Interpregnancy interval and maternal and neonatal morbidity: a nationwide cohort study.
Ontology highlight
ABSTRACT:
SUBMITTER: Muhlrad H
PROVIDER: S-EPMC9579163 | biostudies-literature | 2022 Oct
REPOSITORIES: biostudies-literature
Publications
Interpregnancy interval and maternal and neonatal morbidity: a nationwide cohort study.
Mühlrad Hanna H Björkegren Evelina E Haraldson Philip P Bohm-Starke Nina N Kopp Kallner Helena H Brismar Wendel Sophia S
Scientific reports 20221018 1
This study aimed to assess the association between interpregnancy interval (IPI)-the time from childbirth to conception of the next pregnancy-and maternal and neonatal morbidity. The World Health Organization (WHO) currently recommends an IPI of at least 24 months after a live birth to reduce adverse birth outcomes. However, assessing the relationship between IPI and perinatal outcome is complicated by confounding factors. We conducted a nationwide population-based cohort study using Swedish reg ...[more]
Similar Datasets
Project description:ObjectiveTo study the impact of interpregnancy interval on maternal morbidity and mortality.DesignRetrospective cross sectional study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Montevideo, Uruguay.SettingLatin America and the Caribbean, 1985-97.Participants456 889 parous women delivering singleton infants.Main outcome measuresCrude and adjusted odds ratios of the effects of short and long interpregnancy intervals on maternal death, pre-eclampsia, eclampsia, gestational diabetes mellitus, third trimester bleeding, premature rupture of membranes, postpartum haemorrhage, puerperal endometritis, and anaemia.ResultsShort (<6 months) and long (>59 months) interpregnancy intervals were observed for 2.8% and 19.5% of women, respectively. After adjustment for major confounding factors, compared with those conceiving at 18 to 23 months after a previous birth, women with interpregnancy intervals of 5 months or less had higher risks for maternal death (odds ratio 2.54; 95% confidence interval 1.22 to 5.38), third trimester bleeding (1.73; 1.42 to 2.24), premature rupture of membranes (1.72; 1.53 to 1.93), puerperal endometritis (1.33; 1.22 to 1.45), and anaemia (1.30; 1.18 to 1.43). Compared with women with interpregnancy intervals of 18 to 23 months, women with interpregnancy intervals longer than 59 months had significantly increased risks of pre-eclampsia (1.83; 1.72 to 1.94) and eclampsia (1.80; 1.38 to 2.32).ConclusionsInterpregnancy intervals less than 6 months and longer than 59 months are associated with an increased risk of adverse maternal outcomes.
| S-EPMC27528 | biostudies-literature
Project description:OBJECTIVE: To determine whether a short interval between pregnancies is an independent risk factor for adverse obstetric outcome. DESIGN: Retrospective cohort study. SETTING: Scotland. SUBJECTS: 89 143 women having second births in 1992-8 who conceived within five years of their first birth. MAIN OUTCOME MEASURES: Intrauterine growth restriction (birth weight less than the 5th centile for gestational age), extremely preterm birth (24-32 weeks), moderately preterm birth (33-36 weeks), and perinatal death. RESULTS: Women whose subsequent interpregnancy interval was less than six months were more likely than other women to have had a first birth complicated by intrauterine growth restriction (odds ratio 1.3, 95% confidence interval 1.1 to 1.5), extremely preterm birth (4.1, 3.2 to 5.3), moderately preterm birth (1.5, 1.3 to 1.7), or perinatal death (24.4, 18.9 to 31.5). They were also shorter, less likely to be married, and more likely to be aged less than 20 years at the time of the second birth, to smoke, and to live in an area of high socioeconomic deprivation. When the outcome of the second birth was analysed in relation to the preceding interpregnancy interval and the analysis confined to women whose first birth was a term live birth (n = 69 055), no significant association occurred (adjusted for age, marital status, height, socioeconomic deprivation, smoking, previous birth weight vigesimal, and previous caesarean delivery) between interpregnancy interval and intrauterine growth restriction or stillbirth. However, a short interpregnancy interval (< 6 months) was an independent risk factor for extremely preterm birth (adjusted odds ratio 2.2, 1.3 to 3.6), moderately preterm birth (1.6, 1.3 to 2.0), and neonatal death unrelated to congenital abnormality (3.6, 1.2 to 10.7). The adjusted attributable fractions for these associations were 6.1%, 3.9%, and 13.8%. The associations were very similar when the analysis was confined to married non-smokers aged 25 and above. CONCLUSIONS: A short interpregnancy interval is an independent risk factor for preterm delivery and neonatal death in the second birth.
