Interpregnancy Interval Research Articles

Postpartum long-acting reversible contraceptive use among active-duty, female US Army soldiers

Postpartum utilization of long-acting reversible contraception (LARC) has been found to be effective at increasing inter-pregnancy intervals, reducing unintended pregnancies, and optimizing health outcomes for mothers and babies. Among female active-duty military members, reproductive planning may be particularly important, yet little is known about postpartum long-acting reversible contraceptive use among active-duty soldiers. (1) To quantify postpartum uptake of long-acting reversible contraception among U.S. Army active-duty female soldiers, and (2) to identify demographic and military-specific characteristics associated with utilization. This retrospective cohort study used longitudinal data on all digitally recorded health encounters for active-duty U.S. Army soldiers from 2014-2017. The servicewomen included in our analysis were aged 18-44 years with at least one delivery and a minimum of four months of total observed time post-delivery within the study period. We defined postpartum long-acting reversible contraception utilization as initiation in the delivery month or in the three calendar months following delivery, and identified likely immediate postpartum initiation via the proxy of placement recorded during the same month as delivery. We then evaluated predictors of postpartum long-acting reversible contraception utilization using multivariable logistic regression. Inclusion criteria were met by 15,843 soldiers. Of those, 3,162 (19.96%) received a method of long-acting reversible contraception in the month of, or within the three months following, delivery. Fewer than 5% of these women utilized immediate postpartum long-acting reversible contraception. Among women receiving a postpartum long-acting reversible contraceptive method, 1,803 (57.0%) received an IUD, 1,328 (42.0%) received an etonogestrel implant and 31 received both (0.98%). Soldiers of younger age, self-reported White race, and those married or previously married were more likely to initiate long-acting reversible contraception in the postpartum period. Race-stratified analyses showed that self-reported White women had the highest utilization rates overall. Compared to these women, the adjusted odds of postpartum utilization among self-reported Black and Asian/Pacific Islander women were 18% and 30% lower, respectively (both p<0.001). There was also a trend of decreasing postpartum utilization with increasing age within each race group. Differences observed between age groups and race identities could partially be attributed to differential utilization of permanent contraception (sterilization), which was found to be significantly more prevalent among both women aged 30 years or older, as well as among Black-identifying women. Among active-duty U.S. Army servicewomen, one in five utilized postpartum long-acting reversible contraception, with fewer than 5 percent of these women utilizing an immediate postpartum method. Within this population with universal healthcare coverage, we observed relatively low rates of utilization and significant differences in uptake of effective postpartum long-acting contraceptive methods across self-reported race categories.

Association between inter-pregnancy interval and risk of adverse birth outcomes in subsequent pregnancy: A retrospective study from Jordan.

Adverse birth outcomes, such as preterm birth and low birth weight (LBW), are leading causes of neonatal morbidity and mortality. In this study, we aimed to estimate the association between inter-pregnancy interval (IPI) and the risks of adverse birth outcomes in a subsequent pregnancy. We conducted a retrospective analysis involving 630 mothers who delivered a singleton live infant at a leading tertiary hospital in northern Jordan from March to August 2021. Outcome variables were preterm birth (<37 weeks of gestation) and LBW (<2.5 kg). Using multivariable logistic regression, the association between IPI and these two adverse birth outcomes was investigated. The rates of preterm birth and LBW were 12.4% and 16.8%, respectively. Compared with an optimal IPI (24-36 months), a short IPI (<24 months) was positively associated with preterm birth (aOR: 4.09; 95% CI: 1.48-6.55) and LBW (aOR: 3.58; 95% CI: 1.57-5.15). Infants conceived after a long IPI (≥ 60 months) had increased odds of preterm birth (aOR: 3.78; 95% CI: 1.12-5.78) and LBW (aOR: 2.65; 95% CI: 1.67-4.03). Preterm delivery was also significantly associated with the mother's age (aOR: 1.10; 95% CI: 1.04-1.17), history of multiple cesarean births (aOR: 2.67; 95% CI: 1.14-4.29), prolonged rupture of membranes (aOR: 2.46; 95% CI: 1.10-5.52), and perinatal death (aOR: 3.42; 95% CI: 1.10-5.49). A mother's history of prior LBW (aOR: 4.39; 95% CI: 1.08-6.80), hypertensive disorders (aOR: 1.95; 95% CI: 1.03-3.89), and multiple cesarean births (aOR: 4.35; 95% CI: 2.10-6.99) was associated with LBW. Both short and long IPIs were related to preterm delivery and LBW. Optimal birth spacing is recommended to improve birth outcomes and must be considered when designing effective family planning programs.

