双胎妊娠胎儿不同孕周的适宜体重与妊娠并发症和妊娠结局的探讨

目的探讨双胎妊娠胎儿不同孕周的适宜体重及其妊娠并发症和妊娠结局。方法回顾性分析2004年1月至2020年12月在北京大学第一医院分娩的1 225例双胎妊娠孕妇不同孕周的胎儿体重及相关的妊娠并发症和妊娠结局, 包括妊娠期高血压疾病、妊娠期糖尿病(GDM)、胎儿生长受限(FGR)、胎儿窘迫、早产及新生儿窒息。双胎妊娠胎儿不同孕周的适宜体重使用616例无妊娠并发症(除早产)双胎妊娠孕妇的1 232例新生儿出生体重进行分析, 以第10～90百分位数表示, 并比较小于胎龄儿(SGA)、大于胎龄儿(LGA)与适于胎龄儿(AGA)双胎妊娠的妊娠并发症及不良妊娠结局的发生风险, 以及不同年份间妊娠并发症及不良妊娠结局发生率的变化。结果双胎妊娠不同孕周新生儿适宜体重分别为孕28周910～1 255 g、孕29周996～1 518 g、孕30周1 105～1 785 g、孕31周1 295～1 825 g、孕32周1 336～2 000 g、孕33周1 754～2 321 g、孕34周1 842～2 591 g、孕35周1 913～2 615 g、孕36周2 150～2 847 g、孕37周2 350～3...     

不同绒毛膜性自然受孕双胎围产结局分析

目的:回顾分析自然受孕双胎妊娠相关资料,探讨不同绒毛膜性双胎的围产结局。方法:选取2015年6月至2018年5月于福建医科大学附属福建省妇幼保健院产检和分娩(28周以上)的自然受孕双胎妊娠孕妇,其中单绒毛膜双胎(MCT组)321例,根据年龄、孕前体质量指数(BMI)1∶1对照原则,选取同期双绒毛膜双胎(DCT组)321例,分析两组围产结局的差异。结果:642例双胎孕妇的平均年龄为(29.03±4.53)岁,孕前BMI为(20.73±2.51)kg/m~2,分娩孕周平均为(35.58±2.21)周,新生儿平均出生体重为(2148.89±221.4)g。母、儿围产结局发生前五位的分别为:早产、贫血、胎膜早破、GDM和妊娠期高血压疾病;新生儿高胆红素血症、新生儿畸形、双胎出生体重不一致、小于胎龄儿和新生儿窒息。其中早产的发生率最高,为55.61%。MCT组的早产、34周早产、脐带帆状附着、双胎出生体重不一致的发生率高于DCT组,但新生儿畸形、新生儿高胆红素血症发生率低于DCT组,差异均有统计学意义(P0.05)。两组的妊娠期高血压疾病、胎膜早破、贫血、前置胎盘、胎盘早剥、一胎羊水过多、剖宫产率,以及新生儿窒息、小于胎龄儿、围产儿死亡发生率等方面比较,差异均无统计学意义(P0.05)。结论:单绒毛膜性双胎增加母儿不良妊娠结局的发生率,根据双胎绒毛膜性做好详细的孕期保健,对提高母儿围产结局具有重要意义。     

医源性早产对新生儿窒息的影响

目的:探讨医源性早产对新生儿窒息的影响.方法:回顾性分析我院2002年1月至2006年12月医源性早产对早产儿窒息的影响.结果:孕28～33+6周出生者新生儿窒息率明显高于孕34～36+6周出生者,差异有统计学意义(P＜0.05);医源性早产新生儿窒息组体重明显低于早产儿无窒息组(P＜0.05);医源性早产儿同孕周新生儿窒息率与自发性早产儿比较差异无统计学意义(P＞0.05).结论:体重及孕周是影响早产儿窒息发病率的主要因素,而并非医源性早产本身.医源性早产的患者,在母婴安全的条件下延长孕周,增加新生儿体重以减少早产儿窒息的发病率.     

