Short Interpregnancy Interval Research Articles

Interpregnancy interval and prevalence of selected birth defects: A multistate study.

Both short and long interpregnancy intervals (IPIs) have been associated with adverse birth outcomes. We undertook a multistate study to describe the prevalence of selected birth defects by IPI. We obtained data from nine population-based state birth defects registries for singleton live births in 2000-2009 among mothers with a previous live birth identified through birth certificates. IPI was calculated as the difference between prior birthdate and start of the current pregnancy (conception date). We estimated prevalence of selected defects per 10,000 live births and prevalence ratios (PRs) with 95% confidence intervals (CIs) overall and stratified by maternal age at previous birth and race/ethnicity. Primary analyses focused on short IPI < 6 months and long IPI ≥ 60 months compared to 18-23 months (referent). Sensitivity analyses limited to active-surveillance states and those with<10% missing IPI. Among 5,147,962 eligible births, 6.3% had short IPI while 19.8% had long IPI. Compared to referent, prevalence with short IPI was elevated for gastroschisis (3.7, CI: 3.0-4.5 vs. 2.0, CI: 1.6-2.4) and with both short and long IPI for tetralogy of Fallot (short: 3.4, 2.8-4.2 long: 3.8, 3.4-4.3 vs. 2.7, 2.3-3.2) and cleft lip ± palate (short: 9.9, 8.8-11.2 long: 9.2, 8.5-9.8 vs. 8.4, 7.6-9.2). Stratified analyses identified additional associations, including elevated prevalence of anencephaly with short IPI in younger mothers and limb defects with long IPI in those ages 25-34 at prior birth. Sensitivity analyses showed similar results. In this population-based study, we observed increased prevalence of several birth defects with short and long IPI.

Short interpregnancy interval: circumstance or choice?

IntroductionDespite the knowledge of pregnancy risks attributable to inadequate birth spacing, over one-third of pregnancies occur within 18 months of a preceding birth. In this qualitative study we sought to...

Impact of interpregnancy interval on long-term childhood neoplasm of the offspring

Background The possible impact of interpregnancy interval (IPI) on perinatal outcomes has long been studied, however, a definition of the optimal interval is still not clear. Both short and long IPIs have been associated with obstetrical syndromes and short and long-term complications. In this study, we sought to explore the impact of IPI on the hazard for neoplasm of the offspring, thus contribute to the present literature in determining the preferred birth spacing. Objective We aim to investigate the association between short and long IPIs and the hazard for childhood neoplasm of the offspring. Methods A population-based retrospective cohort analysis comparing offspring neoplasm hazard following three different IPIs. Exposure was defined as short (<6 months), or long (>60 months) IPIs, whereas intermediate IPI (6 months − 60 months) served as the comparison group. The study included singleton live births in a tertiary regional hospital between 1991 and 2014. Offspring were followed for 18 years, and all hospitalization records for neoplasm diagnoses were collected. Kaplan–Meier survival curves were used for the cumulative incidence of neoplasm morbidity, and Cox proportional hazards models were used to control for confounders. Results During the study period, 144,397 deliveries met the inclusion criteria. Of those, 18,947 (13.1%) occurred in women with short IPI, 114,012 (79%) in women with intermediate IPI, and 11,438 (7.9%) in women with long IPI. 61 benign neoplasms and 80 malignant neoplasms were registered in offspring born after long IPI. The total percentage of neoplasm were the highest in the long IPI group versus the intermediate and short IPI groups (malignant − 0.7%, 0.6%, 0.5% respectively, benign − 0.5%, 0.4%, 0.3% respectively). Controlling for maternal age, diabetes mellitus, preterm delivery, birth weight, smoking, cesarean section, and fertility treatments, long IPI was found to be independently associated with high hazard for long-term pediatric neoplasm related hospitalizations (adjusted HR 1.39, 95% CI 1.09, 1.77). Short IPI may be associated to decreased hazard for childhood neoplasms (adjusted HR 0.74, 95% Cl 0.59, 0.92). Conclusions Long IPI is associated with a high hazard for childhood neoplasms, compared with intermediate and short IPIs. Short IPI may be associated with decreased hazard for childhood neoplasms.