The association of federal Medicaid abortion funding restrictions with adverse obstetric outcomes among United States Medicaid recipients

ObjectiveWe examine the association of the Hyde Amendment with obstetrical outcomes in a national Medicaid population. Study designWe conducted a national study of Medicaid-funded abortions to determine the association of restrictions on adolescent, preterm, low-birth weight, and short interpregnancy interval births using administrative data. ResultsStates that restricted coverage for abortion had a higher median rate of adolescent (10.2%; vs 7.4%; p-value < 0.001), preterm (11.4%; vs 10.1%; p < 0.001), short interpregnancy interval, (13.0% vs 9.6%; p < 0.001), and low birth weight births (10.2% vs 8.7%; p = 0.003) than states where Medicaid provided comprehensive coverage. ConclusionsRestricting federal funds for abortion is associated with adverse outcomes. ImplicationsWhen Medicaid does not provide comprehensive coverage for abortion care, few abortions are provided and higher rates of adverse obstetrical outcomes are noted.

Abrupt perturbation and delayed recovery of the vaginal ecosystem following childbirth

The vaginal ecosystem is closely tied to human health and reproductive outcomes, yet its dynamics in the wake of childbirth remain poorly characterized. Here, we profile the vaginal microbiota and cytokine milieu of participants sampled longitudinally throughout pregnancy and for at least one year postpartum. We show that delivery, regardless of mode, is associated with a vaginal pro-inflammatory cytokine response and the loss of Lactobacillus dominance. By contrast, neither the progression of gestation nor the approach of labor strongly altered the vaginal ecosystem. At 9.5-months postpartum—the latest timepoint at which cytokines were assessed—elevated inflammation coincided with vaginal bacterial communities that had remained perturbed (highly diverse) from the time of delivery. Time-to-event analysis indicated a one-year postpartum probability of transitioning to Lactobacillus dominance of 49.4%. As diversity and inflammation declined during the postpartum period, dominance by L. crispatus, the quintessential health-associated commensal, failed to return: its prevalence before, immediately after, and one year after delivery was 41%, 4%, and 9%, respectively. Revisiting our pre-delivery data, we found that a prior live birth was associated with a lower odds of L. crispatus dominance in pregnant participants—an outcome modestly tempered by a longer ( > 18-month) interpregnancy interval. Our results suggest that reproductive history and childbirth in particular remodel the vaginal ecosystem and that the timing and degree of recovery from delivery may help determine the subsequent health of the woman and of future pregnancies.

Determinants of postpartum uterine atony in urban South Ethiopia: a community-based unmatched nested case–control study

BackgroundUterine atony is the most common cause of postpartum hemorrhage, which is the leading preventable cause of maternal morbidity and mortality. Despite several interventions uterine atony-related postpartum hemorrhage remains a global challenge. Identifying risk factors of uterine atony helps to reduce the risk of postpartum hemorrhage and subsequent maternal death. However, evidence about risk factors of uterine atony is limited in the study areas to suggest interventions. This study aimed to assess determinants of postpartum uterine atony in urban South Ethiopia.MethodsA community-based unmatched nested case–control study was conducted from a cohort of 2548 pregnant women who were followed-up until delivery. All women with postpartum uterine atony (n = 93) were taken as cases. Women who were randomly selected from those without postpartum uterine atony (n = 372) were taken as controls. Using a case to control ratio of 1:4, the total sample size was 465. An unconditional logistic regression analysis was done using R version 4.2.2 software. In the binary unconditional logistic regression model variables that have shown association at p < 0.20 were recruited for multivariable model adjustment. In the multivariable unconditional logistic regression model, statistically significant association was declared using 95% CI and p < 0.05. Adjusted odds ratio (AOR) used to measure the strength of association. Attributable fraction (AF) and population attributable fraction (PAF) were used to interpret the public health impacts of the determinants of uterine atony.ResultsIn this study, short inter-pregnancy interval < 24 months (AOR = 2.13, 95% CI: 1.26, 3.61), prolonged labor (AOR = 2.35, 95% CI: 1.15, 4.83), and multiple birth (AOR = 3.46, 95% CI: 1.25, 9.56) were determinants of postpartum uterine atony. The findings suggest that 38%, 14%, and 6% of uterine atony in the study population was attributed to short inter-pregnancy interval, prolonged labor, and multiple birth, respectively, which could be prevented if those factors did not exist in the study population.ConclusionsPostpartum uterine atony was related to mostly modifiable conditions that could be improved by increasing the utilization of maternal health services such as modern contraceptive methods, antenatal care and skilled birth attendance in the community.

