Short Interpregnancy Interval Research Articles

Short inter-pregnancy interval and pregnancy-associated breast cancer

The relationship between pregnancy and breast cancer risk is not fully understood. Most of the literature has described this interaction in terms of the age at first pregnancy and the number of full-term pregnancies. During the prospective accrual of the “Joven & Fuerte: Program for young women with breast cancer in Mexico” cohort, a series of cases with pregnancy-associated breast cancer and a history of a short inter-pregnancy interval was identified. To date, there is a very limited number of descriptions about the interaction between a short inter-pregnancy interval and breast cancer, but none specifically regarding the association of a short inter-pregnancy interval and pregnancy-associated breast cancer. Based on findings from a prospective cohort of young Mexican breast cancer patients, we hypothesize that a short inter-pregnancy interval may increase the incidence of pregnancy-associated breast cancer, possibly by amplifying the effects of the pregnancy-associated factors involved in the development of breast cancer.

192-OR: Association between Gestational Diabetes and the Risk of Short Interpregnancy Intervals

Objective: Short interpregnancy intervals are associated with a number of adverse perinatal outcomes and their prevention is a public health priority. Among women with a history of gestational diabetes (GDM), short interpregnancy intervals further decrease the timeframe for postpartum glucose optimization and testing for type 2 diabetes prior to the next conception. The objective of this study was to evaluate whether women with GDM have higher rates of short interpregnancy intervals. Methods: Data from the 2011-2017 National Survey on Family Growth were analyzed. Study sample included 28,443 women aged 18-44y. Primary outcome was short interpregnancy intervals, defined as pregnancies conceived within 18 months after a previous birth. The rates of short interpregnancy intervals were compared between women with and without GDM using bivariate analysis. Multivariable logistic regression was done to assess independent association between GDM and short interpregnancy intervals. Results: Out of 28,443 women included in the analysis, 2,827 (9.9%) had diagnosis of GDM. Short interpregnancy intervals rates were higher in women with GDM compared to controls (56.4% vs. 43.6%, p<0.001). In bivariate analysis, GDM significantly increased the odds of short interpregnancy intervals compared to controls (OR=1.43, 95% CI 1.22-1.66). After controlling for maternal age, body mass index, race/ethnicity, marital status, education, insurance, family income, contraception use and history of sexually transmitted infections, GDM remained to be independently associated with a higher rate of short interpregnancy intervals (aOR=1.49, 95% CI 1.26-1.76). Conclusion: Women with GDM have higher rates of short interpregnancy intervals. Reducing short interpregnancy intervals in this population will not only reduce perinatal risks of short interpregnancy intervals but will also allow time for adequate preconception counseling for screening and management of type 2 diabetes prior to future pregnancy. Disclosure R. Anguzu: None. L.E. Egede: None. A.R. Shour: None. A. Palatnik: None.

Prenatal Depression and Risk of Short Interpregnancy Interval in a Predominantly Puerto Rican Population

Background: Short interpregnancy interval (IPI) is associated with risk of adverse pregnancy outcomes; however, few studies have evaluated the role of depression as a risk factor for short IPI. Puerto Rican women in the United States experience disparities in adverse birth outcomes and have the highest birth rates. Methods: We analyzed the association between prenatal depressive symptoms and IPI in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women in Western Massachusetts (2006-2011). Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) in early, mid, and late pregnancy. We calculated follow-up time as the difference between the date of delivery of the index pregnancy and the last menstrual period of the subsequent pregnancy using medical records and billing data. We defined short IPI as ≤18 months. Results: Of 1262 eligible women, 35% (n = 440) had at least probable minor depression (EPDS scores ≥13) and 25% (n = 315) had probable major depression (EPDS scores ≥15). Participants were followed for a median of 3.7 years (interquartile range = 1.4-6.0 years) and 240 (20.6%) participants experienced a short IPI. After adjusting for risk factors, women with probable minor depression (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 1.02-1.88) and probable major depression (aOR = 1.42, 95% CI = 1.02-1.97) during pregnancy had increased odds of short IPI. Conclusions: Prenatal depressive symptoms were common in this Puerto Rican population and were associated with a modest increase in odds of short IPI. Further examination of the pathways through which mental health may affect IPI in vulnerable populations is warranted.