Influence of Medicaid expansion on short interpregnancy interval rates in the United States

Short interpregnancy intervals have been associated with poor maternal and infant outcomes. Contraception access could affect the short interpregnancy interval rates. To assess the influence of Medicaid on short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy intervals. Using the United States birth certificate data, we performed a population-based retrospective cohort study including multiparous women who had live births in 2012 and 2016, which is before and after Medicaid expansion had been implemented in 2014. Multivariate logistic regression estimated the influence of Medicaid expansion on short interpregnancy intervals (<12 months). The rate differences of short interpregnancy intervals in 2012 and 2016 were compared between Medicaid expansion vs non-Medicaid expansion states. There were a total of 7,916,908 live births in2012 and 2016 in the United States, of which 3,362,904 (42.5%) were in multiparous women with data on interpregnancy intervals (n=1,961,683 [58.3%]) in Medicaid expansion states and in non-Medicaid expansion states (n=1,401,221 [41.7%]). The rate of short interpregnancy intervals in the United States was slightly lower in 2016 (17.3%) than in 2012 (17.4%), P=.0006; rate difference 0.13% (95% confidence interval, 0.05-0.20). Short interpregnancy intervals occurred more frequently in non-Medicaid expansion states than in Medicaid expansion states in both 2012 (18.1% vs 16.6%, respectively; P<.001) and 2016 (18.1% vs 16.4%, respectively; P<.001). The rate of short interpregnancy intervals decreased by 0.11% (95% confidence interval, 0.01-0.22) in Medicaid expansion states and increased by 0.04% (95% confidence interval, 0.09-0.17) in non-Medicaid expansion states. In 2016, living in a Medicaid expansion state was associated with a modestly decreased risk of short interpregnancy intervals (adjusted relative risk, 0.97; 95% confidence interval, 0.97-0.98), even after adjustment for coexisting risks. The risk of short interpregnancy intervals decreased in the Medicaid expansion states even after adjusting for risk factors. Moreover, the short interpregnancy interval rates increased in nonexpansion states but decreased in Medicaid expansion states. If non-Medicaid expansion states had experienced the same rate of decrease in short interpregnancy intervals as Medicaid expansion states, 1122 fewer women would have had a short interpregnancy interval in 2016.Considering the known association between short interpregnancy intervals and adverse maternal and infant outcomes, these findings indicate that Medicaid expansion could improve perinatal outcomes.

748Misclassification of interpregnancy interval attributable to miscarriages/induced abortions: quantifying its impact on preterm births

Abstract Background A paucity of studies explored how intervening pregnancy events (miscarriages and induced abortions) contribute to interpregnancy interval (IPI) misclassification and whether this misclassification translates into bias in the estimated effect of IPI on adverse birth outcomes. Methods We included identified three national registries (Birth Register, the General Practitioner, and Patient Register) to obtain information on registered pregnancies (n = 167,012), with at least two consecutive pregnancies per mother, occurring between 2008 and 2016 in Norway. We computed two IPIs, one that accounted only two consecutive pregnancies ending after 20 weeks of gestation (standard IPI definition) and the other that accounted two consecutive pregnancies with various outcomes including miscarriages/induced abortions (corrected IPI definition). We independently assessed the association between the two IPIs and preterm births (PTB). Log binomial regression analysis was conducted. Relative risks (aOR) and 95% confidence interval (CI) were estimated. Results In the study, 4.7% of births were PTB. While 11.7% of pregnancies occurred &amp;lt;6 months in the corrected IPI definition, the proportion reduced to 4.4% in the standard IPI definition, with over 60% of IPIs were misclassified. After adjusting for confounders, there was a modest overestimation of risk of PTB for pregnancies following short IPI (&amp;lt;6 months) (RR = 1.76, 95% CI: 1.60-1.95) for the standard IPI definition as compared to the risk of PTB (RR = 1.52, 95% CI: 1.41-1.65) following short IPI in the corrected IPI definition. Conclusions There was a significant misclassification bias associated with miscarriages/induced abortions which should not be ignored when assessing the effect of IPI on PTB.