未足月胎膜早破不同孕周及潜伏期长短对妊娠结局的影响

目的:探讨未足月胎膜早破(PPROM)破膜孕周及不同潜伏期长短对妊娠结局的影响及临床意义.方法:回顾性分析148例孕28～36+6 周PPROM孕产妇和新生儿的临床资料.结果:孕28～33+6 周PPROM组新生儿呼吸窘迫、缺血缺氧性脑病和死亡及绒毛膜羊膜炎均明显高于孕34～36+6 周PPROM组,孕28～33+6 周PPROM组潜伏期在48小时以内的新生儿呼吸窘迫、缺血缺氧性脑病和死亡均高于潜伏期在48小时以后者,差异均有统计学意义(P<0.05).孕34～36+6 周PPROM组潜伏期在48小时以内者的孕产妇与潜伏期在48小时以后者相关并发症发生率差异无统计学意义,结论:对孕28～33+6 周PPROM应采取促胎肺成熟和预防感染等措施,延长孕周,适时终止妊娠;而孕34～36+6周PPROM胎儿肺成熟者应在破膜48小时以内终止妊娠.     

抗磷脂综合征合并妊娠不同干预时机及干预方法抗早产效果研究

目的分析不同干预时机及干预方法在抗磷脂综合征(APS)合并妊娠者存在先兆早产或宫颈功能受到影响病例抗早产的效果。方法分析2006—2014年北京大学第三医院收治的127例原发性抗磷脂综合征合并单胎妊娠患者的临床资料,依据抗APS干预时机分为未干预、孕前干预、孕14周干预及≥孕14周干预的4组,对其中59例存在先兆早产征象或宫颈功能受影响者将抗早产方法分为单纯抑制宫缩(A组)、抗APS+抑制宫缩(B组)以及抗APS+抑制宫缩+宫颈环扎术(C组)3种。分析早产风险因素以及不同干预时机下不同抗早产干预方法的孕周终止情况。结果早产发生率35.4%。59例有先兆早产征象或宫颈功能受影响,但早产风险因素比较差异无统计学意义(P0.05)。平均分娩孕周在B组和C组明显大于A组(P0.001)。C组平均分娩孕周大于B组(P=0.028)。抗APS联合抗早产干预组平均分娩孕周明显大于无抗APS的单纯抑制宫缩A组(P0.001)。孕前干预与孕14周干预与APS先兆早产中34周之后和37周之后分娩呈正相关。结论 APS存在早产风险,孕前或孕14周前开始干预并联合抗早产治疗可以明显延长先兆早产病例的妊娠时间,增加34周后分娩率和足月产率。     

一胎儿结构畸形双胎孕中期减胎术例临床分析

目的 探讨不同绒毛膜性的一胎儿结构畸形双胎胎儿畸形种类差异及不同孕周减胎术妊娠结局。方法 回顾性分析2002—2020年在山东第一医科大学附属省立医院因一胎儿结构畸形行孕中期减胎术的双胎病例,分析双绒毛膜双胎(双绒双胎组)及单绒毛膜双胎(单绒双胎组)胎儿畸形种类及不同减胎孕周的妊娠结局。结果 双绒双胎组颈部畸形占比高,两组其余胎儿畸形种类顺位基本一致。双绒双胎组A(12～13⁺⁶孕周)、B(14～19⁺⁶孕周)、C(20～27⁺⁶孕周)3个亚组流产率、活产率差异无统计学意义,随减胎孕周的增加早产率增加,出生体重降低,差异均有统计学意义,A组早产率低于C组,A组及B组新生儿出生体重高于C组(A、B、C 3组的早产率分别为3.7%、13.9%和25.6%)。单绒双胎组A(12～19⁺⁶孕周)、B(20～27⁺⁶孕周)2个亚组流产率、早产率、活产率差异无统计学意义,A组新生儿分娩孕周及出生体重高于B组[分别为38⁺²(37⁺⁴,40)vs....     

胎膜早破162例临床分析

目的探讨胎膜早破与难产及母儿并发症的关系.方法对829例无妊娠合并症及并发症的产妇资料进行回顾性分析,其中胎膜早破病例162例,胎膜未破病例682例作为对照组.结果胎膜早破组的剖宫产率、早产率、新生儿窒息及肺炎发病率均较对照组显著升高,母亲产褥病率两组间无差异.破膜距妊娠结束时间及早产与新生儿窒息及肺炎关系密切.结论胎膜早破与难产互为因果关系.对不同孕周胎膜早破患者应采取不同治疗方案,以尽可能减少母儿并发症.     