Interpregnancy Interval in a Rural Guatemalan Population: Results from a Quality Improvement Database.

This analysis describes the interpregnancy interval (time from livebirth to subsequent conception) in a convenience sample of women living in Southwest Guatemala and the association of antepartum characteristics and postpartum outcomes with a short interpregnancy interval (< 24months). This is an observational study of a convenience sample of women enrolled in the Madres Sanas community antenatal/postnatal nursing program supported by the Center for Human Development in Southwest Trifinio, Guatemala, between October 1, 2018 and October 1, 2019. We observed the distribution of interpregnancy intervals among the population of women with a reported date of last live birth, and used bivariate comparisons to compare women with a short interpregnancy interval (< 24months) to those with an optimal interval ([Formula: see text] 24months) by antepartum, obstetric and delivery, and postpartum outcomes. 171 parous women enrolled in the Madres Sanas program between October 1, 2018 and October 1, 2019, and reported the date of their last live birth. One hundred-forty-one (82.5%) women delivered and 130 of those women (92.2%) were seen for their 40-day postpartum visit. The mean interval was 37.1months with a 22.1-month standard deviation. The median interval was 33.7months with an interquartile range of 19.6-49.5months. Among these women, 113 (66.1%) the interpregnancy interval was at least 24months. The only covariate of all sociodemographic, obstetric and antepartum, delivery, and postpartum characteristics that differed between women who achieved an interval ([Formula: see text] 24months) compared to those that did not (< 24months), was age (median 22.9, interquartile range (IQR) [19.1,27.0] vs median 24.8, IQR [21.6,27.9], respectively, p = 0.006). A regression model found that with each increasing year of age, the interpregnancy interval increases by 1.08months, p = 0.025. Among parous women, two-thirds of women space pregnancies at least 24months. Older women were more likely to have a longer interval between live births.

Modern contraceptive use and factors associated with use among postpartum women in Ethiopia; further analysis of the 2016 Ethiopia demographic and health survey data

BackgroundThe postpartum period is a critical time to improve maternal and child health. It is a time for accessing contraceptives to prevent short inter-pregnancy intervals. More than 95% of postpartum women do not want to get pregnant within 12 months. However, many women in Ethiopia experience an unintended pregnancy, and there is low information about postpartum contraceptive use among women who have family planning demand. Therefore, this study aimed to estimate the prevalence of postpartum contraceptive use and its predictors among women who give birth 12 months before the survey in Ethiopia.MethodsWe used the 2016 Ethiopia demographic health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 2304 postpartum women were included. Bivariate and multivariable logistics regressions were done to identify factors associated with postpartum contraceptive use. A p-value < 0.05 was used to declare statistical significance.ResultsAbout 23.7% (23.7, 95% CI: 20.7–27.0%) of postpartum women were using modern contraceptives. Women who were urban residents (AOR = 2.18; 95%CI: 1.34–3.55), those who attended secondary or higher education (AOR = 1.79; 95%CI: 1.04–3.10), women who attended 1–3 (AOR = 2.33; 95%CI:1.27–4.25) or 4 or more ANC visits (AOR = 2.59; 95%CI:1.43–4.69) and women who delivered at a health facility (AOR = 1.86; 95%CI: 1.23–2.81) had higher odds of modern contraceptive use during the postpartum period. Similarly, women who reported the last child was no more wanted (AOR = 1.83; 95%CI: 1.01–3.31), women who decided for contraceptive use (AOR = 2.03; 95%CI: 1.13–3.65) and women whose recent child was male (AOR = 1.38; 95%CI: 1.01–1.88) had higher odds of modern contraceptive use.ConclusionPostpartum contraceptive use was low in Ethiopia. Strengthening health facility delivery, promoting girls’ education and encouraging women’s participation in deciding for contraceptive use would improve the uptake of modern contraceptives use during the postpartum period.

Interpregnancy interval and the risk for recurrence of placental mediated pregnancy complications.