432Recurrent stillbirth: a population-based study from South Australia

Abstract Background In high-income countries, stillbirth is a relatively rare event occurring in &amp;lt; 1% of pregnancies. Recurrent stillbirth is even rarer. Our objective was to explore the prevalence of stillbirth and recurrent stillbirth, factors associated with stillbirth and whether a stillbirth in first pregnancy influences the time to subsequent pregnancy. Methods This population-based study involved routinely-collected administrative data on singleton births in South Australia from 1998 to 2015 (n = 333,785). Stillbirth was defined as pregnancies &amp;gt;20 weeks gestation or weighing &amp;gt;400 grams. Univariable and multivariable logistic regression was used to explore associations between sociodemographic factors and stillbirth. Cox proportional hazard was used to explore time to pregnancy. Results 0.7% of all first pregnancies and 0.6% of all second pregnancies were stillbirths. Of women in their second pregnancy, &amp;lt;10 experienced recurrent stillbirth. In univariable analyses, higher odds of stillbirth in second pregnancies were associated with younger and older maternal age (&amp;lt;20 or ≥ 40 years), being single, unemployed, smoking, shorter inter-pregnancy intervals and numerous medical conditions (e.g. diabetes or hypertension). Multivariable models were unstable due to too few data. The hazard ratio for women who previously experienced a stillbirth compared with livebirth was 1.14 (95%CI 0.39, 3.32). Conclusions Studying recurrent stillbirth is especially difficult due to the rare nature of the problem, limiting progress on developing evidence-based advice for women who experience stillbirth in their first pregnancy. Key messages Recurrent stillbirth is challenging to study due to the rareness of the problem but could be addressed by careful pooling of large administrative datasets.

INTERPREGNANCY INTERVAL EFFECT ON PRETERM BIRTH

Identication of modiable and non-modiable risk factors for preterm birth before conception or early in pregnancy may help prevent this complication. Aretrospective analysis of interpregnancy interval in women giving preterm birth in a tertiary health centre was done . All records of obstetric patients, from institutional data centre were examined in detail which included demographic information, reproductive history, maternal characteristics, prenatal care, labor management, maternal complications during pregnancy, delivery, and the puerperium, and neonatal outcomes. In this study , among 112 patients 30 percent were having interpregnancy interval of less than 12 months, 50 percent 12 to &lt; 24 months, 11 percent 24 to 48 months and 9 percent &gt; 48 months. Higher occurrence of short interpregnancy interval &lt;24 months and younger age group &lt;19 years were found in association with preterm births.

Optimal interpregnancy interval in autism spectrum disorder: A multi‐national study of a modifiable risk factor

It is biologically plausible that risk of autism spectrum disorder (ASD) is elevated by both short and long interpregnancy intervals (IPI). We conducted a retrospective cohort study of singleton, non-nulliparous live births, 1998-2007 in Denmark, Finland, and Sweden (N=925,523 births). Optimal IPI was defined as the IPI at which minimum risk was observed. Generalized additive models were used to estimate relative risks (RR) of ASD and 95% Confidence Intervals (CI). Population impact fractions (PIF) for ASD were estimated under scenarios for shifts in the IPI distribution. We observed that the association between ASD (N=9302) and IPI was U-shaped for all countries. ASD risk was lowest (optimal IPI) at 35 months for all countries combined, and at 30, 33, and 39 months in Denmark, Finland, and Sweden, respectively. Fully adjusted RRs at IPIs of 6, 12, and 60 months were 1.41 (95% CI: 1.08, 1.85), 1.26 (95% CI: 1.02, 1.56), and 1.24 (95% CI: 0.98, 1.58) compared to an IPI of 35 months. Under the most conservative scenario PIFs ranged from 5% (95% CI: 1%-8%) in Denmark to 9% (95% CI: 6%-12%) in Sweden. The minimum ASD risk followed IPIs of 30-39 months across three countries. These results reflect both direct IPI effects and other, closely related social and biological pathways. If our results reflect biologically causal effects, increasing optimal IPIs and reducing their indications, such as unintended pregnancy and delayed age at first pregnancy has the potential to prevent a salient proportion of ASD cases. LAY SUMMARY: Waiting 35 months to conceive again after giving birth resulted in the least risk of autism. Shorter and longer intervals resulted in risks that were up to 50% and 85% higher, respectively. About 5% to 9% of autism cases might be avoided by optimizing birth spacing.

