Abstract
BackgroundWomen in high resource nations are increasingly delaying childbearing until their thirties. Delayed childbearing poses challenges for the spacing of a woman’s pregnancies. Inter-pregnancy intervals <12 months are associated with risk for adverse pregnancy outcome, yet increased maternal age at delivery is linked with increased risk. The optimal inter-pregnancy interval for older mothers is uncertain. This systematic review will aim to assess the relation between inter-pregnancy interval and perinatal and maternal health outcomes in women who delay childbearing to age 30 and older.MethodsWe will search MEDLINE, CINAHL, and EMBASE databases for peer-reviewed articles on the effects of inter-pregnancy interval on perinatal and maternal health outcomes among women over 29 years at the time of first birth, in high-income countries. To assess the quality of studies, the Cochrane’s Collaboration tool for assessing risk of bias will be used for randomized controlled trials, and the Newcastle-Ottawa tool to assess quality of case control and cross-sectional studies. The quality of the findings on each outcome will be assessed across studies, using the GRADE approach. The decision to conduct meta-analyses will be based on the concordance in definitions used for inter-pregnancy intervals, age groups studied, or outcomes measured among selected studies. We will report odds ratios and/or relative risks and/or risk differences for different inter-pregnancy intervals and perinatal and maternal outcomes as well as pregnancy complications.DiscussionThis systematic review will summarize existing data on the relation between inter-pregnancy interval and perinatal and maternal health outcomes among women who delay childbearing to age 30 and older. Findings will inform clinical best practices to assist mothers over age 30 to space their pregnancies appropriately.Systematic review registrationProspero CRD42015019057
Highlights
Women in high resource nations are increasingly delaying childbearing until their thirties
This systematic review study will examine the association between inter-pregnancy interval and perinatal and maternal health outcomes in women age 30 and older at the time of birth, with the aim to provide evidence and recommendations on optimal inter-pregnancy intervals for this particular age group of women
Data sources and search strategy We will conduct computerized searches in Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), and CINAHL, using a combination of medical subject headings (MeSH) and keywords related to inter-pregnancy interval without any restrictions on time period, language, or study type
Summary
This systematic review protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement [10] (Additional file 1) and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42015019057). We will decide whether to conduct a meta-analysis based on whether the individual studies differed considerably in definitions used for inter-pregnancy intervals, age groups studied, or outcomes measured. Studies, the Newcastle-Ottawa Scale (NOS) for cohort studies will be used [14] This tool assigns stars to indicate higher quality based on three broad criteria, specific to the study design (i.e., selection of study groups, comparability and outcome assessment). This information will be presented in a summary table, indicating the star rating for each individual study included in the review. A Summary of Findings table will be generated to present the quality of the evidence, the magnitude of the effect, and reasons behind decisions
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