Interpregnancy Interval Research Articles

Subsequent Pregnancy Outcomes Following Prepregnancy Cerclage in Patients with Absent Ecto-Cervix

Background: We aimed to determine whether the prepregnancy cerclage for women with cervical incompetence with absent ecto‑cervix affects the time from surgery to conception and subsequent pregnancy outcome. Methods: This retrospective study was carried out on patients with at least one previous history of second-trimester abortion and extremely short cervix found by gynecological examination. A total of 40 cases of McDonald's cerclage before pregnancy were performed. The time from surgery to conception and pregnancy outcome were followed up for 4 years. The main outcomes were the time from surgery to conception, and the gestational week of delivery, miscarriage rate, preterm delivery rate. Results: Between September 2018 and December 2022, 37 women became pregnant following prepregnancy cerclage. In total, 36 babies were born to 37 mothers. The recurrence rate of second-trimester miscarriage was 8.11% (3/37) and the preterm birth rate was 29.73% (11/37). Mean time from surgery to conception was 38w (range 2w-160w).Mean gestational age at delivery was 36 weeks +4 (256 days).The live birth rate was 100%. There were no maternal complications, no intestinal and bladder injuries. Conclusion: Cervical incompetence patients with absent ecto‑cervix may benefit from prepregnancy cerclage without affecting the interpregnancy interval.

Trends in Short Interpregnancy Interval Births in the United States, 2016-2022.

To measure contemporary trends in the prevalence of short interpregnancy interval (IPI) births in the United States. We conducted a repeated cross-sectional analysis using 2016-2022 natality data from the National Vital Statistics System. We included all singleton live births to individuals with at least one prior live birth. We examined trends over time in short IPIs less than 18 months, as well as for specific durations within this time frame (less than 6 months, 6-11 months, and 12-17 months), using linear probability models that estimated changes in the prevalence of each IPI duration over time. We then estimated the prevalence of each short IPI duration by maternal race and ethnicity, socioeconomic characteristics (age, education, insurance payer at delivery), and geography (U.S. census region, state of residence). The study sample included 14,770,411 singleton live births to individuals with at least one prior live birth in 2016-2022. Roughly a third (29.8%) of births had an overall IPI of less than 18 months (5.0% less than 6 months, 11.0% 6-11 months, and 13.8% 12-17 months). For IPIs less than 6 months, a slight statistical decline in prevalence was identified over the study period in unadjusted and adjusted models (adjusted annual percentage point change -0.02, 95% CI, -0.03 to -0.02). Slight statistical increases in the prevalence of IPIs of 6-11 and 12-17 months were identified in unadjusted models but were no longer significant and reversed direction in adjusted models, respectively. Long-standing inequities in the distribution of the shortest IPIs (less than 6 months) were stable compared with prior work across the indicators examined in this study. Overall, it appears the prevalence of short IPIs has remained stable between 2016 and 2022.

Knowledge, attitude, and practice of Iraqi pregnant women about maternal risk factors

Maternal risk factors can lead to adverse pregnancy outcomes. These include extreme maternal age, short inter-pregnancy intervals, lack or inadequate prenatal care, smoking, and obesity. Good knowledge, positive attitude, and safe practice of women about these risk factors are important in improving pregnancy outcomes. To assess knowledge, attitude, and practice of pregnant mothers attending primary health centres, a cross-sectional study was conducted with 200 randomly selected pregnant women attending the Al-Qudus Family Medicine Primary Health Centre for antenatal care during the period June 2022 to February 2023. Direct interviews of the participants was carried out to obtain data using a structured questionnaire, and the data were tabulated and analyzed using SPSS software The mean age was 22.5 years, 78% of whom knew pregnancy beyond 35 years increases complication; 77% agreed that low maternal educational level has bad effect on pregnancy; 63% were aware of the bad effects of short interpregnancy intervals; while almost all women agreed that smoking has bad effect on pregnancy. About 82% had attitude of planning for pregnancy and frequent antenatal care visits; more than half had regular doctor visits with folic acid supplementation; while three quarters of the women took information from their families and relatives and half from doctors. We conclude that pregnant women in Al-Qudus Family Medicine Health centre, Iraq, have moderately to good knowledge of maternal risk factors.

