The relationship between birth intervals and adverse maternal and neonatal outcomes in six low and lower-middle income c
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RESEARCH
Open Access
The relationship between birth intervals and adverse maternal and neonatal outcomes in six low and lower-middle income countries Melissa Bauserman1* , Kayla Nowak2, Tracy L. Nolen2, Jackie Patterson1, Adrien Lokangaka3, Antoinette Tshefu3, Archana B. Patel4, Patricia L. Hibberd5, Ana L. Garces6, Lester Figueroa6, Nancy F. Krebs7, Fabian Esamai8, Edward A. Liechty9, Waldemar A. Carlo10, Elwyn Chomba11, Musaku Mwenechanya11, Shivaprasad S. Goudar12, Umesh Ramadurg13, Richard J. Derman14, Sarah Saleem15, Saleem Jessani15, Marion Koso-Thomas16, Elizabeth M. McClure2, Robert L. Goldenberg17 and Carl Bose1 From Global Network Virtual. 3-15 Septemeber 2020
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. (Continued on next page)
* Correspondence: [email protected] 1 Department of Pediatrics, University of North Carolina at Chapel Hill, School of Medicine, 101 Manning Drive, Chapel Hill, NC CB 7596, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License
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