151. The relationship between birth intervals and adverse maternal and neonatal outcomes in six low and lower-middle income countries
- Author
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Elwyn Chomba, Musaku Mwenechanya, Shivaprasad S. Goudar, Carl L. Bose, Robert L. Goldenberg, Melissa Bauserman, Sarah Saleem, Ana Garces, Waldemar A. Carlo, Kayla Nowak, Adrien Lokangaka, Patricia L. Hibberd, Richard J. Derman, Elizabeth M. McClure, Antoinette Tshefu, Fabian Esamai, Edward A. Liechty, Marion Koso-Thomas, Archana B. Patel, Saleem Jessani, Umesh Ramadurg, Lester Figueroa, Tracy L. Nolen, Jackie Patterson, and Nancy F. Krebs
- Subjects
Adult ,Birth intervals ,Maternal mortality ,medicine.medical_specialty ,Low birthweight ,Reproductive medicine ,Developing country ,Logistic regression ,lcsh:Gynecology and obstetrics ,Developing countries ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Infant Mortality ,medicine ,Humans ,030212 general & internal medicine ,lcsh:RG1-991 ,Neonatal mortality ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Public health ,Research ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Infant ,Infant, Low Birth Weight ,medicine.disease ,Delivery, Obstetric ,Low birth weight ,Global network ,Reproductive Medicine ,Neonatal outcomes ,Population Surveillance ,Maternal Death ,Maternal death ,Female ,medicine.symptom ,business - Abstract
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.
- Published
- 2020