BACKGROUND: Due to high fertility rates in some low and lower-middle income countries, the interval between pregnancies can be short, which may lead to adverse maternal and neonatal outcomes.
METHODS: We analyzed data from women enrolled in the NICHD Global Network Maternal Newborn Health Registry (MNHR) from 2013 through 2018. We report maternal characteristics and outcomes in relationship to the inter-delivery interval (IDI, time from previous delivery [live or stillborn] to the delivery of the index birth), by category of 6-17 months (short), 18-36 months (reference), 37-60 months, and 61-180 months (long). We used non-parametric tests for maternal characteristics, and multivariable logistic regression models for outcomes, controlling for differences in baseline characteristics.
RESULTS: We evaluated 181,782 women from sites in the Democratic Republic of Congo, Zambia, Kenya, Guatemala, India, and Pakistan. Women with short IDI varied by site, from 3% in the Zambia site to 20% in the Pakistan site. Relative to a 18-36 month IDI, women with short IDI had increased risk of neonatal death (RR = 1.89 [1.74, 2.05]), stillbirth (RR = 1.70 [1.56, 1.86]), low birth weight (RR = 1.38 [1.32, 1.44]), and very low birth weight (RR = 2.35 [2.10, 2.62]). Relative to a 18-36 month IDI, women with IDI of 37-60 months had an increased risk of maternal death (RR 1.40 [1.05, 1.88]), stillbirth (RR 1.14 [1.08, 1.22]), and very low birth weight (RR 1.10 [1.01, 1.21]). Relative to a 18-36 month IDI, women with long IDI had increased risk of maternal death (RR 1.54 [1.10, 2.16]), neonatal death (RR = 1.25 [1.14, 1.38]), stillbirth (RR = 1.50 [1.38, 1.62]), low birth weight (RR = 1.22 [1.17, 1.27]), and very low birth weight (RR = 1.47 [1.32,1.64]). Short and long IDIs were also associated with increased risk of obstructed labor, hemorrhage, hypertensive disorders, fetal malposition, infection, hospitalization, preterm delivery, and neonatal hospitalization.
CONCLUSIONS: IDI varies by site. When compared to 18-36 month IDI, women with both short IDI and long IDI had increased risk of adverse maternal and neonatal outcomes.
TRIAL REGISTRATION: The MNHR is registered at NCT01073475 .
Recommended CitationBauserman, Melissa; Nowak, Kayla; Nolen, Tracy L; Patterson, Jackie; Lokangaka, Adrien; Tshefu, Antoinette; Patel, Archana B; Hibberd, Patricia L; Garces, Ana L; Figueroa, Lester; Krebs, Nancy F; Esamai, Fabian; Liechty, Edward A; Carlo, Waldemar A; Chomba, Elwyn; Mwenechanya, Musaku; Goudar, Shivaprasad S; Ramadurg, Umesh; Derman, Richard J; Saleem, Sarah; Jessani, Saleem; Koso-Thomas, Marion; McClure, Elizabeth M; Goldenberg, Robert L; and Bose, Carl, "The relationship between birth intervals and adverse maternal and neonatal outcomes in six low and lower-middle income countries." (2020). Global Health Articles. Article 18.
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