Interconception care in Australian general practice: a qualitative study.

GPs provide care for women across the lifespan. This care currently includes preconception and postpartum phases of a woman's life. Interconception care (ICC) addresses women's health issues between pregnancies that then have impact on maternal and infant outcomes, such as lifestyle and biomedical risks, interpregnancy intervals, and contraception provision. However, ICC in general practice is not well established. To explore GP perspectives about ICC. Qualitative interviews were undertaken with GPs between May and July 2018. Eighteen GPs were purposively recruited from South-Eastern Australia. Audiorecorded semi- structured interviews were transcribed verbatim and analysed thematically using the Framework Method. Most participants were unfamiliar with the concept of ICC. Delivery was mainly opportunistic, depending on the woman's presenting need. Rather than a distinct and required intervention, participants conceptualised components of ICC as forming part of routine practice. GPs described many challenges including lack of clarity about recommended ICC content and timing, lack of engagement and perceived value from mothers, and time constraints during consultations. Facilitators included care continuity and the availability of patient education material. Findings indicate that ICC is not a familiar concept for GPs, who feel that they have limited capacity to deliver such care. Further research to evaluate patient perspectives and potential models of care is required before ICC improvements can be developed, trialled, and evaluated. These models could include the colocation of multidisciplinary services and services in combination with well-child visits.

Association between interpregnancy interval and gestational diabetes mellitus: A cohort study of the National Vital Statistics System 2020.

To assess the association between interpregnancy interval (IPI) and gestational diabetes mellitus (GDM). Data of this retrospective cohort study were obtained from the National Vital Statistics System (NVSS) 2020. The participants were divided into different groups according to different IPI (<6, 6-11, 12-17, 18-23, 24-59 (reference), 60-119, ≥120 months). Multivariate logistic models were constructed to evaluate the association between IPI and GDM. Subgroup analysis was further performed. A total of 1 515 263 women were included, with 123 951 (8.18%) having GDM. Compared with the 24-59 months group, the <6 months (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.46-0.90, P = 0.009), 12-17 months (OR 0.96, 95% CI 0.94-0.98, P < 0.001), and 18-23 months (OR 0.94, 95% CI 0.93-0.96, P < 0.001) groups had a significantly lower risk of GDM, while the 60-119 months (OR 1.13, 95% CI 1.11-1.15, P < 0.001) and ≥120 months (OR 1.18, 95% CI 1.15-1.21, P < 0.001) groups had a significantly higher risk of GDM. No significant difference was observed in the risk of GDM between the 6-11 and 24-59 months groups (P = 0.542). The PI-GDM association varied across different groups of age, pre-pregnancy body mass index, pre-pregnancy smoking status, history of cesarean section, history of preterm birth, prior terminations, and parity. An IPI of 18-23 months may be a better interval than 24-59 months in managing the risk of GDM.

Prevalence and factors associated with short interpregnancy intervals among women attending antenatal care at selected hospitals in Lusaka, Zambia.

Prevalence and factors associated with short interpregnancy intervals among women attending antenatal care at selected hospitals in Lusaka, Zambia.

Prevalence of anemia and its associated factors among pregnant women in Ilala Municipality - Tanzania: Analytical cross-sectional study.