P–743 The fertility paradox: the need for contraception after in vitro fertilisation

Abstract Study question What are a woman’s contraceptive needs after successful in vitro fertilisation (IVF) pregnancy? and how should services respond to help prevent unintended pregnancies? Summary answer Women who have IVF pregnancies require tailored, postnatal contraception counselling. Services must provide evidence-based information about the risks of spontaneous conception to engage them effectively. What is known already Women undergoing IVF are an increasingly heterogeneous group with a wide range of causative subfertility factors. Furthermore, increasingly, women are accessing treatment primarily for reasons other than subfertility. The evidence relating to rates of spontaneous conception post assisted conception varies widely according to population, cause of subfertility, type and outcome of fertility treatment and length of follow-up. A recent large retrospective UK cohort study estimated the treatment-independent live birth rate after IVF live birth over 5 year follow up as 15% [https://doi.org/10.1093/humrep/dez099]. We aim to explore the experiences and views about contraception among this diverse group of women. Study design, size, duration A qualitative study of the views of women who have had spontaneous pregnancies after successful IVF was conducted in September/October 2020. A qualitative approach of in-depth interviews was chosen to allow exploration of individual experiences in an area not much studied previously. The sample consisted of twenty interviewees from around the UK. Participants/materials, setting, methods Purposive and snowballing sampling methods were used with eligible participants recruited from a range of sources including social media and peer networks. The sample included a wide range of spontaneous pregnancy outcomes after successful IVF, including single and multiple livebirths, miscarriage, ectopic pregnancy and termination of pregnancy. The framework method was used for analysis using NVivo12 software. Main results and the role of chance Contraceptive choices were subject to a complex and dynamic interaction of influencing factors including i) beliefs regarding their own subfertility, ii) desire for more children and iii) their views on contraception. After IVF pregnancy, the majority of women (n = 15) used no contraception or ineffective methods (inconsistent condom use or withdrawal) before their next pregnancy with only two women using hormonal methods (progesterone-only pill). Spontaneous pregnancy was not universally welcomed in this group and the inter-pregnancy intervals were often short (n = 15, less than 18 months) or very short (n = 6, less than 12 months). After subsequent spontaneous pregnancy, use of contraception and the most effective (long-acting reversible) methods remained low. Women held persistent beliefs regarding their subfertility despite subsequent spontaneous pregnancy (or pregnancies). Women associated aspects of the IVF process (e.g. need for multiple cycles, low numbers of eggs collected etc.) with a sense of personal failure, despite an ultimately “successful” outcome resulting in livebirth. This may contribute to or reinforce their self-belief in subfertility. Other specific barriers to contraception use, in women having IVF, included lack of knowledge of the likelihood of spontaneous pregnancy, lack of contraceptive experience and inherent incentives towards shorter inter-pregnancy intervals. Limitations, reasons for caution There is potential recall bias with some women recalling experiences associated with IVF treatment more than ten years ago. However our sample included women who were currently pregnant as well as women who were further towards the end of their reproductive life to capture a range of experiences. Wider implications of the findings: The contraceptive needs of women having IVF pregnancies are being overlooked. Fertility services should take responsibility for providing accurate information on the risks of subsequent spontaneous pregnancy in this population. Maternity and community healthcare professionals must address women’s perceptions of their fertility in order to engage them in contraception counselling. Trial registration number N/A

Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia.

Short inter-pregnancy interval is an interval of <24 months between the dates of birth of the preceding child and the conception date of the current pregnancy. Despite its direct effects on the perinatal and maternal outcomes, there is a paucity of evidence on its prevalence and determinant factors, particularly in Ethiopia. Therefore, this study assessed the prevalence and associated factors of short inter-pregnancy interval among pregnant women in Debre Berhan town, Northern Ethiopia. A community based cross-sectional study was conducted among a randomly selected 496 pregnant women in Debre Berhan town from February 9 to March 9, 2020. The data were collected by using an interviewer-administered questionnaire and analyzed using STATA (14.2) statistical software. To identify the predictors of short inter-pregnancy interval, multivariable binary logistic regression was fitted and findings are presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). The overall prevalence of short inter-pregnancy interval (<24 months) among pregnant women was 205 (40.9%). Being over 30 years of age at first birth (AOR = 3.50; 95% CI: 2.12-6.01), non-use of modern contraceptive (AOR = 2.51; 95% CI: 1.23-3.71), duration of breastfeeding for less than 12 months (AOR = 2.62; 95% CI: 1.32-5.23), parity above four (AOR = 0.31; 95% CI: 0.05-0.81), and unintended pregnancy (AOR = 5.42; 95% CI: 3.34-9.22) were independently associated factors with short inter-pregnancy interval. Despite the public health interventions being tried in the country, the prevalence of short inter-pregnancy interval in this study is high. Therefore, it implies that increasing contraceptive use and encouraging optimal breastfeeding might help in the efforts made to avert the problem.

