TY - JOUR
T1 - The relationship between birth intervals and adverse maternal and neonatal outcomes in six low and lower-middle income countries
AU - Bauserman, Melissa
AU - Nowak, Kayla
AU - Nolen, Tracy L.
AU - Patterson, Jackie
AU - Lokangaka, Adrien
AU - Tshefu, Antoinette
AU - Patel, Archana B.
AU - Hibberd, Patricia L.
AU - Garces, Ana L.
AU - Figueroa, Lester
AU - Krebs, Nancy F.
AU - Esamai, Fabian
AU - Liechty, Edward A.
AU - Carlo, Waldemar A.
AU - Chomba, Elwyn
AU - Mwenechanya, Musaku
AU - Goudar, Shivaprasad S.
AU - Ramadurg, Umesh
AU - Derman, Richard J.
AU - Saleem, Sarah
AU - Jessani, Saleem
AU - Koso-Thomas, Marion
AU - McClure, Elizabeth M.
AU - Goldenberg, Robert L.
AU - Bose, Carl
N1 - Funding Information:
Publication of this supplement is funded by grants from Eunice Kennedy Shriver National Institute of Child Health and Human Development. The funders had no input in the design of the study, collection, analysis, interpretation of data or in the writing of the manuscript, with the exception of the Program Officer of NICHD, whose contributions are outlined.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/11
Y1 - 2020/11
N2 - Background: Due to high fertility rates in some low and lower-middle income countries, the interval between pregnancies can be short, which may lead to adverse maternal and neonatal outcomes. Methods: We analyzed data from women enrolled in the NICHD Global Network Maternal Newborn Health Registry (MNHR) from 2013 through 2018. We report maternal characteristics and outcomes in relationship to the inter-delivery interval (IDI, time from previous delivery [live or stillborn] to the delivery of the index birth), by category of 6–17 months (short), 18–36 months (reference), 37–60 months, and 61–180 months (long). We used non-parametric tests for maternal characteristics, and multivariable logistic regression models for outcomes, controlling for differences in baseline characteristics. Results: We evaluated 181,782 women from sites in the Democratic Republic of Congo, Zambia, Kenya, Guatemala, India, and Pakistan. Women with short IDI varied by site, from 3% in the Zambia site to 20% in the Pakistan site. Relative to a 18–36 month IDI, women with short IDI had increased risk of neonatal death (RR = 1.89 [1.74, 2.05]), stillbirth (RR = 1.70 [1.56, 1.86]), low birth weight (RR = 1.38 [1.32, 1.44]), and very low birth weight (RR = 2.35 [2.10, 2.62]). Relative to a 18–36 month IDI, women with IDI of 37–60 months had an increased risk of maternal death (RR 1.40 [1.05, 1.88]), stillbirth (RR 1.14 [1.08, 1.22]), and very low birth weight (RR 1.10 [1.01, 1.21]). Relative to a 18–36 month IDI, women with long IDI had increased risk of maternal death (RR 1.54 [1.10, 2.16]), neonatal death (RR = 1.25 [1.14, 1.38]), stillbirth (RR = 1.50 [1.38, 1.62]), low birth weight (RR = 1.22 [1.17, 1.27]), and very low birth weight (RR = 1.47 [1.32,1.64]). Short and long IDIs were also associated with increased risk of obstructed labor, hemorrhage, hypertensive disorders, fetal malposition, infection, hospitalization, preterm delivery, and neonatal hospitalization. Conclusions: IDI varies by site. When compared to 18–36 month IDI, women with both short IDI and long IDI had increased risk of adverse maternal and neonatal outcomes. Trial registration: The MNHR is registered at NCT01073475.
AB - Background: Due to high fertility rates in some low and lower-middle income countries, the interval between pregnancies can be short, which may lead to adverse maternal and neonatal outcomes. Methods: We analyzed data from women enrolled in the NICHD Global Network Maternal Newborn Health Registry (MNHR) from 2013 through 2018. We report maternal characteristics and outcomes in relationship to the inter-delivery interval (IDI, time from previous delivery [live or stillborn] to the delivery of the index birth), by category of 6–17 months (short), 18–36 months (reference), 37–60 months, and 61–180 months (long). We used non-parametric tests for maternal characteristics, and multivariable logistic regression models for outcomes, controlling for differences in baseline characteristics. Results: We evaluated 181,782 women from sites in the Democratic Republic of Congo, Zambia, Kenya, Guatemala, India, and Pakistan. Women with short IDI varied by site, from 3% in the Zambia site to 20% in the Pakistan site. Relative to a 18–36 month IDI, women with short IDI had increased risk of neonatal death (RR = 1.89 [1.74, 2.05]), stillbirth (RR = 1.70 [1.56, 1.86]), low birth weight (RR = 1.38 [1.32, 1.44]), and very low birth weight (RR = 2.35 [2.10, 2.62]). Relative to a 18–36 month IDI, women with IDI of 37–60 months had an increased risk of maternal death (RR 1.40 [1.05, 1.88]), stillbirth (RR 1.14 [1.08, 1.22]), and very low birth weight (RR 1.10 [1.01, 1.21]). Relative to a 18–36 month IDI, women with long IDI had increased risk of maternal death (RR 1.54 [1.10, 2.16]), neonatal death (RR = 1.25 [1.14, 1.38]), stillbirth (RR = 1.50 [1.38, 1.62]), low birth weight (RR = 1.22 [1.17, 1.27]), and very low birth weight (RR = 1.47 [1.32,1.64]). Short and long IDIs were also associated with increased risk of obstructed labor, hemorrhage, hypertensive disorders, fetal malposition, infection, hospitalization, preterm delivery, and neonatal hospitalization. Conclusions: IDI varies by site. When compared to 18–36 month IDI, women with both short IDI and long IDI had increased risk of adverse maternal and neonatal outcomes. Trial registration: The MNHR is registered at NCT01073475.
KW - Birth intervals
KW - Developing countries
KW - Global network
KW - Low birthweight
KW - Maternal mortality
KW - Neonatal mortality
UR - http://www.scopus.com/inward/record.url?scp=85096944747&partnerID=8YFLogxK
U2 - 10.1186/s12978-020-01008-4
DO - 10.1186/s12978-020-01008-4
M3 - Article
C2 - 33256784
AN - SCOPUS:85096944747
SN - 1742-4755
VL - 17
JO - Reproductive Health
JF - Reproductive Health
M1 - 157
ER -