Anaemia during pregnancy is still 1 of the leading causes of maternal and neonatal mortality in low and middle-income countries. Initiatives to address this need evidence on trends and their relevant factors, as they vary from 1 area to another. This study determined the prevalence of anemia and its associated factors among pregnant women in Ilala, Tanzania. This community-based, analytical cross-sectional study was conducted in April 2022 involving 367 randomly selected pregnant women. An interviewer-administered questionnaire and a HemoCue analyzer were used for data collection The data was described using descriptive statistics (frequency distributions, percentages, etc) and inferential statistics (Chi-square tests and logistic regression) were used to explore the associations between the study's outcome and its explanatory variables, with a significance level of P < .05. The mean age of participants was 26.2 (standard deviation = 5.2) years, 58.0% had a secondary education level, and 45.2 were prime-para. About half (57.2%) of all participants had low hemoglobin level, among which, 36.2% had moderate anemia. Having a primary education level (adjusted odds ratio [AOR] = 2.3, confidence interval [CI] = 1.1-4.7), having an inter-pregnancy interval of <18 months (AOR = 2.6, CI = 1.2-5.5), being in the third trimester (AOR = 2.4, CI = 1.2-4.7), not taking Intermittent Prophylaxis Treatment (AOR = 3.7, CI = 1.3-10), not taking iron supplement and folic acid (AOR = 3.7, CI = 1.3-10), and having a moderate appetite(AOR = 1.6, CI = 1.0-2.6) were predictors of anemia. Nutritionally related factors were not consuming on a daily basis dairy food (AOR = 3.7, CI = 1.4-9.3), meat/fish (AOR = 6.6, CI = 3-14), dark green and other vegetables (AOR = 6.6, CI = 3.1-14), fruits (AOR = 4.2, CI = 1.4-12) and having a lower dietary diversity score (AOR = 84, CI = 37-188). Approximately half of pregnant women in Ilala municipality were anemic with 1 third of them having moderate anemia. The associated factors varied from nutritional, obstetric, and socio-demographic factors. The targeted interventions should focus on health promotion campaign to sensitize the population on the dangers of anemia in pregnancy and preventive measures that must be adhered to.

Intimate partner violence as a determinant factor for spontaneous abortion during pregnancy: an unmatched case-control study.

Intimate partner violence affects a significant portion of women worldwide throughout their lifetimes. Ethiopia lacks data that policymakers could utilize to develop context-specific policies for handling intimate partner violence during pregnancy. To identify the determinants of spontaneous abortion among women survivors of intimate partner violence during pregnancy in Adigrat General Hospital, Northern Ethiopia, in 2020. A facility based, case-control study design was employed to recruit 371 women (124 cases and 247 controls) attending maternal health services in Adigrat General Hospital, Northern Ethiopia, from March 13 to June 12, 2020. Cases and controls were selected using a consecutive sampling technique. A multivariable binary logistic regression model was carried out to identify potential factors, and a p-value of <0.05 was used to declare statistical significance. The proportion of any form of intimate partner violence during pregnancy among cases and controls was 53.23 and 34.82%, respectively. Any form of intimate partner violence (AOR = 3.66; 95% CI 1.69-7.95), physical intimate partner violence (AOR = 3.06; 95% CI 1.69-7.95), and an interpregnancy interval of <24 months (AOR = 4.46; 95% CI 1.65, 12.07), were the independent determinants of spontaneous abortion among survivors. Spontaneous abortion was significantly associated with exposure to any form of intimate partner violence, including physical intimate partner violence, and a shorter inter-pregnancy interval.

Short interpregnancy interval and adverse pregnancy outcomes among women in a Middle Eastern country

Background/Aims A short interpregnancy interval is associated with several maternal and neonatal complications. In Oman, the incidence of short interpregnancy interval is well documented in the annual health report, but evidence is lacking on its impact on adverse pregnancy outcomes. This study examined short interpregnancy interval, its risk factors and its association with the prevalence of adverse pregnancy outcomes among Omani pregnant women. Methods A retrospective matched case–control design was adopted. Data were collected from medical records between January and December 2020. A total of 597 pregnant women from two tertiary care hospitals in Oman were included. Results There was a significant relationship between interpregnancy interval and the prevalence of adverse maternal and perinatal outcomes, including postpartum haemorrhage, iron deficiency anemia, preterm birth and low birth weight. Significant risk factors for a short interpregnancy interval were advanced maternal age, young age at first birth, low parity and previous perinatal loss. Conclusions Encouraging acceptance of birth spacing through the use of contraception would signify a notable change in cultural values that can act as a barrier to birth spacing. This would therefore improve pregnancy outcomes.