Association of Expanded Prenatal Care Coverage for Immigrant Women With Postpartum Contraception and Short Interpregnancy Interval Births

Access to prenatal and postpartum care is restricted among women with low income who are recent or undocumented immigrants enrolled in Emergency Medicaid. To examine the association of extending prenatal care coverage to Emergency Medicaid enrollees with postpartum contraception and short interpregnancy interval births. This cohort study used a difference-in-differences design to compare the staggered rollout of prenatal care in Oregon with South Carolina, a state that does not cover prenatal or postpartum care. Linked Medicaid claims and birth certificate data from 2010 to 2016 were examined for an association between prenatal care coverage for women whose births were covered by Emergency Medicaid and subsequent short IPI births. Additional maternal and infant health outcomes were also examined, including postpartum contraceptive use, preterm birth, and neonatal intensive care unit admission. The association between the policy change and measures of policy implementation (number of prenatal visits) and quality of care (receipt of 8 guideline-based screenings) was also analyzed. Statistical analysis was performed from August 2020 to March 2021. Medicaid coverage of prenatal care. Postpartum contraceptive use, defined as receipt of any contraceptive method within 60 days of delivery; short IPI births, defined as occurring within 18 months of a previous pregnancy. The study population consisted of 26 586 births to women enrolled in Emergency Medicaid in Oregon and South Carolina. Among these women, 14 749 (55.5%) were aged 25 to 35 years, 25 894 (97.4%) were Black, Hispanic, Native American, Alaskan, Pacific Islander, or Asian women or women with unknown race/ethnicity, and 17 905 (67.3%) lived in areas with urban zip codes. Coverage of prenatal care for women in Emergency Medicaid was associated with significant increases in mean (SD) prenatal visits (increase of 10.3 [0.9] prenatal visits) and prenatal quality. Prenatal care screenings (eg, anemia screening: increase of 65.7 percentage points [95% CI, 54.2 to 77.1 percentage points]) and vaccinations (eg, influenza vaccination: increase of 31.9 percentage points [95% CI, 27.4 to 36.3 percentage points]) increased significantly following the policy change. Although postpartum contraceptive use increased following prenatal care expansion (increase of 1.5 percentage points [95% CI, 0.4 to 2.6 percentage points]), the policy change was not associated with a reduction in short IPI births (-4.5 percentage points [95% CI, -9.5 to 0.5 percentage points), preterm births (-0.6 percentage points [95% CI, -3.2 to 2.0 percentage points]), or neonatal intensive care unit admissions (increase of 0.8 percentage points [95% CI, -2.0 to 3.6 percentage points]). This study found that expanding Emergency Medicaid benefits to include prenatal care significantly improved receipt of guideline-concordant prenatal care. Prenatal care coverage alone was not associated with a meaningful increase in postpartum contraception or a reduction in subsequent short IPI births.

Recurrent short interpregnancy interval: Maternal and neonatal outcomes

ObjectiveTo evaluate maternal and neonatal outcomes associated with recurrent short interpregnancy interval (IPI) in women in their third delivery. MethodsA retrospective computerized database study of all women who delivered their first three consecutive deliveries in a single tertiary medical center over 20 years (1999–2019). Maternal and neonatal outcomes of women with recurrent short IPI (<6 months between the 1st and 2nd pregnancy and the 2nd and 3rd pregnancy) were compared to women with recurrent optimal IPI (18–48 months), and to women with a single short IPI (<6 months between the 1st and 2nd pregnancy followed by an optimal IPI of 18–48 months between the 2nd and 3rd pregnancy). Additionally, in the recurrent short IPI groups, outcomes of the 2nd and 3rd pregnancies were compared in order to achieve an ideal adjustment to background characteristics. Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. ResultsDuring the study period 10,569 women had three consecutive deliveries at our medical center, of those 338 (3.2%) women had recurrent short IPIs, and 1,021 (9.7%) had recurrent optimal IPIs. Recurrent short IPI was associated with a significantly higher risk of maternal anemia (Hb < 10gr%) on admission to labor (aOR 3.4 [95% CI 1.09–10.65], p = 0.04) and higher risk of small for gestational age neonates (aOR 10.4 [95% CI 2.32–46.93], p < 0.01), as compared with women with recurrent optimal IPI and significantly higher rates of low neonatal birth weights (2500 gr) and anemia (Hb < 10gr%) alongside lower rates of operative vaginal deliveries as compared with women with single short IPI followed by an optimal IPI. In the recurrent short IPI groups, the 3rd deliveries had significantly higher rates of in-labor cesarean and anemia (Hb < 10gr%) on admission as compared to their 2nd deliveries. ConclusionRecurrent short IPI is associated with maternal anemia and small for gestational age neonates. Guiding patients towards prolongation of the IPI should include explanatory comments on these outcomes.

