Effects of birth spacing on maternal health: a systematic review

Immediate postplacental intrauterine device placement: retrospective cohort study of expulsion and associated risk factors

BACKGROUND

Postpartum contraception is typically provided during postpartum visits. When desired and accessible, the immediate postpartum period provides an additional opportunity to increase the use of more effective contraceptive methods to potentially reduce subsequent unintended pregnancies and improve pregnancy outcomes. In New York State, recent policy changes expanded Medicaid coverage to include immediate postplacental intrauterine device insertion.

OBJECTIVE

This study aimed to investigate clinically documented intrauterine device expulsion within 12 months of placement in patients who depend on state-funded health insurance.

STUDY DESIGN

This retrospective cohort study included Medicaid patients with an immediate postplacental intrauterine device placed after third-trimester delivery, who delivered between March 2, 2017 and September 2, 2019. Current Procedural Terminology code billing data were used to identify 238 patients who underwent intrauterine device placement during their delivery admission. Electronic medical record data were analyzed using chi-squared tests, t tests, and multivariable logistic regression.

RESULTS

There were 17.6% (42/238) documented intrauterine device expulsions within the first year after placement. Among patients with vaginal deliveries, 22.1% (29/131) of intrauterine devices placed had a documented expulsion, whereas the expulsion rate was 12.2% (13/107) among patients who had cesarean deliveries (P=.04). After controlling for body mass index, parity, intrauterine device type, and gestational age, patients who delivered vaginally were more likely to experience intrauterine device expulsion within 1 year compared with those who had cesarean delivery (adjusted odds ratio, 2.71; 95% confidence interval, 1.27-5.80). Patients with a documented intrauterine device expulsion within 1 year were more likely to have a subsequent pregnancy before October 2020 (35.7% [15/42] vs 15.3% [30/196] in the no-expulsion group; P=.002).

CONCLUSION

The overall percentage of documented intrauterine device expulsion within 1 year following immediate postplacental placement was 17.6%, with a greater percentage of expulsion in patients who underwent vaginal delivery. Patients with a documented intrauterine device expulsion within 1 year of placement were significantly more likely to experience a subsequent pregnancy.

Effect of short inter-pregnancy interval on perinatal and maternal outcomes among pregnant women in SSA 2023: Systematic review and meta-analysis

BACKGROUND

After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months (birth to pregnancy interval) in order to reduce the risk of adverse maternal, perinatal and infant outcomes. Short inter pregnancy interval associated with adverse perinatal and maternal outcomes.

OBJECTIVE

The objective of this review was to determine the effect of short inter pregnancy interval on perinatal and maternal outcomes in Sub-Saharan Africa 2023.

METHODS

A systematic and a comprehensive literature searching mechanism were used without any restriction, through Google scholar, PubMed, Scopus, Web of Sciences, and Grey literature databases for reporting the effect of short inter pregnancy interval. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis was used for this review. All statistical analyses were done using STATA version17 software for windows, and meta-analysis was used with a random-effects method. The results are presented using texts, tables and forest plots with measures of effect and 95% confidence interval.

RESULTS

Thirteen studies were included in this review and most of the studies level of heterogeneity across the study was considerable, mainly due to methodological variations, Statistical heterogeneity, and population and intervention variations of included studies. The effect of short inter pregnancy interval on perinatal and maternal outcome were low birth weight(RR (RR (95% CI) 1.98 (1.48, 2.47); I2:62.97%, preterm birth (RR (95% CI) 1.67 (1.31, 2.03); I2:51%, intra uterine growth retardation(RR (95% CI) 3.78 (2.07, 5.49); I2: 8.52%, low APGAR score(RR (95% CI) 3.49 (1.41, 5.57)); I2: 71.11%, premature rapture of membrane(RR (95% CI) 2.87 (1.22, 4.51)); I2: 49.22%, perinatal mortality(RR (95% CI) 2.95 (1.10, 4.81)); I2: 54.37% and maternal anemia(RR (95% CI) 3.06 (2.12, 3.99)); I2: 74.74%.

CONCLUSIONS

As per our review the main effect of short inter pregnancy interval is low birth weight, preterm birth, intra uterine growth retardation, low APGAR score, premature rapture of membrane, perinatal mortality and maternal anemia. This might be very useful for healthcare policymakers and NGOs to emphasize on it.

Predicting vaginal delivery after labor induction using machine learning: Development of a multivariable prediction model

INTRODUCTION

Induction of labor, often used for pregnancy termination, has globally rising rates, especially in high-income countries where pregnant women present with more comorbidities. Consequently, concerns on a potential rise in cesarean section (CS) rates after induction of labor (IOL) demand for improved counseling on delivery mode within this context.