The influence of birth outcomes and pregnancy complications on interpregnancy interval: a quantile regression analysis

To ascertain whether adverse pregnancy outcomes at first pregnancy influence subsequent interpregnancy intervals (IPIs) and whether the size of this effect varies with IPI distribution METHODS: We included 251,892 mothers who gave birth to their first two singletons in Western Australia, from 1980 to 2015. Using quantile regression, we investigated whether gestational diabetes, hypertension, or preeclampsia in the first pregnancy influenced IPI to subsequent pregnancy and whether effects were consistent across the IPI distribution. We considered intervals at the 25th centile of the distribution as 'short' and the 75th centile as 'long'. The average IPI was 26.6 mo. It was 0.56 mo(95% CI: 0.25-0.88 mo) and 1.12 mo(95% CI: 0.56 - 1.68 mo) longer after preeclampsia, and gestational hypertension respectively. There was insufficient evidence to suggest that the association between previous pregnancy complications and IPI differed by the extent of the interval. However, associations with marital status, race/ethnicity and stillbirth contributed to either shortening or prolonging IPIs differently across the distribution of IPI. Mothers with preeclampsia and gestational hypertension had slightly longer subsequent IPIs than mothers whose pregnancies were not complicated by these conditions. However, the extent of the delay was small (<2 mo).

Association of menstrual blood volume and reproductive outcomes in patients with caesarean scar pregnancy managed using uterine artery embolization and curettage

This study aimed to assess the association of menstrual blood volumes (MBV) and reproductive outcomes in patients after uterine artery embolization (UAE) combined with curettage for caesarean scar pregnancy (CSP). This retrospective observational study enrolled women who underwent UAE plus curettage for CSP at the Interventional Department of Henan Provincial People’s Hospital between December 2012 and December 2017. The primary outcome was pregnancy rate and the secondary outcomes were live birth rate (LBR) and interpregnancy interval. This study finally included 37 women (16 women with normal MBV and 21 women with decreased MBV) with pregnancy intention after UAE plus curettage for CSP. The pregnancy rate in women with normal MBV was higher than those with decreased MBV (81.3% vs. 47.6%; P = 0.048). There were no differences between the two groups regarding the interpregnancy interval (18.4 ± 8.7 vs. 22.2 ± 10.0 months, P = 0.233), and LBR (63% vs. 38%, P = 0.191). In conclusion, Women with normal MBV after UAE combined with curettage for CSP management might have a higher pregnancy rate compared with patients with decreased MBV, but there were no differences in LBR between the two groups.

Interpregnancy Interval After Stillbirth and Adverse Perinatal Outcomes.

We used a retrospective cohort of 5,581 individuals to examine the association between interpregnancy interval (IPI) after stillbirth and pregnancy outcomes of preterm birth, preeclampsia, small for gestational age, recurrent stillbirth, infant death, and neonatal intensive care unit admission in the subsequent pregnancy. The IPI was divided in six categories, with 18-23 months as referent. Association between IPI category and adverse outcomes was determined with logistic regression models adjusted for maternal race and ethnicity, age, education, insurance, and gestational age at preceding stillbirth. Adverse perinatal outcome was common in pregnancies after stillbirth, with 26.7% of individuals delivering preterm. None of the IPI categories were associated with increased risk of adverse perinatal outcomes, including the shortest category (IPI less than 3 months). This finding is meaningful for bereaved parents who desire to conceive shortly after stillbirth.

Impact of Inter-Pregnancy Interval on Maternal Serum Ferritin, Haematocrit Level and Fetal Outcome in University of Ilorin Teaching Hospital Ilorin, Nigeria