早产的定义、分类及诊断

1 早产的定义 早产的上限全球统一,即妊娠不满37孕周分娩.下限设置各国不同,与其新生儿治疗水平有关,不少发达国家采用妊娠满20周,也有一些采用妊娠满22周、24周,大多数发展中国家包括中国沿用WHO上个世纪60年代的定义,即妊娠满28周或新生儿出生体重≥1000 g.早产发生率由于各国定义的差异,发生率的统计存在不同,美国的早产发生率在12％～13％,欧洲则在5％ ～9％,其中约5％发生在28孕周前,12％在28 ～ 31孕周,13％在32 ～ 33孕周,70％在34 ～ 36孕周[1].我国对早产发生率尚缺乏全国统一的数据,约为5％ ～ 10％,呈逐年上升趋势.2005年中华医学会儿科学分会新生儿学组进行了多中心大样本调查显示,我国早产发生率为7.8％.     

286例胎膜早破性早产新生儿结局的临床分析

目的:了解产前糖皮质激素干预对胎膜早破性早产新生儿结局的影响。方法:对我院286例胎膜早破性早产病例的临床资料进行回顾性分析。结果:34~35+6周孕龄组新生儿1分钟Apgar评分<7分的发生率、窒息率及新生儿呼吸窘迫综合征(NRDS)发生率在干预组明显低于对照组,两组间比较差异有显著性(P<0.05)。36~36+6周孕龄组新生儿窒息率、缺血缺氧性脑病(HIE)发生率、NRDS发生率及其他并发症发生率在干预组明显低于对照组,两组间比较差异有显著性(P<0.05)。28~31+6周及32~33+6周孕龄组新生儿结局的各项指标在干预组与对照组间比较差异无显著性(P>0.05)。结论:34~36+6孕周胎膜早破性早产孕妇产前使用糖皮质激素干预能显著改善新生儿结局。因样本量关系,<34孕周的胎膜早破性早产孕妇产前使用糖皮质激素干预对新生儿结局有无明显改善还有待于进一步探讨。     

脐动脉舒张末期血流缺失35例的分娩时机及处理方案

目的 分析胎儿脐动脉舒张末期血流缺失(absent end-diastolic velocity,AEDV)出现时间,探讨其临床处理与围产儿结局的关系以及终止妊娠时机对围产儿预后的影响. 方法 对首都医科大学附属北京妇产医院2008年1月至2009年12月间35例发生AEDV的母儿临床资料进行分析,以妊娠28周为界,并按治疗与否分为4组.第1组5例(14.3％)为发现AEDV孕周＜28周未治疗组;第2组13例(37.1％)为发现AEDV孕周＜28周治疗组;第3组11例(31.4％)为发现AEDV孕周≥28周末治疗组;第4组6例(17.1％)为发现AEDV孕周≥28周治疗组.35例孕妇中,除第2组有3例孕妇外,其余均伴有不同程度的各种妊娠合并症.收集的资料用频数、率或均数±标准差表示. 结果 35例孕妇中,19例分娩,占54.3％,共获23例新生儿,结局良好.第1组出现AEDV孕周＜28周,平均(22.8±2.2)周.其中双胎输血综合征1例及溶血、肝酶升高和血小板减少综合征并胎盘早剥1例,发现AEDV后即引产或剖宫取胎,余3例均未治疗,2周后AEDV自然恢复,新生儿存活.第2组出现AEDV孕周＜28周,平均(24.2±2.0)周,平均终止妊娠孕周(31.4±5.5)周,平均治疗时间(10.7±5.5)d.6例治疗后AEDV未恢复,其中5例引产,1例早产;余7例中,6例剖宫产,1例足月自然分娩.除早产1例家属放弃胎儿、1例新生儿失访外,余新生儿结局良好.第3组出现AEDV孕周＞28周,平均(30.9±2.8)周,平均终止妊娠孕周(31.2±2.9)周,均未治疗.5例因严重母儿合并症引产,余6例剖宫产分娩,其中1例因胎盘早剥新生儿死亡,另6例新生儿(1例双胎)结局良好.第4组出现AEDV孕周＞28周,平均(29.5±0.8)周,平均终止妊娠孕周(32.8±2.9)周,平均治疗时间(i0.8±6.7)d.2例治疗后予引产;4例治疗后AEDV恢复正常,剖宫产分娩,新生儿结局良好. 结论 对于AEDV伴有严重并发症的孕妇,积极治疗后,围产儿预后与终止妊娠的孕周有关.AEDV如不伴严重并发症者,部分可自行恢复,且围产儿结局良好.     