MATERIAL AND METHODS

We aim to develop a prognostic model for predicting vaginal delivery after labor induction using computational learning. Secondary aims include elaborating a prognostic model for CS due to abnormal fetal heart rate and labor dystocia, and evaluation of these models' feature importance, using maternal clinical predictors at IOL admission. The best performing model was assessed in an independent validation data using the area under the receiver operating curve (AUROC). Internal model validation was performed using 10-fold cross-validation. Feature importance was calculated using SHAP (SHapley Additive exPlanation) values to interpret the importance of influential features. Our main outcome measures were mode of delivery after induction of labor, dichotomized as vaginal or cesarean delivery and CS indications, dichotomized as abnormal fetal heart rate and labor dystocia.

RESULTS

Our sample comprised singleton term pregnant women (n = 2434) referred for IOL to a tertiary Obstetrics center between January 2018 and December 2021. Prediction of vaginal delivery obtained good discrimination in the independent validation data (AUROC = 0.794, 95% CI 0.783-0.805), showing high positive and negative predictive values (PPV and NPV) of 0.752 and 0.793, respectively, high specificity (0.910) and sensitivity (0.766). The CS model showed an AUROC of 0.590 (95% CI 0.565-0.615) and high specificity (0.893). Sensitivity, PPV and NVP values were 0.665, 0.617, and 0.7, respectively. Labor features associated with vaginal delivery were by order of importance: Bishop score, number of previous term deliveries, maternal height, interpregnancy time interval, and previous eutocic delivery.

CONCLUSIONS

This prognostic model produced a 0.794 AUROC for predicting vaginal delivery. This, coupled with knowing the features influencing this outcome, may aid providers in assessing an individual's risk of CS after IOL and provide personalized counseling.

Antenatal screening - The roles of medical and family history, routine tests, and examination findings

Routine antenatal care includes history, examination, and several standard laboratory tests. Other than the original objectives, the generated data is seldom utilised for screening for adverse obstetric and perinatal outcomes. Although new approaches and sophisticated tests improve prediction of complications such as pre-eclampsia, these may not be available globally. Maternal age, race/ethnicity, anthropometry, and method of conception can influence the occurrence of pregnancy complications. The importance of medical and obstetric history is well documented but often ignored. Routine test results including blood picture, hepatitis B and rubella serology, and sexually transmitted diseases, have additional health implications. The awareness of, and the ability to utilise, available antenatal data and tests in obstetric management will enhance individualised obstetric risk assessment thus facilitating the targeting of high-risk gravidae for further management, including the use of specific and technology-driven tests where available, and close monitoring and treatment, in a cost-effective manner.

Prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa: a multilevel analysis

Background

Termination of pregnancy is one of the biggest five causes of maternal mortality in countries with low and middle incomes. Although termination of pregnancy is hazardous, its prevalence and determinates are not well studied in developing countries. Therefore, this study aims to assess the prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa.

Methods

Data from the most recent Demographic and Health Surveys, which covered 21 Sub-Saharan African countries from 2015 to 2022, were used for secondary data analysis. The study used a total of 283,785 women. Stata 14 was used to analyze the data. The determinants of termination of pregnancy were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with termination of pregnancy were declared significant at p-values < 0.05. The result was interpreted using the confidence interval and adjusted odds ratio. The best-fit model was determined to be the one with the highest log likelihood ratio and the lowest deviance.

Results

In Sub-Saharan Africa, one in ten women with short birth intervals experienced pregnancy termination. Individual factors, including the sex of the preceding birth (AOR = 1.21, 95% CI: 1.05, 1.40), maternal age (AOR = 1.57, 95% CI: 1.27, 1.95), pregnancy complications (AOR = 1.28, 95% CI: 1.09, 1.49), No ANC visits (AOR = 2.29, 95% CI: 1.26, 4.14), previous cesarean section delivery (AOR = 1.74, 95% CI: 1.32, 2.30), <6 months of breastfeeding (AOR = 1.56, 95% CI: 1.35, 1.81), traditional contraception usage (AOR = 1.67, 95% CI: 1.13, 2.46), poor wealth status (AOR = 1.50, 95% CI: 1.22, 1.85), and community-level factors such as urban residence (AOR = 1.31, 95% CI: 1.06, 1.62) had higher odds of pregnancy termination.

Conclusions

This study concludes that termination of pregnancy rates among women with short preceding birth interval is high. The study identified that both individual and community-level variables were determinants of termination of pregnancy. Therefore, the ministries of health in Sub-Saharan African countries should give attention to those women who underutilize antenatal care services and to women from urban areas while designing policies and strategies targeting reducing termination of pregnancy rates.

