in healthcare are also important in reducing the risk of preterm birth and other pregnancy complications in those with a previous c-section.

If you have a previous c-section and this is associated with an increased risk of preterm birth in your race/ethnicity by insurance grouping (based on HPQ models of more than 5 million California births), then this factor will be included in your overall HPQ score. This and other factors affecting your preterm birth risk should be discussed with your prenatal provider.

If you are completing a HELLO EGG Healthy Pregnancy Plan and have a previous c-section it will be important to note how you plan to manage and address this risk with your provider.