FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 340:589-594 February 25, 1999 Number 8 Next

	Full Text PDF Editorial by Klebanoff, M. A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background A short interval between pregnancies has been associated with adverse perinatal outcomes. Whether that association is due to confounding by other risk factors, such as maternal age, socioeconomic status, and reproductive history, is unknown.

Methods We evaluated the interpregnancy interval in relation to low birth weight, preterm birth, and small size for gestational age by analyzing data from the birth certificates of 173,205 singleton infants born alive to multiparous mothers in Utah from 1989 to 1996.

Results Infants conceived 18 to 23 months after a previous live birth had the lowest risks of adverse perinatal outcomes; shorter and longer interpregnancy intervals were associated with higher risks. These associations persisted when the data were stratified according to and controlled for 16 biologic, sociodemographic, and behavioral risk factors. As compared with infants conceived 18 to 23 months after a live birth, infants conceived less than 6 months after a live birth had odds ratios of 1.4 (95 percent confidence interval, 1.3 to 1.6) for low birth weight, 1.4 (95 percent confidence interval, 1.3 to 1.5) for preterm birth, and 1.3 (95 percent confidence interval, 1.2 to 1.4) for small size for gestational age; infants conceived 120 months or more after a live birth had odds ratios of 2.0 (95 percent confidence interval, 1.7 to 2.4), 1.5 (95 percent confidence interval, 1.3 to 1.7), and 1.8 (95 percent confidence interval, 1.6 to 2.0) for these three adverse outcomes, respectively, when we controlled for all 16 risk factors with logistic regression.

Conclusions The optimal interpregnancy interval for preventing adverse perinatal outcomes is 18 to 23 months.

Source Information

From the Epidemic Intelligence Service (B.-P.Z.), Epidemiology Program Office (R.T.R., J.M.H.), Centers for Disease Control and Prevention, Atlanta; and the Office of Public Health Data, Utah Department of Health, Salt Lake City (B.-P.Z., R.T.R., B.E.N.).

Address reprint requests to Dr. Zhu at the Division of Epidemiology Services, Michigan Department of Community Health, 3423 Martin Luther King, Jr., Blvd., Lansing, MI 48909, or at zhub{at}state.mi.us.

Full Text of this Article

This article has been cited by other articles:

• Bronte-Tinkew, J., Ryan, S., Franzetta, K., Manlove, J., Lilja, E. (2009). Higher-Order Fertility Among Urban Fathers: An Overlooked Issue for a Neglected Population. Journal of Family Issues 30: 968-1000 [Abstract]  
• Axmon, A, Rylander, L (2009). Birth weight and fetal growth in infants born to female hairdressers and their sisters. Occup. Environ. Med. 66: 198-204 [Abstract] [Full Text]  
• van Eijsden, M., Smits, L. J., van der Wal, M. F, Bonsel, G. J (2008). Association between short interpregnancy intervals and term birth weight: the role of folate depletion. Am. J. Clin. Nutr. 88: 147-153 [Abstract] [Full Text]  
• Conde-Agudelo, A., Rosas-Bermudez, A., Kafury-Goeta, A. C. (2006). Birth spacing and risk of adverse perinatal outcomes: a meta-analysis.. JAMA 295: 1809-1823 [Abstract] [Full Text]  
• Hsieh, T.-T., Chen, S.-F., Shau, W.-Y., Hsieh, C.-C., Hsu, J.-J., Hung, T.-H. (2005). The Impact of Interpregnancy Interval and Previous Preterm Birth on the Subsequent Risk of Preterm Birth. Reproductive Sciences 12: 202-207 [Abstract]  
• Bhutta, Z. A., Darmstadt, G. L., Hasan, B. S., Haws, R. A. (2005). Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence. Pediatrics 115: 519-617 [Abstract] [Full Text]  
• El-Kamary, S. S., Higman, S. M., Fuddy, L., McFarlane, E., Sia, C., Duggan, A. K. (2004). Hawaii's Healthy Start Home Visiting Program: Determinants and Impact of Rapid Repeat Birth. Pediatrics 114: e317-e326 [Abstract] [Full Text]  
• Smith, G. C S, Pell, J. P, Dobbie, R. (2003). Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study. BMJ 327: 313- [Abstract] [Full Text]  
• Kramer, M. S. (2003). The Epidemiology of Adverse Pregnancy Outcomes: An Overview. J. Nutr. 133: 1592S-1596 [Abstract] [Full Text]  
• King, J. C. (2003). The Risk of Maternal Nutritional Depletion and Poor Outcomes Increases in Early or Closely Spaced Pregnancies. J. Nutr. 133: 1732S-1736 [Abstract] [Full Text]  
• Skjaerven, R., Wilcox, A. J., Lie, R. T. (2002). The Interval between Pregnancies and the Risk of Preeclampsia. NEJM 346: 33-38 [Abstract] [Full Text]  
• Smith, G. C S, Pell, J. P (2001). Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study. BMJ 323: 476-476 [Abstract] [Full Text]  
• Conde-Agudelo, A., Belizán, J. M (2000). Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study. BMJ 321: 1255-1259 [Abstract] [Full Text]  
• Nathens, A. B, Neff, M. J, Goss, C. H, Maier, R. V, Rivara, F. P (2000). Effect of an older sibling and birth interval on the risk of childhood injury. Inj. Prev. 6: 219-222 [Abstract] [Full Text]  
• (1999). Short or Long Conception Intervals: Marker for High-Risk Pregnancy?. JWatch Women's Health 1999: 12-12 [Full Text]  
• Klebanoff, M. A. (1999). The Interval between Pregnancies and the Outcome of Subsequent Births. NEJM 340: 643-644 [Full Text]