Effect of instructional guidelines on pregnant women's knowledge regarding immediate insertion of an intrauterine contraceptive device during cesarean section versus late insertion after the puerperium

Postpartum intrauterine contraception (PPIUC) should be made more widely available because it can decrease unplanned pregnancies and short inter-pregnancy intervals. The aim was to evaluate the effect of instructional guidelines on Pregnant Women's Knowledge regarding immediate insertion of an intrauterine contraceptive device during cesarean section versus late insertion after the puerperium. Subjects and method: Design: To accomplish the goal of this study, a quasi-experimental research design was used. Setting: the study was carried out antenatal clinic at Beni-Suef University Hospital. Subjects: A purposive sample of 100 pregnant women was included in this study. Tools for data collection: A structured interview questionnaire which consisted of three parts; part (I) pregnant women's personal data; part (II) pregnant women's current obstetric history, part (III) pregnant women's knowledge regarding immediate versus late insertion of the intrauterine contraceptive device (pre/post). Results: The study's findings showed that pregnant women's knowledge regarding early vs late placement of an intrauterine contraceptive device after cesarean section showed highly significant improvements post-instructional guidelines (P&lt;0.001). Conclusion: The results of the current study showed that the application of instructional guidelines improved pregnant women's knowledge of early vs late placement of an intrauterine contraceptive device during cesarean section.

Association between interpregnancy interval and hypertensive disorders of pregnancy: Effect modification by maternal age.

Short and long interpregnancy intervals (IPI) are associated with increased risk of hypertensive disorders of pregnancy, yet whether this association is modified by maternal age remains unclear. To examine if the association between IPI and hypertensive disorders of pregnancy varies by maternal age at birth prior to IPI. We conducted a population-based cohort study of all mothers who had their first two (n=169896) consecutive births in Western Australia (WA) between 1980 and 2015. We estimated the risk of preeclampsia and gestational hypertension for 6 to 60months of IPI according to maternal age at birth prior to IPI (<20years, 20-24, 25-29, 30-34 and ≥35years). We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 6, 12, 24, 36, 48 and 60months, with 18months as reference. The risk of preeclampsia was increased at longer IPIs (60months) compared to 18months for mothers 35years or older (RR 2.19, 95% confidence interval (CI) 1.14, 4.18) and to a lesser extent for mothers 30- to 34years old (RR 1.43, 95% CI 1.10, 1.84). Compared to 18months, the risk of preeclampsia was lower at 12months of IPI for mothers younger than 20years (RR 0.74, 95% CI 0.57, 0.96), but not for mothers 35years or older (RR 0.62, 95% CI 0.36, 1.07). There was insufficient evidence for increased risk of hypertensive disorders of pregnancy at shorter IPIs of <18months for mothers of all ages. Our findings challenge the "one size fits all" recommendation for an optimal IPI, and a more tailored approach to family planning counselling may be required to improve health.

Analysis of Postpartum Uptake of Long-Acting Reversible Contraceptives Before and After Implementation of Medicaid Reimbursement Policy.

The postpartum period is a time of high unmet contraception need. Providing long-acting reversible contraception (LARC), particularly in the immediate postpartum period, is one strategy to meet contraceptive needs. This practice may also prevent unintended and short interpregnancy interval pregnancies. In recent years, state Medicaid programs have implemented reimbursement policies for LARC use in the inpatient setting. The purpose of this study was to assess the uptake of inpatient postpartum LARCs at a large urban hospital with a sizable Medicaid population, before and after policy implementation. Using billing records from January 2015 and December 2017, we extracted data on patient demographics and LARC uptake before Medicaid policy change (2015) and after policy change (2016 and 2017). Implant and intrauterine device insertions were classified as inpatient postpartum (0-7days after birth), outpatient postpartum (1-8weeks after) or interval (9+ weeks after). In the 3-year study period, 2091 LARC insertions occurred, of which 700 (33.5%) were inpatient postpartum, 429 (20.5%) outpatient postpartum, and 962 (46.0%) interval. After policy implementation, inpatient postpartum LARC insertions increased from 2.6 per 100 deliveries to 16.8 per 100 deliveries. Significant differences in uptake were seen in Black and Hispanic populations. The number of outpatient postpartum LARCs remained stable and tubal sterilizations decreased. Implementation of reimbursement policies contributed to a sharp uptake of inpatient postpartum LARCs. Improved access to effective, reversible contraception could reduce the number of unplanned and short interpregnancy interval pregnancies, ultimately lowering rates of maternal morbidity and mortality.