Objective The aim of this study was to investigate the effect of short or long interpregnancy interval (IPI) with placental mediated pregnancy complications after already complicated first delivery. Methods We performed a retrospective cohort analysis of all women with singleton pregnancies who delivered their first three consecutive deliveries in one university-affiliated medical center (1994-2013). Placental mediated complications included placental abruption, small for gestational age, preeclampsia, gestational hypertension, or preterm delivery. Following first complicated delivery, IPI was compared stratified by second delivery outcome. Following two complicated deliveries, IPI was compared stratified by third delivery outcome. IPI was evaluated as continuous or categorical variable (>18, 18-60, >60 months). Related samples Cochrans' Q test and Mann-Whitney analysis were used as appropriate. Results Overall, 4310 women entered analysis. Of them, 18.3%, 10.5%, and 9.3% had complicated first, second, and third delivery, consecutively. Evaluated continuously, longer IPI, but not short IPI, was associated with higher rates of complicated second delivery. Stratified to categories, IPI had no effect on recurrent complications evaluated separately or as composite. Conclusion Our results suggest that long IPI may increase risk for placental mediated pregnancy complications. Further studies are needed to evaluate this effect.

Influence of Medicaid Expansion on Short Interpregnancy Interval Rates in the US [OP03-1C

INTRODUCTION: To assess the impact of improved access to contraception through Medicaid expansion (ME) on the rate of short interpregnancy intervals (IPIs) in the US. METHODS: Population-based retrospective cohort study using US live birth data of multiparous women with data on IPI in 2012 and 2016 (pre and post expansion in 2014). Rate differences of short IPI (&lt;12 months) from 2012 to 2016 were compared between ME vs non-ME states. RESULTS: The rate of short IPI in the US was slightly lower in 2016 (17.3%) compared to 2012 (17.4%), p=0.0006; rate difference 0.13% (95% CI 0.05-0.20). Short IPIs occurred more frequently in non-ME states compared to ME states in both 2012 (18.08% vs 16.55%, p&lt;.001) and 2016 (18.12% vs 16.44%, p&lt;.001). The rate of short IPI decreased 0.11% (95% CI 0.01%-0.22%) in ME states vs increased 0.04% (95% CI 0.09-0.17) in non-ME states over the time period. CONCLUSION: The rate of short interpregnancy interval increased over time in non-expansion states but decreased in the states that adopted Medicaid expansion. If non-ME states had experienced the same rate of decrease in short IPI as ME states, 1122 fewer women would have experienced a short IPI in the US in 2016. Considering the known association between short IPI and adverse maternal and infant outcomes, these findings indicate Medicaid expansion could have an impact on improvement of perinatal outcomes in the US.

Influence of Access to Immediate Postpartum LARCs on Interpregnancy Interval [16J

INTRODUCTION: Assess the effect of immediate access to postpartum (PP) LARCs (long-acting reversible contraceptives) and contraceptive access through Medicaid expansion (ME) on short interpregnancy interval (IPI) rates in the US. METHODS: Population-based retrospective cohort study of all US live births, 2016 (n=3,956,112), using Birth Certificate data. We categorized states into those that adopted Medicaid expansion (+ME), which improves access to PP contraception, and states that provide access to immediate PP-LARCs (https://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Immediate-Postpartum-LARC-Medicaid-Reimbursement). States were classified as: (1) +ME/+LARC, (2) +ME/-LARC, (3) –ME/+LARC, (4) –ME/-LARC. Births from 13 states who adopted ME after 1/1/2014 were not included. Multivariate logistic regression estimated the relative influence of ME and PP-LARCs on the outcome of short IPI (&lt;12 months), after adjusting for maternal race, age, marital status, and WIC. RESULTS: The study population comprised 1,831,665 births to multiparous women with data on IPI among included states. Of those, 50% were in 19 states with +ME/+LARC, 151,999 (8%) in 5 states with +ME/-LARC, 742,836 (40%) in 12 states with –ME/+LARC, and 3,876 (0.2%) in one state with –ME/-LARC. The rate/risk of short IPI was lowest in states with ME plus immediate PP-LARC access (16.17%, 95% CI 16.09-16.25%), adjusted RR 0.926, 95% CI 0.92-0.93). Short IPI rates and adjusted risks were slightly higher in states that adopted only one program or neither: +ME/-LARC 18.05% (CI 17.86-18.25%), -ME/+LARC 18.12% (CI 18.03-18.20%), -ME/-LARC 18.83% (CI 17.60-20.06%), with highest risk in the state with –ME/-LARC, adjRR 1.12, CI 1.05-1.19. CONCLUSION: These data demonstrate that both Medicaid expansion and access to immediate PP LARCs decrease the frequency of short IPI, which may reduce adverse birth outcomes in the US associated with insufficient birth spacing.