| S-EPMC169644 | biostudies-other
Project description:Interpregnancy interval (IPI) is associated with adverse perinatal outcomes, but its contribution to severe maternal morbidity (SMM) remains unclear. We examined the association between IPI and SMM, using data linked across sequential pregnancies to women in California during 1997-2012. Adjusting for confounders measured in the index pregnancy (i.e., the first in a pair of consecutive pregnancies), we estimated adjusted risk ratios for SMM related to the subsequent pregnancy. We further conducted within-mother comparisons and analyses stratified by parity and maternal age at the index pregnancy. Compared with an IPI of 18-23 months, an IPI of <6 months had the same risk for SMM in between-mother comparisons (adjusted risk ratio (aRR) = 0.96, 95% confidence interval (CI): 0.91, 1.02) but lower risk in within-mother comparisons (aRR = 0.76, 95% CI: 0.67, 0.86). IPIs of 24-59 months and ≥60 months were associated with increased risk of SMM in both between-mother (aRR = 1.18 (95% CI: 1.13, 1.23) and aRR = 1.76 (95% CI: 1.68, 1.85), respectively) and within-mother (aRR = 1.22 (95% CI: 1.11, 1.34) and aRR = 1.88 (95% CI: 1.66, 2.13), respectively) comparisons. The association between IPI and SMM did not vary substantially by maternal age or parity. In this study, longer IPI was associated with increased risk of SMM, which may be partly attributed to interpregnancy health.
| S-EPMC8168254 | biostudies-literature
Project description:ObjectiveTo evaluate the maternal and neonatal outcomes of women with short interpregnancy intervals (IPI < 6 months) following a multifetal pregnancy.Study designA multicenter retrospective cohort study of women with an index multifetal delivery and a subsequent singleton gestation between 2005 and 2021. The obstetrical outcomes of pregnancies following short IPI (<6 months) were compared to those with an IPI of 18-48 months. Additional analyses were also conducted for the other IPI groups: 7-17 months, and longer than 49 months, while women with an IPI of 18-48 months served as the reference group. The primary outcome was preterm birth (<37 weeks) rate. Secondary outcomes were other adverse maternal and neonatal outcomes. Univariate and multiple logistic regression analyses were performed.ResultsOverall, 2514 women had a primary multifetal delivery with a subsequent singleton gestation at our medical centers; 160 (6.4%) had a short IPI, and 1142 (45.4%) had an optimal IPI. Women with a singleton gestation following a short IPI were younger, with lower rates of previous cesarean and fertility treatments. Women in the short IPI group had significantly higher rates of preterm birth <37 weeks, anemia (Hb < 11 gr%) on admission to the delivery room, and placental abruption. Multivariable logistic regression analysis demonstrated that short IPI is associated with an increased risk for preterm birth (aOR 2.39, 95% CI 1.12-5.11, p = 0.03).ConclusionShort IPI following a multifetal gestation is associated with an increased risk for preterm birth in subsequent singleton pregnancy.