A national study on maternal vomiting during pregnancy in Iran: prevalence, determinants, adverse birth outcomes, and the trend

BackgroundNausea and vomiting during pregnancy (NVP) is one of the most common complication of pregnancy. The present study was aimed to determine the association between vomiting during pregnancy and adverse birth outcomes.MethodsA cross-sectional study was conducted on 3649 pregnant women across 11 provinces of Iran. Cluster sampling method was used to select samples and data collection was done using family record and face-to-face interviews. Data were analyzed by logistic regression, using STATA14.2 software.ResultsThe prevalence of vomiting during pregnancy was 9.7% (95% CI: 8.8, 10.7), with an increasing trend by birth cohort. After adjusting for other confounders, the prevalence of vomiting revealed a decreasing trend by body mass index (OR = 0.63, 95%CI: 0.53, 0.78, P-trend < 0.001). In addition, long inter-pregnancy interval (IPI) significantly increased the odds of NVP (ORIPI of 1−3 year=2.42, ORIPI of >3 year=1.63). Multivariate analyses showed that the odds of stillbirth (AOR = 1.61, 95% CI: 1.17, 2.19) and the odds of infant mortality (AOR = 1.78, 95% CI: 1.29, 2.45) were significantly increased in women with daily vomiting during pregnancy. The odds of vomiting during pregnancy was significantly shown to reduce the odds of abortion by 45%.ConclusionThe prevalence of NVP was shown to have an increasing trend in Iran. This complication is associated with many adverse health outcomes during pregnancy and negatively affect maternal and fetal health. Given the importance of pregnancy period, nutrition education and increase the awareness of pregnant women towards NVP, especially pre-pregnancy training is suggested.

Effect of Levonorgestrel Implant on Lactation and Infant Growth: A Review

Background: Family Planning is a way to regulate the number of children born and the spacing of pregnancies through information, education, and the use of contraceptives. Postpartum contraception is important to obtain an optimal interpregnancy interval. Postpartum contraception should be initiated early; one of which is Long-Acting Reversible Contraception (LARC). Levonorgestrel can be used to prevent pregnancy because it interferes with ovulation, implantation, and fertilization. Objectives: This study aimed to assess the efficacy and effects of using levonorgestrel implants on breastfeeding and infant growth. Methods: Primary data were in the form of research papers obtained from ScienceDirect, PubMed, and Google Scholar published from the period 2010-2018. The keywords for the searches included: “levonorgestrel”, “levonorgestrel (LNG)-releasing implant”, “levonorgestrel on lactogenesis”, “levonorgestrel on infant growth”, and “levonorgestrel on breastfeeding”, which were used alone or in combination. Results: The 20 selected articles were reviewed based on five identified phrases. Levonorgestrel subdermal implants were shown to be a good choice for women who wanted effective contraception. When used by breastfeeding mothers, levonorgestrel subdermal implants affected neither infant growth (0-1 year of age) nor lactation duration. Conclusions: Levonorgestrel subdermal implants can be effective long-term contraception. These implants are safe for breastfeeding mothers and do not affect infant growth.