Chte-Level Access to Contraception [04J

INTRODUCTION: To assess the influence of Medicaid on the rate of short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy (IPIs) rates. METHODS: Using the US Birth Certificate data, we performed a population-based retrospective cohort study including all multiparous women who had a live birth in the US in 2016, after Medicaid expansion had been implemented. Multivariate logistic regression estimated the relative influence of Medicaid expansion on the outcome of short interpregnancy interval (&lt;12 months). RESULTS: There were 3,956,112 live births in the US in 2016: 2,244,158 (56.7%) in multiparous women with data on IPI (n=1,077,411, 48% ME states, n=746,712, 33.3% non-ME states). The rate of short IPI was 18.1% in non-ME states compared to 16.4% in ME states, rate difference 1.68% (95% CI 1.57-1.79%). Living within a state that adopted ME was associated with a modestly decreased risk of a short interpregnancy interval (adjusted relative risk, 0.973; 95% CI 0.966-0.979), even after adjustment for coexisting risks for short IPI. The individual-level factors most strongly associated with short IPI in women who gave birth in states that did not adopt ME were black race, younger maternal age, unmarried, Medicaid enrollment and utilization of WIC, lack of early initiation of prenatal care initiation, and grand multiparity. CONCLUSION: The risk of short interpregnancy interval decreases with Medicaid expansion, even after adjusting for coexisting risk factors. This demonstrates the value of expanding Medicaid to women of child bearing ages.

Assessment of prevalence and risk factors for anaemia in pregnant women attending Karnataka institute of medical sciences, outpatient department, Hubballi, Karnataka, India

Background: Anaemia in pregnancy is one of the major causes of maternal morbidity and mortality in India and world. Anaemia in pregnancy continues to be a problem in spite of national programs for its prevention and control. It accounts for 1/5th of maternal deaths worldwide and 16% in India and is the major factor responsible for low birth weight, abortions, premature birth, and post-partum haemorrhage. Hence determining the status and factors influencing anaemia among pregnant women is essential to treat and prevent the same. Objective of this study was to assess the prevalence and risk factors associated with anaemia among pregnant women.Methods: A cross sectional study was conducted among 200 pregnant women attending for antenatal care at KIMS OPD from 3rd June to 4th July. A pretested, semi-structured questionnaire was applied to collect data. Haemoglobin estimation was done by Sahli’s method.Results: Prevalence of anaemia among pregnant women was found to be 81%; majority had moderate anaemia 57%. The mean age of pregnant women in the study is 24.55 years and 46.5% belong to lower socioeconomic status, 43% lived in joint families. Factors influencing anaemia were multi-parity, short inter-pregnancy interval, no history of recent deworming and iron and folic acid tablets intake.Conclusions: In the present study, the prevalence of anaemia among pregnant women was found to be very high i.e., 81% especially among illiterates, low income groups, multiparous women, short inter-pregnancy interval, no history of recent deworming and iron and folic acid tablets intake.

Interpregnancy interval and hypertensive disorders of pregnancy: A population-based cohort study.

Despite extensive research on risk factors and mechanisms, the extent to which interpregnancy interval (IPI) affects hypertensive disorders of pregnancy in high-income countries remains unclear. To examine the association between IPI and hypertensive disorders of pregnancy in a high-income country setting using both within-mother and between-mother comparisons. A retrospective population-based cohort study was conducted among 103909 women who delivered three or more consecutive singleton births (n=358046) between 1980 and 2015 in Western Australia. We used conditional Poisson regression with robust variance, matching intervals of the same mother and adjusted for factors that vary within-mother across pregnancies, to investigate the association between IPI categories (reference 18-23months), and the risk of hypertensive disorders of pregnancy. For comparison with previous studies, we also applied unmatched Poisson regression (between-mother analysis). The incidence of preeclampsia and gestational hypertension during the study period was 4%, and 2%, respectively. For the between-mother comparison, mothers with intervals of 6-11months had lower risk of preeclampsia with adjusted relative risk (RR) 0.92 (95% confidence interval [CI] 0.85, 0.98) compared to reference category of 18-23months. With the within-mother matched design, we estimated a larger effect of long IPI on risk of preeclampsia (RR 1.29, 95% CI 1.18, 1.42 for 60-119months; and RR 1.30, 95% CI 1.10, 1.53 for intervals ≥120months) compared to 18-23months. Short IPIs were not associated with hypertensive disorders of pregnancy. In our cohort, longer IPIs were associated with increased risk of preeclampsia. However, there was insufficient evidence to suggest that short IPIs (<6months) increase the risks of hypertensive disorders of pregnancy.

