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29), preterm premature rupture of membranes (RR= 1.15; 1.01-1.32), and spontaneous PTB (RR= 1.12; 1.05-1.2. Associations did not differ by second-born infant's sex or paternity change. Having a first-born male infant was associated with a greater risk of PTB, LBW, and SGA in the second-born infant. Having a first-born male infant was associated with a greater risk of PTB, LBW, and SGA in the second-born infant. Annually, 1%-2% of hospitalized patients are discharged against medical advice (AMA), positioning them at an increased risk