Risk of preeclampsia in HIV-positive pregnant women receiving HAART: a matched cohort study

Objective: We sought to determine whether HIV-positive women receiving highly active anti-retroviral therapy (HAART) are at higher risk for preeclampsia than HIV-negative women. Secondary outcomes included comparing the risks of preterm birth, low birth weight, and small for gestational age birth in these women. Methods: In this retrospective matched cohort study, we compared the pregnancy outcomes of HIV-positive women treated with HAART with those of HIV-negative women who gave birth at Mount Sinai Hospital, Toronto, Ontario. Data were ascertained through chart review. Univariate and multivariate logistic regression models were used to compare pregnancy outcomes between the two groups. Results: Ninety-one HIV-positive pregnant women receiving HAART and 273 HIV-negative pregnant women were identified. After adjusting for confounding factors, there was no difference between HIV-positive and HIV-negative women in the odds of preeclampsia (3.3% vs. 5.1%; adjusted odds ratio [aOR] 0.59; 95% CI 0.11 to 3.08), preterm birth (15.6% vs. 11.4%; aOR 1.70, 95% CI 0.79 to 3.66) or small for gestational age infants (20.2% vs. 8.8%; aOR 2.08, 95% CI 0.89 to 5.24). HIV-positive women treated with HAART had increased odds of giving birth to a low birth weight infant compared to HIV-negative women (20.2% vs. 9.9%; aOR 2.91; 95% CI 1.47 to 5.78). Conclusion: In this cohort, HIV-positive women on HAART did not demonstrate a higher risk of preeclampsia, preterm birth, or small for gestational age infants; however, they did have a higher risk of having low birth weight infants.     

Subsequent pregnancy following labor of a very-low-birth-weight infant

During a period of 5 years (1978-1982), 55 mothers with an average age of 27.5 +/- 5.4 years, delivered 59 infants, weighing less than 1500 g. These infants had a mean birth weight of 1160.5 +/- 263 g and a mean gestational age of 28.7 +/- 2.25 weeks (range 25-32 weeks). Subsequently 47 (79.6%) survived and 12 (20.4%) died. There was a statistical difference of both mean gestational age and of mean gestational weight between survivors or infants with neonatal death. Twenty two of 29 mothers who subsequently became pregnant, gave birth to liveborn infants, who subsequently survived (four pregnancies terminated in induced abortion). Mean gestational age was 37 +/- 3 weeks (range 32-41 weeks) (P less than 0.001) and a mean birth weight was 2753.2 +/- 570 g (range 1620-3600 g) (P less than 0.001. All the 22 infants subsequently born weighed more than 1501 g, 7 (31.8%) infants weighed 1501-2500 g and 15 (68.2%) more than 2500 g. Similar data were obtained from a control group of 615 mothers (chosen at random) who delivered a normal infant at term, 202 subsequently became pregnant and 176 gave birth to a normal infant at term. Mean gestational age was 39.54 +/- 1.24 weeks (P less than 0.001) and mean birth weight was 3299.3 +/- 412 g (P less than 0.001). (In the control group 10 pregnancies terminated in induced abortions). The above data could be used in advising for future pregnancy outcome in regard to women with premature births.     

不同类型早产所致围生儿存活及发病情况研究

目的:探讨不同类型早产是否与围生儿的存活及发病情况有关。方法:回顾分析489例活胎妊娠孕妇(孕28~36+6周)及其分娩的550例新生儿(活产儿539个,死产儿11个),按早产类型将其分为自发性早产(SPB)、胎膜早破性早产(PPROM)、医源性早产(IPD)3组。对3组孕妇和新生儿的临床特征,围产儿的存活和发病情况进行了比较分析。结果:(1)IPD单胎围生儿存活率低于SPB和PPROM(P<0.01)。多胎围生儿存活率无统计学差异;(2)围生儿主要并发症的发病率在3组早产中无统计学差异(P>0.05)。(3)非条件Logistic回归多因素分析结果显示:Apgar 5m in评分,孕周,剖宫产与围生儿的存活成正相关。医源性早产,小于胎龄儿与围生儿存活成负相关。Apgar 5m in评分,孕周与围生儿的发病成负相关。结论:IPD与围生儿的存活呈负相关,IPD单胎围生儿存活率低于SPB和PPROM(P<0.01)。     