Increased Risk of ADHD at Short and Long Interpregnancy Intervals in a National Birth Cohort.

Short or long interpregnancy interval (IPI) may adversely impact conditions for foetal development. Whether attention deficit hyperactivity disorder (ADHD) is related to IPI has been largely unexplored. To examine the association between IPI and ADHD in a large, population-based Finnish study. All children born in Finland between 1991 and 2005 and diagnosed with ADHD (ICD-9 314x or ICD-10 F90.x) from 1995 to 2011 were identified using data from linked national registers. Each subject with ADHD was matched to 4 controls based on sex, date of birth, and place of birth. A total of 9564 subjects with ADHD and 34,479 matched controls were included in analyses. IPI was calculated as the time interval between sibling birth dates minus the gestational age of the second sibling. The association between IPI and ADHD was determined using conditional logistic regression and adjusted for potential confounders. Relative to births with an IPI of 24 to 59months, those with the shortest IPI (<6months) had an increased risk of ADHD (odds ratio [OR] 1.30, 95% confidence interval (CI) 1.12, 1.51) and the ORs forthe longer IPI births (60-119months and ≥120months) were 1.12 (95% CI 1.02, 1.24) and 1.25 (95% CI 1.08, 1.45), respectively. The association of longer IPI with ADHD was attenuated by adjustment for maternal age at the preceding birth, and comorbid autism spectrum disorders did not explain the associations with ADHD. The risk of ADHD is higher among children born following short or long IPIs although further studies are needed to explain this association.

Identifying barriers to post-placental intrauterine device placement: male partners’ views

Objective: The use of post-placental intrauterine devices (IUDs) has potential to address the health issues of suboptimal breastfeeding rates and short inter-pregnancy intervals. An understudied factor that may influence choice of breastfeeding-compatible contraception among postpartum women is their romantic partner. We aimed to identify male partner influences on women’s postpartum breastfeeding-compatible contraception choices.Methods: Questionnaires were administered to 75 men in Cleveland, OH, USA. Data on partner priorities, opinions and knowledge about breastfeeding and contraception, and barriers to partner IUD receipt were collected. Survey data were summarised using frequencies and percentages, and univariate logistic regression models were used to explore associations between responses.Results: Participants were predominantly African American, unmarried and had at least one child. Twenty-six participants (36%) reported using contraception with their current partner; men who had discussions and agreed about contraception with their partner were more likely to use it. Thirty-nine men (54%) intended for a future child to breastfeed; this intention was more likely for men who had a child that was breastfed previously and for those with knowledge of breastfeeding benefits. Only 25 (35%) thought a post-placental IUD was safe for breastfeeding mothers; correct IUD knowledge and a partner’s positive IUD experience were significantly associated with this response.Conclusion: Our findings suggest that knowledge about breastfeeding and contraception as well as experiential learning regarding breastfeeding and contraception within a partnered relationship are important and that minimal prior experience and low knowledge in these areas may be a male partner barrier to post-placental IUD placement for breastfeeding mothers.

Perceptions of Women, Their Husbands and Health Care Providers about Anemia in Rural Pakistan

Background: In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age. This study was undertaken to explore the perceptions of women, their husbands and health care providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan. Methods: A qualitative study was conducted in Thatta, Pakistan from September to December 2018. We conducted focus group discussions with women and their husbands as well as key-informant interviews with healthcare providers to understand their perceptions about anemia. Data were analyzed using NVivo 10 software. Results: We conducted 20 interviews using semi-structured interview guides. Six over-arching themes were identified: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron–folic Acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women’s health behavior. Conclusion: The study revealed that most men and women were not aware of the term “anemia” but acknowledged that women of reproductive age may suffer from ‘blood deficiency’. Both men and women identified the intake of chewable tobacco (ghutka) as one of the major causes of anemia among women of reproductive age. In addition, short inter-pregnancy intervals, inappropriate dietary practices and poor health behavior of women were identified as important causes of anemia in women of Thatta, Pakistan.

