El intervalo intergenésico: un factor de riesgo para complicaciones obstétricas y neonatales

Abstract

Objective To determine the impact of the interval between pregnancies on maternal-foetal morbidity. Materiads Method A cohort study carried out from 1st May until 31st December 2002 in the Gynaecology and Obstetric Department of the Metropolitan Hospital Complex (Social Security) in Panama. We included patients with previous pregnancies, and who were admitted with spontaneous abortion, and patients of any gestational age who were admitted because of pregnancy termination. We excluded primigravidas, patients with a disease existing before pregnancy, and those with incomplete records. We correlated obstetric pathologies, neonatal outcome, and the interval between pregnancies. Statistical analysis was made with EPI-INFO 2002, Chi-square. The odds ratio (OR) had a confidence interval (CI) of 95% and p < 0.05. Results A total of 1044 patients were analysed, the average age was 29.7 ± 5.14 years and 8.1% were multiparous patients. The average interval between pregnancies was 45 ± 31.7 months. The obstetrical and neonatal pathologies associated with the interval between pregnancies were pre-eclampsia, gestational diabetes, placental abruption, stillbirth, foetal distress, premature delivery, placenta previa, admission to NICU, apgar score and perinatal death. We found that the period between 25 and 48 months had a protective factor against the development of obstetric and neonatal complications. A period ≤ 24 months is a risk factor for the development of premature delivery, OR 13 (95% CI, 9-18), a higher number of admissions to NICU, OR 5.7 (95% CI, 3-9), and perinatal death OR 3.2 (95% CI, 1.3-8). An interval between pregnancies o ≥ 49 months is a risk factor for the development of pre-eclampsia OR 29 (95% CI, 19-45), placental abruption OR 3.6 (95% CI, 1.2-11) and caesarean section OR 10.1 (95% CI, 6-17). Conclusions An interval between pregnancies ≤ 24 months and = 49 months are associated with an increase in obstetric and neonatal complications, thus the period between 25 and 48 months is optimal to prevent maternal-foetal complications.