Effect of Interpregnancy Interval on Pregnancy Outcome in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Interpregnancy interval has a major impact on the maternal and fetal health worldwide. Women with short interpregnancy interval show higher rates of low birth weight and preterm babies. So this study aimed to study the effect of interpregnancy interval on pregnancy outcomes.Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care center after taking ethical approval from Institutional Review Committee (Reference number:229/080/081(6-11)E2). Data from September 1st, 2023 to January 30th, 2024 was collected. All multigravida women with singleton pregnancy after 28 weeks of gestation who delivered in our hospital with previous birth were enrolled in the study. Convenience sampling method was done. Point estimate and 95% Confidence Interval were calculated. The data was entered and analyzed using IBM SPSS Statistics version 26.0Results: Among the women , 31 (3.57%) women had short interpregnancy interval ≤18 months whereas 836 (96.43%) had interpregnancy interval of &gt;18 months. The mean age of the women was 28 years. Previous cesarean section was common indication of cesarean section 27 (87.09%) among women with short interpregnancy interval. These women had higher rates of preterm and low birth weight babies 11(35.58%) &amp; 15(48.38%).Conclusions: Women with short interpregnancy interval ≤18 months had higher preterm births and low birth weight babies. Pregnancy induced hypertension, hypothyroidism and gestational diabetes were increased in women with interpregnancy interval of &gt;18 months.

Determinants of Success and Complications in Vaginal Birth After Cesarean Section: A Systematic Literature Review

Trial of Labor After Cesarean (TOLAC) is the process of attempting a vaginal delivery after a prior cesarean section. TOLAC offers an alternative to repeat cesarean delivery but requires careful assessment of risks and benefits. This research aims to evaluate the factors affecting VBAC success and associated risks, providing guidance for clinical practice in determining VBAC eligibility. Relevant literature on VBAC was sourced from databases such as PubMed and Cochrane Library using the keywords "VBAC," "VBAC success," and "VBAC risks." Literature searches for these articles are conducted through databases of scientific journals such as PubMed and Google Scholar. Analysis was conducted to assess predictive factors for VBAC success, including previous vaginal delivery history, cervical conditions, and other parameters. VBAC success is significantly influenced by previous vaginal delivery history, cervical conditions at admission, and factors such as BMI and interpregnancy interval. The main risk associated with VBAC is uterine rupture, occurring in approximately 0.2–0.9% of cases. Proper management and careful risk assessment can minimize complications. VBAC can be a safe and effective option for women who meet specific criteria. Adequate monitoring and assessment are crucial to minimize risks and enhance success rates. Individual evaluation and thorough planning are essential for achieving optimal delivery outcomes. The decision to implement VBAC should be made with careful consideration of the benefits and risks to ensure safe and optimal outcomes for both mother and baby.

A Systematic Review of The Risk Factors Affecting Low Birth Weight

Backgrounds: Low birth weight (LBW) is a significant factor in 60 to 80 percent of all neonatal fatalities and is one of the most important health indicators in the primary measure set used by the International Dietary Surveillance Application. Objectives: This systematic review was conducted to determine the factors affecting to LBW. Materials &amp; Methods: Embase, Cochrane Library, Web of Science, Google Scholar, PubMed, and Scopus, and Persian scientific databases were searched from 2012 to 2022. Selection procedure, data screening and analysis were performed by two independent reviewers. The quality of included articles were evaluated with the 22-item strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and a checklist of appropriate criteria based on the research design for each one. Results: Of the 1200 articles collected, 51 met the study inclusion criteria. The most common variables with a frequency of more than 15% that led to LBW were the mother's age (22 studies, 43/13%), mother's chronic diseases (Hypertension and diabetes mellitus), mother's iron deficiency anemia (14 studies, 27/45%), mother's weight and BMI (13 studies, 25/4%), ANC visits (12 studies, 23/52%), sex of the child (9 studies, 17/64%), parity and inter-pregnancy interval (8 studies, 15/68%). Conclusion: The mother's age, chronic diseases, mother’s anemia, mother's weight and BMI, insufficient ANC visits, sex of the child, parity and inter-pregnancy interval have a great impact on the LBW. Therefore, interventions, plans and programs aimed at addressing these risk factors could potentially reduce the incidence of LBW.