The views of postnatal women and midwives on midwives providing contraceptive advice and methods: a mixed method concurrent study

BackgroundProvision of contraception to women in the immediate postnatal period has been endorsed by professional bodies, to reduce the incidence of short inter-pregnancy intervals. This study examined the views of postnatal women and practising midwives regarding provision of contraceptive advice and contraceptive methods by midwives, in a region of the United Kingdom.MethodsA mixed-method approach using qualitative interviews with midwives, and a postnatal survey followed by qualitative interviews with postnatal women, in five hospitals in the East of England. Twenty-one practising midwives and ten women were interviewed. Two hundred and twenty-seven women returned a survey.Survey data was analysed descriptively, augmented by Student’s t-tests and Chi-squared tests to examine associations within the data.Interviews were recorded, transcribed and analysed guided by the phases of thematic analysis.ResultsMidwives and women supported the concept of increased midwifery provision of contraceptive advice, and provision of contraceptive methods in the postnatal period. Convenience and an established trusting relationship were reasons for preferring midwifery provision over visiting a doctor for contraception.The best time for detailed discussion was reported to be antenatal and community visits. The Progesterone-only-pill (POP) was the method, in which women indicated most interest postnatally.Concerns for midwives included the need for increased education on contraceptive methods and training in supplying these. Structural barriers to such provision were time pressures, low prioritisation of contraceptive training and disputes over funding.ConclusionsWomen reported interest in midwives supplying contraceptive methods and expressed the view that this would be convenient and highly acceptable. Midwives are supportive of the concept of providing enhanced contraceptive advice and methods to women in their care, and believe that it would be advantageous for women.Institutional support is required to overcome structural barriers such as poor access to continuous professional development, and to allow contraceptive provision to be fully recognised as integral to the midwifery role, rather than a marginalised addition.

Short interpregnancy intervals and risks for birth defects: support for the nutritional depletion hypothesis

Research suggests short interpregnancy intervals increase risks for adverse perinatal outcomes, including some birth defects. A hypothesized cause is nutritional depletion, including folic acid (FA). We evaluated associations between short interpregnancy intervals, alone and in combination with FA intake, and the occurrence of select malformations. Data were from the National Birth Defects Prevention Study (US case-control, 1997-2011). Participants included multiparous women whose prior pregnancy resulted in live birth. Cases included 8 noncardiac and 6 cardiac defect groups (n=3219); controls were nonmalformed live-borns (n=2508). We categorized interpregnancy interval (<6, 6-11, 12-17, and 18-23 mo) and periconceptional FA intake [no FA supplement use and dietary folate equivalents (DFE) <400 µg/d, no FA supplement use and DFE ≥400 µg/d, or any FA supplement use]. We controlled for age, race/ethnicity, income, pregnancy intention, and study center. ORs <0.8 or >1.2 were considered to represent potentially meaningful associations. ORs for <6 compared with 18-23 mo were >1.2 for 4/8 noncardiac and 3/6 cardiac malformations. Among participants with any FA supplement use, ORs comparing <6 with 6-23 mo were <1.2 for most defects. Conversely, most ORs were >1.2 for <6 mo+no FA supplement use and DFE <400 µg/d compared with 6-23 mo+any FA supplement use. Magnitude and precision varied by defect. Short interpregnancy intervals were associated with a trend of higher risks for several defects, notably in the absence of FA supplement use. To our knowledge, our study is the first to provide preliminary empirical support that these etiologies may be related to shorter interpregnancy intervals and possible nutritional deficiencies. Because FA intake is highly correlated with other nutrients, and because our estimates were generally imprecise, more research with larger sample sizes is needed to better understand the role of FA compared with other nutrients in each defect-specific etiology.

Association of Short and Long Interpregnancy Intervals with Adverse Birth Outcomes: Evidence from a Cross-Sectional Study in Northwest China.