Association of Overweight and Obesity Development Between Pregnancies With Stillbirth and Infant Mortality in a Cohort of Multiparous Women.

To identify the association of newly developed prepregnancy overweight and obesity with stillbirth and infant mortality. We studied subsequent pregnancies of mothers who were normal weight at fertilization of their first identified pregnancy, from a population-based cohort that linked birth registry with death records in Pennsylvania, 2003-2013. Women with newly developed prepregnancy overweight and obesity were defined as those whose body mass index (BMI) before second pregnancy was between 25 and 29.9 or 30 or higher, respectively. Our main outcomes of interest were stillbirth (intrauterine death at 20 weeks of gestation or greater), infant mortality (less than 365 days after birth), neonatal death (less than 28 days after birth) and postneonatal death (29-365 days after birth). Associations of both prepregnancy BMI categories and continuous BMI with each outcome were estimated by nonparametric targeted minimum loss-based estimation and inverse-probability weighted dose-response curves, respectively, adjusting for race-ethnicity, smoking, and other confounders (eg, age, education). A cohort of 212,889 women were included for infant mortality analysis (192,941 women for stillbirth analysis). The crude rate of stillbirth and infant mortality in these final analytic cohorts were 3.3 per 1,000 pregnancies and 2.9 per 1,000 live births, respectively. Compared with women who stayed at a normal weight in their second pregnancies, those becoming overweight had 1.4 (95% CI 0.6-2.1) excess stillbirths per 1,000 pregnancies. Those becoming obese had 3.6 (95% CI 1.3-5.9) excess stillbirths per 1,000 pregnancies and 2.4 (95% CI 0.4-4.4) excess neonatal deaths per 1,000 live births. There was a dose-response relationship between prepregnancy BMI increases of more than 2 units and increased risk of stillbirth and infant mortality. In addition, BMI increases were associated with higher risks of infant mortality among women with shorter interpregnancy intervals (less than 18 months) compared with longer intervals. Transitioning from normal weight to overweight or obese between pregnancies was associated with an increased risk of stillbirth and neonatal mortality.

Unscarred uterine rupture and subsequent pregnancy outcome - a tertiary centre experience.

The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred uterine rupture and in those with a history of uterine rupture MATERIAL AND METHODS: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone fertility-preserving surgery were evaluated. During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in 67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in 60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these, eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36-37 wk. of gestation, and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively. The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be validated in another studies.

Intentionally or Ambivalently Risking a Short Interpregnancy Interval: Reproductive-Readiness Factors in Women's Postpartum Non-Use of Contraception.

A focus of research on short interpregnancy intervals (IPI) has been on young disadvantaged women whose births are likely to be unintended. Later initiation of family formation in the United States and other high-income countries points to the need to also consider a woman's attributes indicative of readiness for purposefully accelerated family formation achieved through short IPIs. We test for whether factors indicating "reproductive readiness"-including being married, being older, and having just had a first birth or a birth later than desired-predict a woman's non-use of contraception in the postpartum months. We also test for whether this contraceptive non-use results explicitly from wanting to become pregnant again. The data come from the 2012-2015 Pregnancy Risk Assessment Monitoring System, representing women who recently gave birth in any of 35 U.S. states and New York City (N = 120,111). We find that these reproductive-readiness factors are highly predictive of women's postpartum non-use of contraception because of a stated desire to become pregnant and are moderately predictive of contraceptive non-use without an explicit pregnancy intention. We conclude that planning for, or ambivalently risking, a short IPI is a frequent family-formation strategy for women whose family formation has been delayed. This is likely to become increasingly common as family formation in the United States is initiated later in the reproductive life course.

A Novel Approach to Postpartum Contraception Provision Combined with Infant Care: A Randomized, Controlled Trial.

