Impact of Increasing Inter-pregnancy Interval on Maternal and Infant Health

• Type of Material: Article
• Authors: Amanda Wendt, Emory University; Cassandra M. Gibbs, Emory University; Stacey Peters, Emory University; Carol J Hogue, Emory University
• Language: English
• Date: 2012-07-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Blackwell Publishing Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1365-3016.2012.01285.x
• Title of Journal or Parent Work: Paediatric and Perinatal Epidemiology
• ISSN: 0269-5022
• Volume: 26
• Issue: SUPPL. 1
• Start Page: 239
• End Page: 258
• Keywords: FOLATE; Obstetrics & Gynecology; interpregnancy intervals; preterm; Life Sciences & Biomedicine; VITAMIN-A; PRETERM BIRTH; early neonatal death; Science & Technology; LOW-BIRTH-WEIGHT; maternal morbidity; DEPLETION; maternal nutrition status; ASSOCIATION; SUBSEQUENT RISK; Pediatrics; Public, Environmental & Occupational Health; NUTRITIONAL-STATUS; stillbirth; low birthweight; SHORT INTERPREGNANCY INTERVALS; PERINATAL OUTCOMES; maternal mortality
• Research Categories: Health Sciences, Obstetrics and Gynecology

Abstract

Short inter-pregnancy intervals (IPIs) have been associated with adverse maternal and infant health outcomes in the literature. However, many studies in this area have been lacking in quality and appropriate control for confounders known to be associated with both short IPIs and poor outcomes. The objective of this systematic review was to assess this relationship using more rigorous criteria, based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. We found too few higher-quality studies of the impact of IPIs (measured as the time between the birth of a previous child and conception of the next child) on maternal health to reach conclusions about maternal nutrition, morbidity or mortality. However, the evidence for infant effects justified meta-analyses. We found significant impacts of short IPIs for extreme preterm birth [<6 m adjusted odds ratio (aOR): 1.58 [95% confidence interval (CI) 1.40, 1.78], 6-11 m aOR: 1.23 [1.03, 1.46]], moderate preterm birth (<6 m aOR: 1.41 [1.20, 1.65], 6-11 m aOR: 1.09 [1.01, 1.18]), low birthweight (<6 m aOR: 1.44 [1.30, 1.61], 6-11 m aOR: 1.12 [1.08, 1.17]), stillbirth (aOR: 1.35 [1.07, 1.71] and early neonatal death (aOR: 1.29 [1.02, 1.64]) outcomes largely in high- and moderate-income countries. It is likely these effects would be greater in settings with poorer maternal health and nutrition. Future research in these settings is recommended. This is particularly important in developing countries, where often the pattern is to start childbearing at a young age, have all desired children quickly and then control fertility through permanent contraception, thereby contracting women's fertile years and potentially increasing their exposure to the ill effects of very short IPIs.