| S-EPMC10094927 | biostudies-literature
Project description:BackgroundPrepregnancy body mass index and gestational weight gain have been linked with severe maternal morbidity, suggesting that weight change between pregnancies may also play a role, as it does for neonatal outcomes.ObjectiveThis study assessed the association of changes in prepregnancy body mass index between 2 consecutive singleton pregnancies with the outcomes of severe maternal morbidity, stillbirth, and small- and large-for-gestational-age infants in the subsequent pregnancy.Study designThis observational study was based on birth records from 1,111,032 consecutive pregnancies linked to hospital discharge records in California (2007-2017). Interpregnancy body mass index change between the beginning of an index pregnancy and the beginning of the subsequent pregnancy was calculated from self-reported weight and height. Severe maternal morbidity was defined based on the Centers for Disease Control and Prevention index, including and excluding transfusion-only cases. We used multivariable log-binomial regression models to estimate adjusted risks, overall and stratified by prepregnancy body mass index at index birth.ResultsSubstantial interpregnancy body mass index gain (≥4 kg/m2) was associated with severe maternal morbidity in crude but not adjusted analyses. Substantial interpregnancy body mass index loss (>2 kg/m2) was associated with increased risk of severe maternal morbidity (adjusted relative risk, 1.13; 95% confidence interval (1.07-1.19), and both substantial loss (adjusted relative risk, 1.11 [1.02-1.19]) and gain (≥4 kg/m2; adjusted relative risk, 1.09 [1.02-1.17]) were associated with nontransfusion severe maternal morbidity. Substantial loss (adjusted relative risk, 1.17 [1.05-1.31]) and gain (1.26 [1.14-1.40]) were associated with stillbirth. Body mass index gain was positively associated with large-for-gestational-age infants and inversely associated with small-for-gestational-age infants.ConclusionSubstantial interpregnancy body mass index changes were associated with modestly increased risk of severe maternal morbidity, stillbirth, and small- and large-for-gestational-age infants.
| S-EPMC10960247 | biostudies-literature
Project description:BackgroundAfter the implementation of the universal two-child policy in China, it was more frequent to have long interpregnancy intervals (IPIs) and advanced maternal age. However, the interactions between long IPIs and advanced maternal age on neonatal outcomes are unknown.MethodsThe study subjects of this historical cohort study were multiparas with singleton live births between October 1st, 2015, and October 31st, 2020. IPI was defined as the interval between delivery and conception of the subsequent pregnancy. Logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the risks of preterm birth (PTB), low birth weight (LBW), small for gestation age, and 1-min Apgar score ≤ 7 in different IPI groups. Relative excess risk due to interaction (RERI) was used to evaluate the additive interaction between long IPIs and advanced maternal age.ResultsCompared with the 24 ≤ IPI ≤ 59 months group, the long IPI group (IPI ≥ 60 months) was associated with a higher risk of PTB (aOR, 1.27; 95% CI: 1.07-1.50), LBW (aOR, 1.32; 95% CI 1.08-1.61), and one-minute Apgar score ≤ 7 (aOR, 1.46; 95% CI 1.07-1.98). Negative additive interactions (all RERIs < 0) existed between long IPIs and advanced maternal age for these neonatal outcomes. Meanwhile, IPI < 12 months was also associated with PTB (aOR, 1.51; 95% CI 1.13-2.01), LBW (aOR, 1.50; 95% CI 1.09-2.07), and 1-min Apgar score ≤ 7 (aOR, 1.93; 95% CI 1.23-3.04).ConclusionsBoth short and long IPIs are associated with an increased risk of adverse neonatal outcomes. Appropriate IPI should be recommended to women planning to become pregnant again. In addition, better antenatal care might be taken to balance the inferiority of advanced maternal age and to improve neonatal outcomes.
