Impact of interpregnancy intervals on perinatal and neonatal outcomes in a multiethnic Pakistani population

Abstract

Background Short birth intervals (SBIs) and long birth intervals (LBIs) have been shown to have serious implications for health of both mothers and their children. This study was aimed to investigate the determinants and reproductive outcome of SBI and LBI in a multiethnic Pakistani population. Methods In a cross-sectional prospective study design, 2798 women admitted in a tertiary-care hospital in Islamabad for delivery were recruited and data on second or higher birth order deliveries were collected. Birth intervals were defined as short (<24 months) and long (>36 months). The reproductive outcome was defined in terms of perinatal and neonatal mortalities, and neonatal complications. Univariate and multivariate logistic regression analyses were performed. Results Pregnancies with SBI and LBI were observed in 20% and 24% of 2798 women, respectively. Women with SBI had increased odds of perinatal death [adjusted odd ratio (AOR): 1.50] and neonatal death (AOR: 1.47) as compared to women with optimal birth intervals, while women with LBI had slightly lower odds of perinatal deaths (AOR: 0.96), but increased odds of neonatal deaths (AOR: 1.12). Further, the pregnancies with both SBI and LBI were associated with increased odds of short body length, low birth weight, small head circumference and low APGAR score. Conclusion Nearly half of all pregnancies do not have optimal birth spacing albeit there is wide heterogeneity in the distribution of BI in various Pakistani ethnicities. Pregnancies with SBI and LBI had high risk of adverse reproductive outcome. Intervention programs for maternal and child health need to emphasize optimal birth spacing.

Effects of short inter-pregnancy/birth interval on adverse perinatal outcomes in Asia-Pacific region: A systematic review and meta-analysis

“…The remaining studies were conducted in Bangladesh (n = 3) [ 45 , 50 , 54 ], Japan (n = 4) [ 47 , 75 – 77 ], Australia (n = 3) [ 43 , 56 , 78 ], Afghanistan (n = 2) [ 53 , 79 ], Indonesia (n = 1) [ 44 ], Nepal (n = 1) [ 80 ], and Papua New Guinea (n = 1) [ 81 ]. More than half of the included studies were cross-sectional (n = 23)[ 38 – 40 , 42 – 45 , 48 – 50 , 52 , 53 , 55 , 61 , 63 , 64 , 68 , 70 , 71 , 79 , 82 – 84 ], one quarter (n = 12)[ 41 , 47 , 51 , 54 , 66 , 67 , 73 , 75 , 78 , 85 – 87 ] were cohort studies, and the remaining six studies were case controls [ 46 , 62 , 72 , 74 , 81 , 88 ]. Twenty-five studies were facility-based [ 41 – 44 ,…”

Short birth interval in the Asia-Pacific region: A systematic review and meta-analysis

“…Socio-demographic and economic factors, women's reproductive history, and child-related factors were commonly investigated in relation to short birth interval. Mother's educational status showed varying associations with short birth interval across different studies, with some reporting increased risks among illiterate mothers [78] and others reporting decreased odds among women with higher education [29]. Although educated women usually tend to delay their first pregnancy [89], it has also been hypothesised that these women may want to compress motherhood into fewer years and, therefore are likely to have shorter birth intervals [97].…”

“…Maternal age was one of the most investigated demographic factors in relation to short birth interval. Out of the 11 studies that investigated maternal age, four reported a positive association between maternal age and short birth interval, four reported a negative association, and three found no significant association [50,54,78]. Although measured slightly differently across the studies, the findings were inconsistent, with varying risks observed across different age groups.…”

“…Among the 140 studies included, 39 studies considered the duration of time elapsed between the birth of the index child (child under study) and the birth of the previous child, commonly referred to as the birth-tobirth interval, to define the short birth interval. Of these 39 studies, 36 studies used the term birth interval to report short birth interval, while the remaining three studies used either inter-pregnancy interval (n = 1) [45], inter-outcome interval (n = 1) [46] or birth spacing (n = 1) [37] to describe the same concept. Additionally, 37 studies considered the duration of time between the birth of the previous child and the subsequent pregnancy, referred to as the birth-to-conception interval, and three studies [47][48][49] measured the time between two pregnancies, known as the pregnancy-to-pregnancy interval.…”

“…A study from Bangladesh reported a 1.6 increased odds of experiencing short birth interval among women with no formal education compared to those with a higher education [29]. Another community-based cross-sectional study from the same country found a much higher risk among illiterate mothers (odds ratio (OR) = 4.0; 95% CI = 1.9-17.2) [78]. A cross-sectional study from Pakistan also reported a decreased odds of the short birth interval by 25% (hazard ratio (HR) = 0.75; 95% CI = 0.7-0.9), 38% (HR = 0.6; 95% CI = 0.5-0.8), and 31% (HR = 0.69; 95% CI = 0.5-0.9) among women with a secondary, intermediate, and higher education, respectively, as compared to those with no education [17].…”