Who actualizes postpartum contraceptive intentions? A trajectory cluster analysis

Contraceptive intention is an important woman-centered indicator for family planning. Yet, few studies have examined the determinants of women or couples actualizing their contraceptive intentions. We leverage panel data from the Performance Monitoring for Action (PMA) survey in Ethiopia to examine these dynamics among a pregnancy cohort, over the first year postpartum. Using cluster analysis on intent-to-use trajectories, we find distinct patterns across wealth categories, education levels, and regions. Additionally, we find that receiving family planning counseling in both antenatal and postnatal care visits led to a higher likelihood of intending to use. However, counseling did not increase the odds of actualization. We argue that examining actualization through model-based approaches like cluster analysis generates better insight into woman-centered contraceptive demand and provides stronger evidence for strengthening postpartum family planning interventions, than quantifying contraceptive use alone. Modeling postpartum actualization trajectories can shed light on the barriers to women's and couple's reproductive autonomy and inform future investments in both upstream development of better contraceptive methods and downstream implementation.

The Thematic Analysis of Barriers to Immediate Post-Partum Long-Acting Reversible Contraception

BACKGROUND

Globally, many women express the desire to avoid immediate pregnancy for 24 months postdelivery, and only forty percent use contraceptives during this period. There is an enormous demand for postpartum family planning, particularly in developing countries with low- or middle-income grades. Postpartum intrauterine devices such as long-acting reversible contraceptives (LARCs) are among the most effective methods of family planning in the immediate postpartum period, yet their effectiveness is hindered because of a lack of availability and training. Strategies to increase access to LARCs are essential. Hence, the purpose of the current study is to determine the barriers among healthcare providers in providing immediate postpartum family planning services.

METHODS

A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at SIMS, a tertiary care teaching hospital, from January to March 2024. Approximately 293 healthcare providers who fulfilled the inclusion criteria were provided an online questionnaire in the form of a Google Forms link, which included a structured questionnaire focusing on various aspects, including demographics, knowledge, practices, and barriers in their practice. The data collected were analysed through SPSS version 26, which employs chi-square tests and Pearson's correlation to determine any significant associations among them. Based on the key statistical outcomes and the significant correlations observed related to the data, a thematic analysis through SWOT (strengths, weaknesses, opportunities, threats) was conducted. The study adhered to the method outlined by Braun and Clarke (2006) and compiled with the COREQ (consolidated criteria for reporting qualitative research) checklist to uphold methodological integrity.

RESULTS

Among the participants, 92.4% provided family planning counselling after childbirth, predominantly during the antenatal period (75.1%), and the provision of immediate postnatal family planning was reported in 76.1% of the participants, with PPIUDs identified as the most utilized method by 52.6%. Various barriers were identified, including insufficient training on Implanon (33.4%) and the PPIUCD (12.6%), the unavailability of implants (59.0%), and a lack of interest among patients (46.1%). Statistically significant associations were observed between the practice setting and knowledge of postpartum family planning (p = 0.002), as well as deficiencies in training for the PPIUCD (p < 0.001). The study highlights the place of practice and the practitioners' experience as significant strengths in offering immediate postpartum contraception and referring patients for family planning. However, qualification was identified as a limiting factor for practicing immediate postpartum family planning.

CONCLUSIONS

This study revealed significant difficulty in delivering prompt postpartum long-acting reversible contraceptives (LARCs), underscoring the necessity of improved education and training for professionals. Focusing on these challenges is important in enhancing postpartum family planning acceptance and decreasing unfulfilled requirements in resource-limited settings.

Lonely, stressed-out moms: Does the postindustrial social experience put women at risk for perinatal mood disorders?

Perinatal mood and anxiety disorders (PMADs) are estimated to affect as many as 17.7% of mothers in agricultural and postindustrial societies. Various lines of research converge to suggest that PMADs may be 'diseases of modernity', arising from a mismatch between the environments in which humans evolved over hundreds of thousands of years and contemporary postindustrial lifestyles. Here we highlight the social context of childrearing by focusing on three sources of mismatch associated with PMADs: closer interbirth spacing, lack of allomaternal support and lack of prior childcare experience. The transitions to agriculture and industrialization disrupted traditional maternal support networks, allowing closer birth spacing without compromising infant survival but increasing maternal isolation. Caring for closely spaced offspring is associated with high levels of parenting stress, and poses a particular challenge in the context of social isolation. The mother's kin and community play a critical role in allomothering (childcare participation) in all contemporary hunter-gatherer societies, facilitating a system of simultaneous care for children of a range of ages with unique age-specific needs. The absence of social support and assistance from allomothers in postindustrial societies leaves mothers at increased risk for PMADs due to elevated caregiving burdens. Furthermore, the traditional system of allomothering that typified human evolutionary history afforded girls and women experience and training before motherhood, which likely increased their self-efficacy. We argue that the typical postindustrial motherhood social experience is an evolutionary anomaly, leading to higher rates of PMADs.