| S-EPMC10590323 | biostudies-literature
Project description:BackgroundInterpregnancy interval (IPI) has been linked with several maternal and neonatal adverse events in the general population. However, the association between IPI and maternal and neonatal outcomes in women whose first delivery was by cesarean delivery is unclear. We aimed to investigate the association between IPI after cesarean delivery and the risk of maternal and neonatal adverse events.MethodsWomen (aged ≥ 18 years) whose first delivery was cesarean delivery with 2 consecutive singleton pregnancies from the National Vital Statistics System (NVSS) database between 2017 and 2019 were included in this retrospective cohort study. In this post-hoc analysis, logistic regression analyses were used to examine IPI (≤ 11, 12-17, 18-23 [reference], 24-35, 36-59, and ≥ 60 months) in relation to the risk of repeat cesarean delivery, maternal adverse events (maternal transfusion, ruptured uterus, unplanned hysterectomy, and admission to an intensive care unit), and neonatal adverse events (low birthweight, premature birth, Apgar score at 5 min < 7, and abnormal conditions of the newborn). Stratified analysis based on age (< 35 and ≥ 35 years) and previous preterm birth.ResultsWe included 792,094 maternities, 704,244 (88.91%) of which underwent a repeat cesarean delivery, 5,246 (0.66%) women had adverse events, and 144,423 (18.23%) neonates had adverse events. After adjusting for confounders, compared to an IPI of 18-23 months, the IPI of ≤ 11 months [odds ratio (OR) = 1.55, 95% confidence interval (CI): 1.44-1.66], 12-17 months (OR = 1.38, 95%CI: 1.33-1.43), 36-59 months (OR = 1.12, 95%CI: 1.10-1.15), and ≥ 60 months (OR = 1.19, 95%CI: 1.16-1.22) were associated with an increased risk of repeat cesarean delivery. In terms of maternal adverse events, only IPI of ≥ 60 months (OR = 0.85, 95%CI: 0.76-0.95) was observed to be associated with decreased risk of maternal adverse events in women aged < 35 years. In analysis of neonatal adverse events, IPI of ≤ 11 months (OR = 1.14, 95%CI: 1.07-1.21), 12-17 months (OR = 1.07, 95%CI: 1.03-1.10), and ≥ 60 months (OR = 1.05, 95%CI: 1.02-1.08) were related to an increased risk of neonatal adverse events.ConclusionBoth short and long IPI were associated with an increased risk of repeat cesarean delivery and neonatal adverse events, and women < 35 years may benefit from a longer IPI.
| S-EPMC10127338 | biostudies-literature
Project description:BackgroundTo investigate associations between interpregnancy intervals (IPIs) and adverse birth outcomes in twin pregnancies.MethodsThis retrospective cohort study of 9,867 twin pregnancies in Western Australia from 1980-2015. Relative Risks (RRs) were estimated for the interval prior to the pregnancy (IPI) as the exposure and after the pregnancy as a negative control exposure for preterm birth (< 37 weeks), early preterm birth (< 34 weeks), small for gestational age (SGA: < 10th percentile of birth weight by sex and gestational age) and low birth weight (LBW: birthweight < 2,500 g).ResultsRelative to IPIs of 18-23 months, IPIs of < 6 months were associated with a higher risk of early preterm birth (aRR 1.41, 95% CI 1.08-1.83) and LBW for at least one twin (aRR 1.16, 95% CI 1.06-1.28). IPIs of 6-11 months were associated with a higher risk of SGA (aRR 1.24, 95% CI 1.01-1.54) and LBW for at least one twin (aRR 1.09, 95% CI 1.01-1.19). IPIs of 60-119 months and ≥ 120 months were associated with an increased risk of preterm birth (RR 1.12, 95% CI 1.03-1.22; and (aRR 1.25, 95% CI 1.10-1.41, respectively), and LBW for at least one twin (aRR 1.17, 95% CI 1.08-1.28; and aRR 1.20, 95% CI 1.05-1.36, respectively). IPIs of ≥ 120 months were also associated with an increased risk of early preterm birth (aRR 1.42, 95% CI 1.01-2.00). After negative control analysis, IPIs ≥ 120 months remained associated with early preterm birth and LBW.ConclusionEvidence for adverse associations with twin birth outcomes was strongest for long IPIs.