Role of gender in morbidity and mortality of extremely premature neonates

We investigated the effect of gender on survival and short-term outcomes of extremely premature infants (≤27 weeks) born in Canada. The records of infants admitted between 2000 and 2005 to a neonatal intensive care unit participating in the Canadian Neonatal Network were reviewed for infant gender, birth weight, gestational age, outborn status, Score for Neonatal Acute Physiology II, and antenatal corticosteroid exposure. The following outcomes were recorded: survival at final discharge, necrotizing enterocolitis, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage grade ≥3, retinopathy grade ≥3, days on ventilation, and length of hospital stay. Among 2744 extremely premature infants, 1480 (54%) were male and 1264 (46%) were female. Mean birth weight of female neonates was significantly lower at each week of gestational age. Although no significant difference in survival at discharge was found between genders overall, the prevalence of BPD, combined adverse outcomes, and mortality for infants born between 24 and 26 weeks were significantly higher in males. This study suggests that, in the postsurfactant era, males remain at higher risk of respiratory complications and may have higher mortality when born between 24 and 26 weeks of gestation.     

Growth hormone, somatomedin C, and nonsuppressible insulin-like activity levels compared in premature, small, average birth weight, and large infants

We have investigated the relationship between growth hormone, somatomedin C, nonsuppressible insulin-like activity, weight, gestational age, and 1-minute Apgar score in newborn infants. The 153 infants were categorized as small for gestational age (n = 19), average for gestational age (n = 59), large for gestational age (n = 60), and premature (gestational age at birth, 36 weeks or less (n = 15). Our study showed that (1) growth hormone levels were elevated in premature infants and correlated with Apgar scores and birth weights; (2) somatomedin C and nonsuppressible insulin-like activity levels were significantly lower in premature than in term infants; and (3) the birth weight of all infants studied had a significant overall effect on both somatomedin C and nonsuppressible insulin-like activity levels, suggesting that these factors may be involved in fetal growth. However, because in small for gestational age infants somatomedin C and nonsuppressible insulin-like activity were similar to levels in average for gestational age infants, it is suggested that other factors may inhibit fetal growth.     

Reexamining the effects of gestational age, fetal growth, and maternal smoking on neonatal mortality

BACKGROUND: Low birth weight (<2,500 g) is a strong predictor of infant mortality. Yet low birth weight, in isolation, is uninformative since it is comprised of two intertwined components: preterm delivery and reduced fetal growth. Through nonparametric logistic regression models, we examine the effects of gestational age, fetal growth, and maternal smoking on neonatal mortality. METHODS: We derived data on over 10 million singleton live births delivered at >/= 24 weeks from the 1998-2000 U.S. natality data files. Nonparametric multivariable logistic regression based on generalized additive models was used to examine neonatal mortality (deaths within the first 28 days) in relation to fetal growth (gestational age-specific standardized birth weight), gestational age, and number of cigarettes smoked per day. All analyses were further adjusted for the confounding effects due to maternal age and gravidity. RESULTS: The relationship between standardized birth weight and neonatal mortality is nonlinear; mortality is high at low z-score birth weights, drops precipitously with increasing z-score birth weight, and begins to flatten for heavier infants. Gestational age is also strongly associated with mortality, with patterns similar to those of z-score birth weight. Although the direct effect of smoking on neonatal mortality is weak, its effects (on mortality) appear to be largely mediated through reduced fetal growth and, to a lesser extent, through shortened gestation. In fact, the association between smoking and reduced fetal growth gets stronger as pregnancies approach term. CONCLUSIONS: Our study provides important insights regarding the combined effects of fetal growth, gestational age, and smoking on neonatal mortality. The findings suggest that the effect of maternal smoking on neonatal mortality is largely mediated through reduced fetal growth.     

Outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks of gestation

OBJECTIVE: To identify factors influencing the outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks' gestation. DESIGN AND POPULATION: All premature infants with gestational age <34 weeks, either inborn or outborn, with history of rupture of membranes before 25 weeks' gestation, admitted to our NICU between January 1992 and July 1997, were eligible for this retrospective study. Collected information included birth weight, gestational age at rupture of membranes and at delivery, duration between rupture of membranes and delivery (latency period), severity of oligohydramnios, pre- and post-natal managements, and follow-up of survivors. RESULTS: A total of 28 neonates fulfilled the inclusion criteria. Despite new strategies of ventilation and optimal management, the overall mortality rate was 43% (12/28). Nonsurvivors were significantly less mature at rupture of membranes, and had severe oligohydramnios (anamnios). We also noted less antenatal corticosteroids and antibiotic therapy in this group. Nine of eleven infants (82%) following rupture of membranes before 22 weeks' gestation died shortly after birth. The two remaining infants developed severe bronchopulmonary dysplasia. Nine deaths occurred in thirteen cases (69%) of anamnios. The major death causes were refractory respiratory failure and neurologic complications. Half of all survivors (8/16) developed bronchopulmonary dysplasia. CONCLUSION: The outcome of premature infants following prolonged premature rupture of membranes before 25 weeks' gestation is influenced by gestational age at rupture, severity of oligohydramnios, and antenatal antibiotics and corticosteroids. Neonates with rupture of membranes before 22 weeks have a very low chance of survival at the present time.     

A retrospective study on the effects of steroid administration and prolongation of the latent phase in patients with preterm premature rupture of the membranes

To address the issues of whether corticosteroid treatment and prolongation of the latent phase improve the outcome of pregnancy in patients with preterm premature rupture of the membranes, we studied 96 patients with premature rupture of the membranes who were delivered of infants of adequate weight for gestational age with birth weights between 751 and 2000 gm and who had a latent period longer than 48 hours. Of these 96 infants, 53 received treatment with steroids and tocolytic agents and 43 received no treatment. We found a significant decrease in perinatal mortality and in the incidence of moderate and severe hyaline membrane disease in infants whose mothers received glucocorticoids. The protective effect of glucocorticoid therapy was limited to infants with a birth weight between 751 and 1000 gm or with a gestational age of 27 to 28 weeks. We also found a significant increase in perinatal mortality, mainly due to infection, when the latent phase was prolonged for greater than 7 days, regardless of the type of management.     

重度子(癎)前期早产与自发性早产临床对比分析

目的:通过不同类型的重度子前期(severe preeclampsia,S-PE)早产和自发早产的对比分析,探讨影响S-PE早产结局的相关因素。方法:将重度子前期(研究组)早产72例(早产儿83例),按不同孕周分为早期早产、中型早产及轻型早产3类,分别与相同类型的自发早产(对照组)222例(早产儿279例)进行孕产妇及围生儿结局对比分析。结果:研究组及对照组3类型间的早产儿病死率差异有显著性(P=0.000)。研究组与对照组同类型间早产儿病死率比较,差异无显著性(P>0.05);研究组早期早产儿平均出生体重明显低于对照组(P=0.003),而早产儿并发症发生率与对照组比较,差异无显著性(P>0.05);研究组中的中型早产新生儿除重度窒息明显高于对照组外(P=0.022),新生儿平均出生体重、新生儿轻度窒息率、新生儿病死率及新生儿加强护理NICU(neonatel intensive care unit,NICU)住院日和住院费两组间差异无显著性;在轻型早产组,除研究组NICU住院日明显长于对照组外(P=0.000),两组间其他观察指标的差异均无显著性。多元回归分析显示,早产的分娩孕龄是影响重度子前期早产儿死亡的主要因素;促胎肺成熟和孕期检查是影响新生儿病率的主要因素。结论:不论重度子前期早产还是自发早产,在早期早产阶段影响围生儿预后的主要因素是分娩孕龄,重度子前期早产与自发早产围生结局无明显差异。     

Premature delivery and subsequent reproduction

To examine the relationship between premature delivery and subsequent reproductive behavior, we attempted to trace 100 mothers four years after the birth of a surviving preterm or term infant. Seventy mothers were successfully traced. Maternal age, ethnicity, gravidity, parity, religion, and socioeconomic status, and the sex, birthweight, gestational age, mode of delivery, and hospital days of the index infant were jointly related to three outcome measures: occurrence of subsequent pregnancy, and, among those who again became pregnant, pregnancy interval and number of subsequent children. Among women who had one or more subsequent births during the follow-up period, those whose index infants were of lower gestational age had fewer subsequent births (r = 0.602, df = 32, p less than 0.011). No other variables, including cesarean birth, were significantly related to later reproductive behavior. These findings indicate that the birth of a premature infant may have a significant effect of decreasing or delaying subsequent reproduction. Through confirmatory studies are needed, awareness of this relationship may help obstetric perinatologists and neonatologists sensitively discuss plans for contraception and further childbearing with women who have experienced the stress of the birth of a premature infant.