Interpregnancy intervals and behavioural outcomes in children: A population-based longitudinal study

BackgroundWhile the physical health consequence of short interpregnancy intervals (IPIs) is well documented, its mental health impact is not well explored. This study aimed to examine the associations between IPIs and behavioural outcomes in children born following the interval at four developmental time points between ages 7 and 16. MethodsOur study sample comprised participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, an ongoing population-based longitudinal birth cohort in Bristol, Avon, United Kingdom. Behavioural problems, including total behavioural difficulties, hyperactivity, emotional symptoms, conduct problems, peer-problems, and problems of pro-social behaviour, were assessed using the Strengths and Difficulties Questionnaire (SDQ). Over 2300 mothers and their singleton children were included in this study. Generalized Estimating Equations (GEE) were used to estimate odds ratios for the associations. ResultsChildren born to mothers with short IPI (<6 months) were 1.54 (95%CI: 1.12–2.11), 1.42 (95% CI: 1.12–1.81) and 1.37 (95%CI: 1.04–1.79) times more likely to have total behavioural difficulties, conduct problems and hyperactivity/inattention problems across the child's age, respectively, compared with children of mothers with IPIs of 18–23 months. We found no evidence of associations between short IPI (<6 months) and emotional symptoms, peer-relationship problems and pro-social behaviour problems. ConclusionShort IPI (<6 months) was associated with externalising (conduct and hyperactivity/inattention) but not internalising (emotional and peer-relationship problems) problems. Further studies are needed to confirm this association and elucidate the underlying mechanisms.

FIGO and ICM joint statement on contraception: 2024.

Contraception, and the opportunity and ability to decide the timing, number, and spacing of one's pregnancies, is not just critical for maternal and infant health, but necessary for the attainment of basic reproductive rights. Short inter-pregnancy intervals have significant consequences for both maternal and newborn mortality, including preterm birth and maternal anemia, and they are a key cause of preventable deaths worldwide. Addressing the unmet need for contraception could have widespread implications for health equity and access. Integrating comprehensive contraceptive services into various health settings including antenatal care, postpartum care, and child immunization visits is vital. Contraceptive counseling should be holistic, and should involve shared decision-making and patient autonomy. Contraceptive counseling is particularly important in the post-pregnancy period, where loss to follow-up may be high, and for adolescents and other vulnerable populations who are often overlooked in these discussions. Addressing the unmet need for contraception requires collaboration and teamwork among healthcare professionals, particularly midwives and physicians, who have the opportunity to amplify one another's efforts, share best practices, advocate for broader contraceptive services, and strengthen training among midwifery and medical trainees. Members of FIGO and ICM have worked together to produce this joint statement, identifying priorities within contraceptive provision and underlining key collaborative strategies to address the unmet need for contraception.

Safety of the Seasonal Influenza Vaccine in 2 Successive Pregnancies

ImportanceAlthough influenza vaccination has been found to be safe in pregnancy, few studies have assessed repeated influenza vaccination over successive pregnancies, including 2 vaccinations in a year, in terms of adverse perinatal outcomes.ObjectiveTo examine the association of seasonal influenza vaccination across successive pregnancies with adverse perinatal outcomes and whether the association varies by interpregnancy interval (IPI) and vaccine type (quadrivalent or trivalent).Design, Setting, and ParticipantsThis retrospective cohort study included individuals with at least 2 successive singleton live-birth pregnancies between January 1, 2004, and December 31, 2018. Data were collected from the Vaccine Safety Datalink, a collaboration between the Centers for Disease Control and Prevention and integrated health care organizations. Data analysis was performed between January 8, 2021, and July 17, 2024.ExposuresInfluenza vaccination was identified using vaccine administration codes. The vaccinated cohort consisted of people who received influenza vaccines during the influenza season (August 1 through April 30) in 2 successive pregnancies. The comparator cohort consisted of people identified as unvaccinated during both pregnancies.Main Outcomes and MeasuresMain outcomes were risk of preeclampsia or eclampsia, placental abruption, fever, preterm birth, preterm premature rupture of membranes, chorioamnionitis, and small for gestational age among individuals with and without vaccination in both pregnancies. Adjusted relative risks (RRs) from Poisson regression were used to assess the magnitude of associations. The associations with adverse outcomes by IPI and vaccine type were evaluated.ResultsOf 82 055 people with 2 singleton pregnancies between 2004 and 2018, 44 879 (54.7%) had influenza vaccination in successive pregnancies. Mean (SD) age at the start of the second pregnancy was 32.2 (4.6) years for vaccinated individuals and 31.2 (5.0) years for unvaccinated individuals. Compared with individuals not vaccinated in both pregnancies, vaccination in successive pregnancies was not associated with increased risk of preeclampsia or eclampsia (adjusted RR, 1.10; 95% CI, 0.99-1.21), placental abruption (adjusted RR, 1.01; 95% CI, 0.84-1.21), fever (adjusted RR, 0.87; 95% CI, 0.47-1.59), preterm birth (adjusted RR, 0.83; 95% CI, 0.78-0.89), preterm premature rupture of membranes (RR, 1.00; 95% CI, 0.94-1.06), chorioamnionitis (adjusted RR, 1.03; 95% CI, 0.90-1.18), or small for gestational age birth (adjusted RR, 0.99; 95% CI, 0.93-1.05). IPI and vaccine type did not modify the observed associations.Conclusions and RelevanceIn this large cohort study of successive pregnancies, influenza vaccination was not associated with increased risk of adverse perinatal outcomes, irrespective of IPI and vaccine type. Findings support recommendations to vaccinate pregnant people or those who might be pregnant during the influenza season.

