Objective Attention for recurrent preterm delivery has primarily focused on spontaneous subtypes with less known about indicated preterm delivery. Study Design In a retrospective cohort of consecutive pregnancies among 51,086 women in Utah (2002–2010), binary relative risk regression was performed to examine risk of preterm delivery < 37 weeks (PTD) in the second observed delivery by PTD in the first, adjusting for maternal age, race/ethnicity, prepregnancy body mass index, insurance, smoking, alcohol and/or drug use, and chronic disease. Analyses were also performed stratified by prior preterm delivery subtype: spontaneous, indicated, or no recorded indication. Results There were 3,836 (7.6%) women that delivered preterm in the first observed pregnancy, of which 1,160 (30.7%) repeated in the second. Rate of recurrent PTD was 31.6% for prior spontaneous, 23.0% for prior indicated delivery, and 27.4% for prior elective delivery. Prior spontaneous PTD was associated with RR 5.64 (95% CI 5.27–6.05) of subsequent spontaneous and RR 1.61 (95% CI 0.98–2.67) of subsequent indicated PTD. Prior indicated PTD was associated with RR 9.10 (95% CI 4.68–17.71) of subsequent indicated and RR 2.70 (2.00–3.65) of subsequent spontaneous PTD. Conclusions Prior indicated PTD was strongly associated with subsequent indicated PTD and with increased risk for subsequent spontaneous PTD. Spontaneous PTD had the highest rate of recurrence. Some common pathways for different etiologies of preterm delivery are likely, and indicated PTD merits additional attention for recurrence risk.

IntroductionTwo thirds of United States adults are overweight or obese, which puts them at higher risk of developing chronic diseases and of death compared with normal-weight individuals. However, recent studies have found that overweight and obesity by themselves may be protective in some contexts, such as hospitalization in an intensive care unit (ICU). Our objective was to determine the relation between body mass index (BMI) and mortality at 30 days and 1 year after ICU admission.MethodsWe performed a cohort analysis of 16,812 adult patients from MIMIC-II, a large database of ICU patients at a tertiary care hospital in Boston, Massachusetts. The data were originally collected during the course of clinical care, and we subsequently extracted our dataset independent of the study outcome.ResultsCompared with normal-weight patients, obese patients had 26% and 43% lower mortality risk at 30 days and 1 year after ICU admission, respectively (odds ratio (OR), 0.74; 95% confidence interval (CI), 0.64 to 0.86) and 0.57 (95% CI, 0.49 to 0.67)); overweight patients had nearly 20% and 30% lower mortality risk (OR, 0.81; 95% CI, 0.70 to 0.93) and OR, 0.68 (95% CI, 0.59 to 0.79)). Severely obese patients (BMI ≥ 40 kg/m2) did not have a significant survival advantage at 30 days (OR, 0.94; 95% CI, 0.74 to 1.20), but did have 30% lower mortality risk at 1 year (OR, 0.70 (95% CI, 0.54 to 0.90)). No significant difference in admission acuity or ICU and hospital length of stay was found across BMI categories.ConclusionOur study supports the hypothesis that patients who are overweight or obese have improved survival both 30 days and 1 year after ICU admission.