PurposeTo analyze the effects of a short interpregnancy interval (IPI) (<6 months) and a long IPI (>120 months) on neonatal adverse birth outcomes including low birth weight (LBW), small for gestational age (SGA), preterm birth (PTB), and birth defects in Shaanxi Province.Patients and MethodsA stratified multistage random sampling method was used to recruit participants who gave birth between 2010 and 2013 in Shaanxi province. A self-designed questionnaire was used to collect the information of the participants. With the confounding factors controlled, the generalized linear model (GLM) was used to investigate the association between IPI and neonatal birth outcomes. The restricted cubic spline (RCS) function was used to evaluate the dose–response relationship between IPI and birth outcomes.ResultsA total of 13,231 women were included. The prevalence of LBW, SGA, PTB, and birth defects was 3.24%, 12.96%, 2.93%, and 2.12%, respectively. GLM showed that a short IPI (<6 months) was associated with a higher risk of SGA (RR=1.25, 95% CI: 1.04–1.52) and birth defects (RR=2.55, 95% CI: 1.45–4.47), and a long IPI (≥120 months) was associated with a higher risk of LBW (RR=1.54, 95% CI: 1.01–2.34) and PTB (RR=1.73, 95% CI: 1.08–2.76) than an IPI of 18–23 months. The RCS showed that LBW, SGA, and PTB demonstrated a j-shaped relationship with IPI (P for overall association < 0.001 for these three birth outcomes), and birth defects (P for overall association <0.001) had an inversely non-linear relationship with IPI.ConclusionBoth short and long IPIs are associated with an increased risk of adverse birth outcomes.

Breastfeeding While Pregnant: A Country-Wide Population Study.

Background: There are no national data on the prevalence of breastfeeding during pregnancy (BDP) in the world. Also, there is no consensus for the BDP. Aim: The purpose was to determine the prevalence of breastfeeding status in pregnant mothers having children younger than 24 months of age and to evaluate the associated sociodemographic factors and characteristics of the last-born child and current pregnancy through two consecutive national health survey. Methods: Data from the 2012 and 2017 Jordan Family Health and Population Survey were merged. Individual, household, and community-level factors associated with BDP were analyzed by using complex sample multivariate logistic regression. Results: Two surveys enrolled 6,858 women having at least one child younger than 24 months and 8.8% (weighted count: 603) of them got pregnant also. Of the pregnant women, 8.9% continued breastfeeding their last-born children. Being younger than 12 months positively affected breastfeeding compared to last-born child aged 12-23 months. Multivariate analysis revealed that BDP was associated positively with wealth index (richest vs. poorest) and postnatal care for the last-born child within 2 months (presence vs. absence), whereas negatively with bottle use (presence vs. absence), traditional contraceptive methods (abstinence/withdrawn vs. modern, lactational amenorrhea vs. modern), short interpregnancy interval (months), and current pregnancy duration (months) in Jordan. Conclusions: The prevalence for BDP differs according to some maternal, last-born infant, and current pregnancy characteristics. Prospective cohort studies are necessary to evaluate the impact of BDP on "mother, last-child, and future-child," and to detect the duration and prevalence of BDP in different countries.

Effects of a Short Interpregnancy interval on Pregnancy Outcomes

Background: Birth spacing is an important subject that is put into consideration by obstetricians to be discussed with women who are thinking about getting pregnant. A decision that is taken by a couple to plan or postpone a pregnancy is affected by many factors. These factors can include the age of the couples, availability of family planning counseling, last pregnancies outcome, cultural aspects, religious beliefs, personal preference, fecundity and fertility aspirations. Objective: To investigate the effects of a short interpregnancy interval on the subsequent pregnancy. Patients and Methods: This study is designed as retrospective cohort study at obstetrics and gynecology department at EL-Sayed Galal university hospital and El-Monira general hospital between January 2020 till December 2020. Results: The results of this study showed that there were no any differences of great significance between the studied groups regarding the maternal complications. The results of this study showed that preterm labor, babies of SGA, LBW and Jaundice were linked to the Short IPI group. Conclusion: One of the most important subjects in obstetric practice is birth spacing. In this study we have investigated the effects of a short inter-pregnancy interval on the pregnancy outcomes and what possible determinants there are for a short IPI. After analyzing the results of this study, the following conclusions were made: A short IPI was associated with Small-for-Gestational age babies. This finding can impact neonatal morbidity.