Interpregnancy interval, air pollution, and the risk of low birth weight: a retrospective study in China

BackgroundBoth interpregnancy intervals (IPI) and environmental factors might contribute to low birth weight (LBW). However, the extent to which air pollution influences the effect of IPIs on LBW remains unclear. We aimed to investigate whether IPI and air pollution jointly affect LBW.MethodsA retrospective cohort study was designed in this study. The data of birth records was collected from the Jiangsu Maternal Child Information System, covering January 2020 to June 2021 in Nantong city, China. IPI was defined as the duration between the delivery date for last live birth and date of LMP for the subsequent birth. The maternal exposure to ambient air pollutants during pregnancy—including particulate matter (PM) with an aerodynamic diameter of ≤ 2.5 μm (PM2.5), PM10, ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO)—was estimated using a hybrid kriging-LUR-RF model. A novel air pollution score was proposed, assessing combined exposure to five pollutants (excluding CO) by summing their concentrations, weighted by LBW regression coefficients. Multivariate logistic regression models were used to estimate the effects of IPI, air pollution and their interactions on LBW. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP) and synergy index (S) were utilized to assess the additive interaction.ResultsAmong 10, 512 singleton live births, the LBW rate was 3.7%. The IPI-LBW risk curve exhibited an L-shaped pattern. The odds ratios (ORs) for LBW for each interquartile range increase in PM2.5, PM10, O3 and the air pollution score were 1.16 (95% CI: 1.01–1.32), 1.30 (1.06–1.59), 1.22 (1.06–1.41), and 1.32 (1.10–1.60) during the entire pregnancy, respectively. An additive interaction between IPI and PM2.5 was noted during the first trimester. Compared to records with normal IPI and low PM2.5 exposure, those with short IPI and high PM2.5 exposure had the highest risk of LBW (relative risk = 3.53, 95% CI: 1.85–6.49, first trimester).ConclusionThe study demonstrates a synergistic effect of interpregnancy interval and air pollution on LBW, indicating that rational birth spacing and air pollution control can jointly improve LBW outcomes.

Antenatal Care Interventions to Increase Contraceptive Use Following Birth in Low- and Middle-Income Countries: Systematic Review and Narrative Synthesis.

