Sex During Late Pregnancy: A Risk of Premature

Delivery?

Mostbut not allstudies suggest that pregnant sex

poses no risk of prematurity.
Some prenatal care providers advise pregnant women to abstain from sex, especially
during the third trimester, to reduce risk of premature delivery. But does sex during
late pregnancy increase risk of prematurity? Research findings are all over the map. Some
studies show that third trimester sex does, indeed, increase risk of premature labor. Others
show it has no effect. And one suggests that sex during late pregnancy decreases risk of
prematurity. So what should a pregnant couple do?
Prematurity: High Risk of Complications
Pregnancy usually lasts about 40 weeks. Doctors generally define prematurity as delivery
more than three weeks prior to the babys due date, or before around the 37th week.
Prematurity is associated with a host of problems. Short-term hazards to the infant include:
infections, anemia, jaundice, low blood sugar (hypoglycemia), breathing problems, heart
defects, bleeding in the brain, and digestive disorders. Longer-term risks as preemies grow
include cerebral palsy, learning disabilities, and behavior, vision, hearing, and dental
problems.
Maternal risk factors for prematurity include: diabetes, smoking, poor nutrition, multiple
fetuses, a previous preemie, high blood pressure, some physical injuries, an interval of
less than six months between pregnancies, in vitro fertilization, insufficient weight gain
during the pregnancy, several infections, stressful life events (particularly domestic
violence)and according to some studies, sex, especially during the third trimester.
Many of these risk factors are beyond womens control. Prenatal care providers urge
pregnant women to avoid those that are preventable by not smoking, eating a plant-based
diet, managing weight, and getting regular prenatal care. Some providers also advise
abstaining from sex.
The Research: Confusing
I searched the medical literature and identified 10 studies since 1990 that have
investigated sex as a possible risk factor for prematurity. Six show no association. Four do.
Studies showing that sex does NOT boost prematurity risk (and just might reduce it):
Malaysian researchers instructed 108 women with normal pregnancies to have sex as
much as they liked, but told 102 similar women to abstain. The two groups showed no
difference in rate of prematurity.
University of Texas scientists tracked the pregnancies of 187 women whod had previous
preemies, placing them at high risk of premature deliveries the next time around. During
their subsequent pregnancies, sex made no statistically significant difference in their risk.
Researchers at the University of Pittsburgh surveyed 341 women whod delivered
prematurely, asking about all their possible risk factors. Sex had no impact on risk.
 University of Colorado investigators followed 126 African-American teens through their
pregnancies. Sex was not associated with prematurity.
In a large, multicenter trial, scientists at the National Institutes of Health found that sex
during pregnancy reduced risk of prematurityunless the women had vaginal infections
(trichomonas, mycoplasma), in which case the infections increased risk.
Researchers with the National Institute of Environmental Health followed the pregnancies
of 596 North Carolina women and found sex during pregnancy linked to a substantially
reduced risk of prematurity.
Studies asserting that sex IS a risk factor for prematurity:
University of Chicago investigators found that sex during pregnancy raised risk of
prematuritybut only sex in the man-on-top (missionary) position.
Researchers at Harvard analyzed the health and lifestyle of 50 women whod
experienced premature labor. Third trimester sex significantly increased risk.
Chinese scientists compared 1391 women whod experienced prematurity with 1391
women whod delivered at term. Late pregnancy sex raised risk.
Greek researchers analyzed all 5,250 births at one hospital, of which 351 were preemies.
Sex during the last weeks of pregnancy increased risk.
What Should Pregnant Couples Do?
The weight of the evidence suggests that sex is not a major risk factor for prematurity; if
women have no vaginal infections and pregnant couples avoid the man-on-top position the
"score," at least among these studies, is eight to two.
But we cant entirely dismiss the evidence showing a sex-induced prematurity risk, so I
urge pregnant couples to review their risk factors for prematurity in consultation with their
prenatal providers. The more risk factors you have, the more sexual caution your provider
is likely to recommend.
If youve had a previous preemie and you have other risk factors, its probably prudent to
abstain from sex during the third trimester and maybe earlier. But if you have a normal
pregnancy and no risk factors, the evidence suggests that its fine to make love right up to
term if you want to.
References
Ekwoo, EE et al. Coitus Late in Pregnancy: Risk of Preterm Rupture of Amniotic Sac
Membranes, American Journal of Obstetrics and Gynecology (1993) 168:22.
Harger, JH et al. Risk Factors for Preterm Premature Rupture of Fetal Membranes: A
Multicenter Case-Control Study, American Journal of Obstetrics and Gynecology (1990)
163:130.
Hernandez-Diaz, S et al. Triggers of Spontaneous Preterm Delivery: Why
Today? Paediatric and Perinatal Epidemiology (2014) 28:79.
Petridou, E et al. Are There Common Triggers of Preterm
Deliveries? BJOPG [formerly British Journal of Gynecology] (2001) 108:598.
Read, JS and MA Klebanoff. Sexual Interourse During Pregnancy and Preterm Delivery:
Effects of Vaginal Micro-organisms. The Vaginal Infections and Prematurity Study
Group, American Journal of Obstetrics and Gynecology (1993) 168:514.
Sayle, AE et al. Sexual Activity During Late Pregnancy and Risk of Preterm
Delivery, Obstetrics and Gynecology (2001) 97:283.
Stevens-Simon, C et al. Factors Associated with Preterm Delivery Among Pregnant
Adolescents, Journal of Adolescent Health (1993) 14:340.
Tan, PC et al. Effect of Coital Activity on Onsent of Labor in Women Scheduled for Labor
Induction: A Randomized Controlled Trial, Obstetrics and Gynecology (2007) 110:820.
Yost, NP et al. Effect of Coitus on Recurrent Preterm Birth, Obstetrics and
Gynecology (2006) 107:793.
Zhang, YP et al. Risk Factors for Preterm Birth in Five Maternal and Child Health
Hospitals in Beijing, PLoS One (2012) 352780. Doi: 10.1371