Background: Short inter-pregnancy interval (SIPI) has been linked with low maternal haematological indices and adverse fetal outcome. The World Health Organization (WHO) recommended a minimum of 24 months inter-pregnancy interval to reduce the risk of adverse maternal and fetal outcomes. However, sub-optimal pregnancy spacing is common in many developing countries including Nigeria. Objectives: To determine the impact of inter-pregnancy interval on maternal serum ferritin, haematocrit level and fetal outcome among parturient in University of Ilorin Teaching Hospital, Ilorin, Nigeria. Study Design: A prospective cohort study of parturient less than 20weeks gestation. Those who did not satisfy the WHO recommended inter-pregnancy interval of at least 24months were categorized as group II while gestational age and social status matched parturient who satisfied the WHO recommendation were in group I. Methodology: A total of 316 parturient who satisfied the inclusion criteria were recruited for the study by systematic sampling. These were equal number of 158 participants each as subject and control. Subject and control were matched for gestational age and social status. The serum ferritin and haematocrit levels as well as fetal outcome were evaluated for each participant. The results were analysed using SPSS version 20.0 with appropriate tables and figures generated. Results: There was statistically significance difference in the mean levels of serum ferritin (P&lt;0.001) and haematocrit (P&lt;0.001) at booking for the two groups of participants. There was statistically significant difference in the gestational age at delivery (P&lt;0.001) with higher rate of preterm delivery (22.1% vs. 1.9%; P&lt;0.001) in group II compared to group I. In addition, there were higher percentages of group II babies with 1st (32.5% vs. 9.6%; P&lt;0.001) and 5th minute (18.2% vs. 1.9%; P&lt;0.001) APGAR scores &lt; 7 compared to group I babies (P&lt;0.001). The mean birth weight was lower in group II (2.70±0.35 vs. 3.10±0.31; P&lt;0.001) with higher need for neonatal resuscitation (16.9% vs. 2.6%; P&lt;0.001) and intensive care admission (18.2% vs. 1.3%; P&lt;0.001) among neonates of women in group II. Neonatal anaemia (15.4% vs. 0.0%; P&lt;0.001) occurred only in group II participants’ babies. Neonatal mortality was zero for group I and 18(11.7%) for group II babies. Conclusion: Inter-pregnancy interval below the WHO recommendation is associated with low maternal serum ferritin and haematocrit levels as well as adverse fetal outcome. Recommendations: Adequate child spacing should be emphasized during antenatal visits, postpartum counselling, postnatal clinic visits as well as other contacts with non-pregnant women of reproductive age.

A Descriptive Analysis of Emergency Contraception Familiarity in Postpartum People [ID: 1377163

INTRODUCTION: Ensuring access to emergency contraception (EC) is a fundamental component of comprehensive contraceptive counseling and reproductive health care. Despite this, little is known about familiarity with EC in postpartum people, a population motivated to prevent pregnancy in part because of the risk of short interpregnancy interval. This study aims to assess familiarity with EC in postpartum people. METHODS: After IRB approval, 76 participants choosing a lower-efficacy method of postpartum contraception were recruited from a large urban hospital on postpartum day 1. Most participants were between the ages of 25 and 34, married, employed, and have had multiple pregnancies. Familiarity with EC and reproductive health were assessed via surveys after attaining patient consent. Descriptive statistics were performed. RESULTS: Nearly all participants (91%) had heard of EC before. A minority of participants (18%) have brought up EC with a health care professional, while approximately half (46%) reported a health care professional bringing up EC with them. Most participants (75%) reported being at least somewhat likely to take EC if they wanted to prevent pregnancy. One-third of participants reported prior use of EC, while nearly half of participants (42%) reported having at least one unplanned pregnancy. CONCLUSION: A majority of participants were aware of and willing to use EC despite a minority of participants having discussed the option with a health care professional. For all patients but especially those who select a lower-efficacy postpartum contraceptive method, health care providers can supplement reproductive choice and reduce the risk of short interpregnancy interval through comprehensive counseling on when and how to use EC.

Interactions between long interpregnancy interval and advanced maternal age on neonatal outcomes.

After 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 onneonataloutcomes are unknown. The 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. Compared with the 24 ≤ IPI ≤ 59months group, the long IPI group (IPI ≥ 60months) 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 < 12months 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). Both 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.

Parental Perceptions of Counseling Regarding Interpregnancy Interval after Stillbirth or Neonatal Death.