Health risks associated with short interpregnancy intervals, coupled with women's desires to avoid pregnancy following childbirth, underscore the need for effective postpartum family planning programs. The antenatal period provides an opportunity to intervene; however, evidence is limited on the effectiveness of interventions aimed at reaching women in the antenatal period to increase voluntary postpartum family planning in low- and middle-income countries (LMICs). This systematic review aimed to identify and describe interventions in LMICs that attempted to increase postpartum contraceptive use via contacts with pregnant women in the antenatal period. Studies published from January 2012 to July 2022 were considered if they were conducted in LMICs, evaluated an intervention delivered during the antenatal period, were designed to affect postpartum contraceptive use, were experimental or quasi-experimental, and were published in French or English. The main outcome of interest was postpartum contraceptive use within 1 year after birth, defined as the use of any method of contraception at the time of data collection. We searched EMBASE, Global Health, and Medline and manually searched the reference lists from studies included in the full-text screening. We double-screened 771 records and included 34 reports on 31 unique interventions in the review. Twenty-three studies were published from 2018 on, with 21 studies conducted in sub-Saharan Africa. Approximately half of the study designs (n=16) were randomized controlled trials, and half (n=15) were quasi-experimental. Interventions were heterogeneous. Among the 24 studies that reported on the main outcome of interest, 18 reported a positive intervention effect, with intervention recipients having greater contraceptive use in the first year postpartum. While the studies in this systematic review were heterogeneous, the findings suggest that interventions that included a multifaceted package of initiatives appeared to be most likely to have a positive effect.

Utilization of Immediate Postpartum Contraception and Its Association with Interpregnancy Interval: 10-Year Experience at a Single Center.

Increasing availability of immediate postpartum long-acting reversible contraception (LARC) has added contraceptive alternatives to bilateral tubal ligation (BTL) in the immediate postpartum period. The resultant access to long-term contraception has provided patients with improved control over the timing of pregnancies. Our objective is to evaluate changes in the utilization of immediate postpartum contraceptive methods over a 10-year period and its association with interpregnancy interval (IPI). Retrospective cohort study of 36,445 patients delivered at a single academic hospital center from 2012 to 2020. Deliveries <23 weeks gestation and patients who underwent a cesarean hysterectomy or postpartum hysterectomy for obstetric indications were excluded. The primary outcome was the utilization of postpartum BTL, intrauterine devices, contraceptive implants, and Depo-Provera over the study time period. The secondary outcomes were IPI and interdelivery interval (IDI). Outcomes were compared using appropriate tests of trend. We adjusted for significant covariates as assessed in baseline characteristics. A total of 35,281 patients were included in our study. Groups were different in baseline characteristics including age, race/ethnicity, parity, BMI, insurance status, comorbidity risk, and attendance at postpartum exam. Over the study period, there was a significant difference in utilization of Depo-Provera, LARC, intrauterine device (IUD), and implant (p < 0.001). There was a significant increase in IPI (p < 0.001) and IDI (p < 0.001). We observed a significant increase in utilization of immediate postpartum LARC over the study period which corresponded to a significant increase in IPI and IDI. Our findings emphasize the importance of the availability of immediate postpartum contraception as well as its effectiveness in improving family planning options for reproductive-aged patients. We found significantly increased IPI and IDI associated with increased utilization of long-acting reversible contraceptives immediately postpartum. Our findings emphasize the importance of providers offering these options to patients as well as being comfortable initiating immediate postpartum contraception. · Immediate postpartum LARC access has increased over the past 10 years.. · Access to more methods of contraception allows patients more options for family planning.. · Increased utilization of LARC led to increased IPI and IDI..

The prevalence of short inter-pregnancy interval and its associated risk factors among women attending primary health care centers of NGHA in Jeddah, Saudi Arabia: A cross-sectional study.