| S-EPMC10832241 | biostudies-literature
Project description:ImportanceInterpregnancy intervals shorter than 18 months are associated with higher risks of adverse pregnancy outcomes. It is currently unknown whether short intervals are associated with increased risks among older women to the same extent as among younger women.ObjectiveTo evaluate whether the association between short interpregnancy (delivery to conception) interval and adverse pregnancy outcomes is modified by maternal age.Design, setting, and participantsA population-based cohort study conducted in British Columbia, Canada, evaluated women with 2 or more singleton pregnancies from 2004 to 2014 with the first (index) pregnancy resulting in a live birth. Data analysis was performed from January 1 to July 20, 2018.Main outcomes and measuresRisks of maternal mortality or severe morbidity (eg, mechanical ventilation, blood transfusion >3 U, intensive care unit admission, organ failure, death), small-for-gestational age (<10th birthweight percentile for gestational age and sex), fetal and infant composite outcome (stillbirth, infant death, <third birthweight percentile for gestational age and sex, delivery <28 weeks), and spontaneous and indicated preterm delivery. Risks of each outcome for 3- to 24-month interpregnancy intervals were estimated, according to maternal age at index birth (20-34 and ≥35 years). Adjusted risk ratios (aRRs) comparing predicted risks at 3-, 6-, 9-, and 12-month intervals with risks at 18-month intervals for each age group were calculated. The potential role of other factors explaining any differences (unmeasured confounding) was examined in several sensitivity analyses.ResultsAmong 148 544 pregnancies, maternal mortality or severe morbidity risks were increased at 6-month compared with 18-month interpregnancy intervals for women aged 35 years or older (0.62% at 6 months vs 0.26% at 18 months; aRR, 2.39; 95% CI, 2.03-2.80), but not for women aged 20 to 34 years (0.23% at 6 months vs 0.25% at 18 months; aRR, 0.92; 95% CI, 0.83-1.02). Increased adverse fetal and infant outcome risks were more pronounced for women aged 20 to 34 years (2.0% at 6 months vs 1.4% at 18 months; aRR, 1.42; 95% CI, 1.36-1.47) than women 35 years or older (2.1% at 6 months vs 1.8% at 18 months; aRR, 1.15; 95% CI, 1.01-1.31). Risks of spontaneous preterm delivery at 6-month interpregnancy intervals were increased for women 20 to 34 years old (5.3% at 6 months vs 3.2% at 18 months; aRR, 1.65; 95% CI, 1.62-1.68) and to a lesser extent for women 35 years or older (5.0% at 6 months vs 3.6% at 18 months; aRR, 1.40; 95% CI, 1.31-1.49). Modest increases in risks of small-for-gestational age and indicated preterm delivery at short intervals did not vary meaningfully by maternal age. Sensitivity analyses suggested that observed associations were not fully explained by unmeasured confounding.Conclusions and relevanceThe findings of this study suggest that short interpregnancy intervals are associated with increased risks for adverse pregnancy outcomes for women of all ages.
| S-EPMC6583597 | biostudies-literature
Project description:Pregnancy represents a metabolic challenge to women; in a normal pregnancy, transient metabolic changes occur that support the needs of the growing fetus. It is possible that repeating this challenge within a relatively short amount of time may result in lasting damage to the woman's cardiovascular health. Conversely, it is also possible that a long interpregnancy interval (IPI) may reflect subfertility, which has been found to be associated with cardiovascular disease (CVD). We examine the associations of short and long IPI with measures of cardiovascular health.Prospective cohort.Mothers of the Avon Longitudinal Study of Parents and Children (ALSPAC).Women with two live births in order to control for confounding by parity.Arterial distensibility, common carotid intima, adiposity, blood pressure, lipids, glucose, insulin, proinsulin, triglycerides, C reactive protein.25% (n=3451) of ALSPAC mothers had provided sufficient data to determine full reproductive history-of these, 1477 had two live births, with 54% mothers having non-missing data on all variables required for our analyses. A total of 1268 mothers with IPI (interbirth interval minus 9 months' gestation) had CVD risk factors measured/imputed at mean age 48 years. After adjusting for confounding, we found no association of either short (?15 months) or long (>27 months) IPI and increased levels of cardiovascular risk factors. There was some suggestion that women with long and short IPIs had a more favourable lipid profile compared with women whose IPI was 16-27 months; however, the differences were small in magnitude and imprecisely estimated.This study does not support the hypothesis that either long or short IPI is a risk factor for later cardiovascular health.
| S-EPMC3963084 | biostudies-literature