Although guidelines exist regarding optimal interpregnancy interval (IPI) after live birth, both optimal IPI and counseling regarding recommended IPI (rIPI) after stillbirth or neonatal death is not well established. Our goal was to describe the counseling bereaved parents receive regarding IPI, parents' reactions to that counseling, and actual IPI after loss. Bereaved parents who had a previous pregnancy result in stillbirth or neonatal death participated in a web-based survey. Questions included demographics, details of stillbirth or neonatal death, IPI counseling, and pregnancy after loss. Demographic information, rIPI, and ac'tual IPI were reported using descriptive statistics. The Wilcoxon's rank sum test was used to test the association between rIPI and mode of delivery. The Spearman's correlation was used to test the association between rIPI and maternal age. A total of 275 surveys were analyzed. Mean gestational age of stillbirth delivery was 33.1 (standard deviation: 6.6) weeks. A total of 29% delivered via cesarean. Median rIPI was 6 (interquartile ratio [IQR]: 2-9) months, with the primary reason for IPI reported as the need to heal (74%). Delivery via cesarean was associated with longer rIPI, 9 versus 4.2 months (p < 0.0001). Maternal age was not associated with rIPI. Of 144 people who pursued pregnancy again, median time until attempting conception was 3.5 (IQR: 2-6) months. Median actual IPI was 6 (IQR: 4-10) months. Bereaved parents receive a wide range of counseling regarding rIPI. The majority receive rIPI and pursue actual IPI shorter than current national and international recommendations for optimal IPI. · There is variation in IPI recommendation after stillbirth/neonatal death.. · Cesarean birth is associated with longer IPI recommendation, but maternal age is not.. · Median IPI after stillbirth or neonatal death was short: 6 (IQR: 4-10) months..

Effect of inter-pregnancy interval on serum ferritin, haematocrit and pregnancy outcome in Ilorin, Nigeria.

Available information remains limited on inter-pregnancy interval (IPI) and its effect on maternal health and pregnancy outcome. To determine the effect of IPI on maternal serum ferritin, haematocrit and pregnancy outcome. A prospective cohort study of 316 women categorized into WHO recommended IPI of ≥24 months (group I) and IPI <24 months i.e. short IPI (SIPI) as group II after matching for gestational age and social status. Serum ferritin and haematocrit levels were assayed in first and second trimesters; primary outcome measures were maternal serum ferritin, haematocrit and pregnancy outcome gestational age at delivery, birth and placental weights, APGAR scores and neonatal intensive admission). Participants were followed up until six-week post-delivery. Data analysis was with SPSS version 21.0; p<0.05 was significant. Women in group I had higher mean serum ferritin (37.40±3.15 vs. 32.61±2.68; P<0.001), booking haematocrit (33.24±3.59 vs. 27.92±2.67; P<0.001) and mean birth weight (3100±310 vs. 2700±350; P<0.001). Antenatal hospital admission (P0.002), preterm delivery (P<0.001) and neonatal intensive care admission (P<0.001) were higher for group II. There was no maternal mortality; perinatal mortality was zero (group I) and 95/1000 livebirth (group II). Low serum ferritin, haematocrit and adverse neonatal outcomes were associated with SIPI.

Association Between Maternal Hemoglobin Level and Incomplete Abortion At RSUP Dr. Hasan Sadikin Bandung 2017-2019

Objective: To evaluate the association between maternal hemoglobin concentrations and incomplete abortion.Methods: An analytic, cross-sectional study with consecutive sampling method was conducted using medical records of 45 pregnant women aged 18 – 35 years old visiting the Obstetrics and Gynecology Department of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from January 1, 2017 to December 31, 2019. Participants were grouped into incomplete abortion and non-abortion groups.Results: Maternal characteristics in the incomplete abortion group showed that the majority of pregnant women in this group were 25.58 years of age, non-anemic (n=37, 82.22%), had no previous spontaneous abortion (n=40, 88.89%), and were nulliparous (n=25, 55.55%) with a mean interpregnancy interval of 4.03 years. The characteristics in both incomplete abortion group and non-abortion group were homogenous in the level of anemia (p-value=0.380), previous spontaneous abortion (p-value=1.00), and interpregnancy intervals (p-value=0.667). The mean hemoglobin concentration for the incomplete abortion group was 11.81 gr/dL (95% CI, 11.30 to 12.26). Heterogenous data was found in age (p-value=&lt;0.001) and parity (p-value=0.002). Parity was a strong confounder, causing the hemoglobin concentration insignificantly associated to incomplete abortion (p-value=0.884).Conclusion: No statistically significant association is found between hemoglobin concentration and incomplete abortion. Most women with incomplete abortion are around 25 years old, nulliparous, non-anemic with a mean hemoglobin concentration of 11.81 gr/dL with no history of previous abortion, and a rather secure interpregnancy intervals.