The inter-pregnancy interval (IPI) refers to the time between one pregnancy and the next. Studies have shown that IPIs shorter than 18 months are linked to negative outcomes, such as preterm delivery, infant mortality, and small-for-gestational-age birth. The aim of this study was to measure the prevalence and risk factors of short inter-pregnancy intervals among women receiving care at primary health centers in Jeddah, Saudi Arabia. This is a cross-sectional study conducted at primary health care centers among mothers with a history of giving birth to at least one child and having two successive pregnancies. The data was collected through face-to-face interviews using a structured questionnaire. Statistical analysis was carried out using RStudio (R version 4.3.0). A total of 300 responses were analyzed. The prevalence of short IPI was 36.0%, 31.0% had prolonged IPI, and 33.0% had optimal IPI. Lower educational level, unemployment as a student, low or middle income, a rise in the number of children, typically more than six, and an increase in the number of male offspring, mostly four or more, lack of breastfeeding, and breastfeeding duration have all been identified as statistically significant risk factors for short IPIs. Short inter-pregnancy interval is prevalent in Jeddah city, which can negatively impact the perinatal outcomes. Addressing the risk factors and providing proper education in antenatal and postnatal clinics to reduce the number of unintended pregnancies can help in decreasing the number of short inter-pregnancy intervals and improving maternal and fetal outcomes.

The Risk Factors for Anemia in Women at Third Trimester of Pregnancy in the Primary Health Center of Tanjung Sekayam: A Case-Control Study

Background: The presence of anemia in pregnant women significantly affects the health of both mothers and their fetuses. Around 37% of pregnant women worldwide experience anemia. In the Community Health Center of Tanjung Sekayam, the prevalence of anemia in women at the third trimester of their pregnancy was notably high, at 50.4%. Objectives: This study aims to identify the risk factors for anemia in women at third trimester of pregnancy in the working area of the Community Health Center of Tanjung Sekayam Subdistrict, Sanggau Regency. Methods: This study was an observational research with a case-control design. The study population consisted of 153 women at third trimester of pregnancy, receiving antenatal care in the Community Health Center of Tanjung Sekayam. The samples included 62 respondents, selected through a simple random sampling, comprising of 31 cases and 31 controls. Data were collected using questionnaires and analyzed with the Chi-Square test to assess the factors associated with the occurrence of anemia. Results: There was a relation among maternal age (p=0.000; OR=22.9), interpregnancy interval (p=0.024; OR=6.9), parity (p=0.011; OR=2.2), nutritional status (chronic energy deficiency) (p=0.000; OR=11.3), compliance (p=0.021; OR=3.9), and knowledge (p=0.001; OR=8.2) and the prevalence of anemia in the third trimester. However, the family support did not show any significant relation. Conclusions: Maternal age, pregnancy interval, parity, nutritional status, compliance with iron tablet intake, and knowledge are related to the prevalence of anemia in third trimester of pregnancy. Family support did not show any significant relation with the incidence of anemia, possibly due to the limitations in measuring the family support itself and other factors, such as discomfort in consuming iron tablets and forgetfulness. More structured interventions and intensive education on the importance of iron and nutrition during the pregnancy are needed to reduce the risk of anemia.

Interpregnancy Interval and Risk of Gestational Diabetes

Interpregnancy Interval and Risk of Gestational Diabetes

Linking Inter-professional Newborn and Contraception Care (LINCC) trial: Protocol for a stepped wedge cluster randomized trial to link postpartum contraception care with routine Well-Baby Visits

BackgroundPregnancies conceived within 18 months of a prior delivery (termed short inter-pregnancy interval [IPI]) place mothers and infants at high risk for poor health outcomes. Despite this, nearly one third of U.S. women experience a short IPI. ObjectiveTo address the gap in the current model of postpartum (PP) contraception care by developing and implementing a novel approach to link (co-schedule) PP contraception care with newborn well-baby care to improve access to timely PP contraception. MethodsThe LINCC Trial will take place in seven clinical locations across five community health centers within the U.S. PP patients (planned n = 3150) who are attending a Well-Baby Visit between 0 and 6 months will be enrolled. The LINCC Trial aims to leverage the Electronic Health Record to prompt providers to ask PP patients attending a Well-Baby Visit about their PP contraception needs and facilitate co-scheduling of PP contraception care with routine newborn care visits. The study includes a cluster randomized, cross-sectional stepped wedge design to roll out the intervention across the seven sites. The outcomes of the study include receipt of most or moderately effective methods of contraception by two and six months PP; and rate of short IPI pregnancies. Implementation outcomes will be assessed at baseline and 6 months after site enters intervention period. ConclusionsThe LINCC Trial seeks to evaluate the effectiveness and feasibility of a linked care model in comparison to usual care.