Unintended pregnancy among women with short interpregnancy intervals remains common. Women's attendance at the 4- to 6-week postpartum visit, when contraception provision often occurs, is low, whereas their attendance at well-baby visits is high. We aimed to evaluate if offering co-located contraceptive services to mothers at well-baby visits increases use of long-acting reversible contraception (LARC) at 5months postpartum compared with usual care in a randomized, controlled trial. Women with infants aged 4.5months or younger who were not using a LARC method and had not undergone sterilization were eligible. Generalized linear models were used to estimate risk ratios. Likability and satisfaction of the contraception visit were assessed. Between January 2015 and January 2017, 446 women were randomized. LARC use at 5months was 19.1% and 20.9% for the intervention and control groups, respectively, and was not significantly different after controlling for weeks postpartum (risk ratio, 0.85; 95% confidence interval, 0.59-1.23). Uptake of the co-located visit was low (17.7%), but the concept was liked; insufficient time to stay for the visit was the biggest barrier to uptake. Women who accepted the visit were more likely to use a LARC method at 5months compared with women in the control group (risk ratio, 1.97; 95% confidence interval, 1.26-3.07). Women perceived co-located care favorably and LARC use was higher among those who completed a visit; however, uptake was low for reasons including inability to stay after the infant visit. Intervention effects were possibly diluted. Future research should test a version of this intervention designed to overcome barriers that participants reported.

Effects of short inter-pregnancy interval on maternal and perinatal outcomes: A cohort study of pregnant women in a low-income country.

Short inter-pregnancy interval (IPI) is a potential risk factor for adverse pregnancy outcomes. Previous reports from sub-Sahara Africa documented increasing incidence of short IPI but evidence is lacking in its effect on pregnancy outcome. The study aimed to determine the effect of short IPI on pregnancy outcome in Nigeria. It was a prospective cohort study of 271 pregnant women receiving antenatal care in a tertiary hospital in Nigeria. For every eligible woman with short IPI (<18 months) recruited; a suitable control with IPI ≥18 months was selected. Statistical analysis was both inferential and descriptive using the statistical package for social sciences version 24 (SPSS Inc. Chicago, Illinois, USA) for windows. A P value of less than 0.05 was considered statistically significant. Incidence of maternal anemia was higher in women with short IPI than control (RR: 2.091; 95% CI: 1.4433.031; P < 0.001). Other maternal and perinatal outcome measures including premature rupture of membranes, preterm labor/delivery, pregnancy induced hypertension, third trimester bleeding, postpartum hemorrhage, and inadequate gestational weight gain did not show any significant association with short IPI (P > 0.05). Short IPI is associated with anemia in pregnancy in Nigeria. Public health campaigns for improvement in uptake of family planning services and breastfeeding may help reduce the incidence of short IPI and anemia in low income countries.

Impact of inter-pregnancy interval on long-term endo-metabolic health of the offspring

Background: Inter-pregnancy interval (IPI), defined as the time interval between a live birth and estimated conception time of a subsequent pregnancy, has an established effect on perinatal outcome. The long-term impact of IPI on offspring is unknown. This study aimed to examine the effect of short and long IPIs on long-term endo-metabolic health of offspring. Subjects and Method: This population-based cohort study included singleton live births in parturient with at least one previous birth. Singleton deliveries between the years 1991-2014 in a regional tertiary medical center were included. Offspring were followed until 18 years of age for endo-metabolic related hospitalizations. Survival curves were used to compare cumulative incidence of endo-metabolic morbidity, and Cox proportional hazards models to control for confounders. Results: During the study period 144,397 deliveries met the inclusion criteria. Offspring following long IPIs exhibited higher rates of endo-metabolic related hospitalizations. Survival curve demonstrated a significantly higher cumulative incidence of endo-metabolic morbidity in the long IPI group (p<0.001). The Cox model demonstrated long IPI to significantly increase the risk for endo-metabolic related hospitalizations during childhood (aHR= 1.34, 95%CI= 1.06 to 1.70; p=0.015). Conclusion: Long IPI appears to have an independent impact on long-term endo-metabolic health of the offspring. Keywords: pregnancy interval, offspring, endocrine health, metabolic morbidity, obesity Correspondence: Liron Seidman. The Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev. Ben-Gurion University Medical School, Soroka University Medical Center, 151 IzakRager Ave, Be’er-Sheva 84101, Israel. Email: lironseidman@gmail.com. Mobile: +972-524215808 Journal of Maternal and Child Health (2020, 5(3): 321-330 https://doi.org/10.26911/thejmch.2020.05.03.11