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From Reuters Health Information

With Premature Rupture of Membranes, Delaying the Next Pregnancy May Cut Risk of Recurrence

By Anne Harding

NEW YORK (Reuters Health) Mar 02 - Pregnant women with premature rupture of membranes may want to wait at least 18 months before having their next child, new research shows.

This complication occurs in up to 5% of pregnancies and accounts for 25% of premature births, Dr. Darios Getahun of Kaiser Permanente Southern California Medical Group in Pasadena and colleagues note in their report.

The reason for premature rupture of membranes is "elusive," Getahun and his team said in their February 4th online report in the American Journal of Obstetrics & Gynecology. There are likely many factors involved. Women who have had the complication previously, they add, are known to be at greater risk in subsequent pregnancies. And the risk is also known to be higher for black women compared to whites.

To investigate whether the length of time between pregnancies might also influence this risk, the researchers reviewed data from the state of Missouri on nearly 200,000 women who had two or three children between 1989 and 1997. Approximately 3% of black women and 1% of white women had premature rupture of their membranes in a first or second pregnancy.

Among white women whose water broke early, 6% had the complication in their subsequent pregnancy, compared to 2% of women who hadn't suffered premature membrane rupture.

The rates for black women were 10% and 4%, respectively. This translated to a nearly nine-fold increased risk in a subsequent pregnancy for white women, and a seven-fold greater risk for black women.

The risk was even further increased if a woman became pregnant again within 18 months, and was particularly high for African-American women. For example, a black woman who became pregnant again within three to six months would be nearly nine times more likely to have the complication than a woman who waited at least 18 months.

The risk of in white women who became pregnant again this soon was tripled.

This suggests, the researchers say, that the complication may be related to inflammation, and that a longer interval between pregnancies is needed to allow for full recovery. "We think that it might be a chronic inflammation that may persist from one pregnancy to another pregnancy," Dr. Getahun told Reuters Health.

Women with a history of premature rupture of her membranes should be watched closely in subsequent pregnancies, he added, so that if infection does develop they can receive prompt antibiotic treatment, which could help prevent the complication from recurring.

Am J Obstet Gynecol 2010.