Interpregnancy interval and adverse perinatal outcomes: A within-individual comparative method.

Previously observed associations between interpregnancy interval (IPI) and perinatal outcomes using a between-individual method may be confounded by unmeasured maternal factors. This study aims to examine the association between IPI and adverse perinatal outcomes using within-individual comparative analyses. We studied 10,647 individuals from the National Institute of Child Health and Human Development Consecutive Pregnancies Study in Utah with ≥3 liveborn singleton pregnancies. We matched two IPIs per individual and used conditional logistic regression to examine the association between IPI and adverse perinatal outcomes, including preterm birth (PTB, <37 weeks' gestation), small-for-gestational-age (SGA, <10th percentile of sex-specific birthweight for gestational age), low birthweight (LBW, <2,500 g), and neonatal intensive care unit (NICU) admission. Point and 95% confidence interval (CI) estimates were adjusted for factors that vary across pregnancies within individuals. CIsdid not unequivocally support either an increase or a decrease in the odds of PTB (adjusted odds ratio [aOR]: 1.31, 95% CI: 0.87, 1.96), SGA (aOR: 0.81, 95% CI: 0.51, 1.28), LBW (aOR: 1.59, 95% CI: 0.90, 2.80), or NICU admission (aOR: 0.96, 95% CI: 0.66, 1.40) for an IPI<6 months compared to 18-23-months IPI (reference), and neither did the CIs for the aOR of IPIs of 6-11 and 12-18 months compared to the reference. In contrast, an IPI≥24 months was associated with increased odds of LBW (aOR: 1.66, 95% CI: 1.03, 2.66 for 24-29 months; aOR: 2.27, 95% CI: 1.21, 4.29 for 30-35 months; and aOR: 2.09, 95% CI: 1.17, 3.72 for ≥36 months). Using a within-individual comparative method, we did not find evidence that a short IPI compared to the recommended IPI of 18-23 months was associated with increased odds of PTB, SGA, LBW, and NICU admission. IPI ≥ 24 months was associated with increased odds of delivering anLBW infant.

Short inter-pregnancy interval and birthweight: a reappraisal based on a follow-up study of all women in Norway with two singleton deliveries during 1970–2019

We studied mean changes in birthweight from the first to the second delivery according to length of the inter-pregnancy interval. We also studied recurrence risk of low birthweight, preterm birth and perinatal death. We followed all women in Norway from their first to their second singleton delivery at gestational week 22 or beyond during the years 1970–2019, a total of 654 100 women. Data were obtained from the Medical Birth Registry of Norway. Mean birthweight increased from the first to the second delivery, and the increase was highest in pregnancies conceived < 6 months after the first delivery; adjusted mean birthweight increase 227 g (g) (95% CI; 219–236 g), 90 g higher than in pregnancies conceived 6–11 months after the first delivery (137 g (95% CI; 130–144 g)). After exclusion of women with a first stillbirth, the mean increase in birthweight at inter-pregnancy interval < 6 months was attenuated (152 g, 95% CI; 143–160 g), but remained higher than at longer inter-pregnancy intervals. This finding was particularly prominent in women > 35 years (218 g, 95% CI; 139 –298 g). In women with a first live born infant weighing < 2500 g, mean birthweight increased by around 1000 g to the second delivery, and the increase was most prominent at < 6 months inter-pregnancy interval. We found increased recurrence risk of preterm birth at inter-pregnancy interval < 6 months, but no increased recurrence risk of low birthweight, small for gestational age infant or perinatal death. In conclusion, we found the highest mean increase in birthweight when the inter-pregnancy interval was short. Our results do not generally discourage short pregnancy intervals.