Short inter-pregnancy interval and birthweight: a reappraisal based on a follow-up study of all women in Norway with two singleton deliveries during 1970-2019

We studied mean changes in birthweight from the first to the second delivery according to length of the inter-pregnancy interval. We also studied recurrence risk of low birthweight, preterm birth and perinatal death. We followed all women in Norway from their first to their second singleton delivery at gestational week 22 or beyond during the years 1970-2019, a total of 654 100 women. Data were obtained from the Medical Birth Registry of Norway. Mean birthweight increased from the first to the second delivery, and the increase was highest in pregnancies conceived < 6 months after the first delivery; adjusted mean birthweight increase 227 g (g) (95% CI; 219-236 g), 90 g higher than in pregnancies conceived 6-11 months after the first delivery (137 g (95% CI; 130-144 g)). After exclusion of women with a first stillbirth, the mean increase in birthweight at inter-pregnancy interval < 6 months was attenuated (152 g, 95% CI; 143-160 g), but remained higher than at longer inter-pregnancy intervals. This finding was particularly prominent in women > 35 years (218 g, 95% CI; 139 -298 g). In women with a first live born infant weighing < 2500 g, mean birthweight increased by around 1000 g to the second delivery, and the increase was most prominent at < 6 months inter-pregnancy interval. We found increased recurrence risk of preterm birth at inter-pregnancy interval < 6 months, but no increased recurrence risk of low birthweight, small for gestational age infant or perinatal death. In conclusion, we found the highest mean increase in birthweight when the inter-pregnancy interval was short. Our results do not generally discourage short pregnancy intervals.

Effects of short inter-pregnancy/birth interval on adverse perinatal outcomes in Asia-Pacific region: A systematic review and meta-analysis

BACKGROUND

Short inter-pregnancy or birth interval is associated with an increased risk of adverse perinatal outcomes. However, some emerging evidence questions this association and there are also inconsistencies among the existing findings. This study aimed to systematically review the evidence regarding the effect of short inter-pregnancy or birth intervals on adverse perinatal outcomes in the Asia-Pacific region.

METHODS

A comprehensive search of five databases was conducted targeting studies published between 2000 to 2023. Studies that reported on short inter-pregnancy or birth interval and examined adverse perinatal outcomes, such as low birthweight (LBW) preterm birth (PTB), small for gestational age (SGA), and neonatal mortality were included and appraised for methodological quality using the Joanna Briggs Institute critical appraisal tools. Three reviewers independently screened the studies and performed data extraction. Narrative synthesis and meta-analyses were conducted to summarise the key findings.

RESULTS

A total of 41 studies that fulfilled the inclusion criteria were included. A short-interpregnancy interval was associated with an increased risk of low birthweight (odds ratio [OR] = 1.65; 95%CI:1.39, 1.95), preterm birth (OR = 1.50; 95%CI: 1.35, 1.66), and small for gestational age (OR = 1.24; 95%CI:1.09, 1.41). We also found elevated odds of early neonatal mortality (OR = 1.91; 95%CI: 1.11, 3.29) and neonatal mortality (OR = 1.78; 95%CI: 1.25, 2.55) among women with short birth intervals.

CONCLUSION

This review indicates that both short inter-pregnancy and birth interval increased the risk of adverse perinatal outcomes. This underscores the importance of advocating for and implementing strategies to promote optimal pregnancy and birth spacing to reduce the occurrence of adverse perinatal outcomes. Reproductive health policies and programs need to be further strengthened and promote access to comprehensive family planning services and increase awareness about the importance of optimal pregnancy and birth spacing.

Healthcare experiences of pregnant and postnatal women and healthcare professionals when facing child protection in the perinatal period: A systematic review and Critical Interpretative Synthesis

BACKGROUND

The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers.

AIM

To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement.

METHODS

A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline.

RESULTS

A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play.

CONCLUSIONS

Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.

Separation at birth due to safeguarding concerns: Using reproductive justice theory to re-think the role of midwives

Separation at birth due to safeguarding concerns is a deeply distressing and impactful event, with numbers rising across the world, and has devastating outcomes for birth mothers and their children. It is one of the most challenging aspects of contemporary midwifery practice in high-income countries, although rarely discussed and reflected on during pre- and post-registration midwifery training. Ethnic and racial disparities are prevalent both in child protection and maternity services and can be explained through an intersectional lens, accounting for biases based on race, gender, class, and societal beliefs around motherhood. With this paper, we aim to contribute to the growing body of critical midwifery studies and re-think the role of midwives in this context. Building on principles of reproductive justice theory, Intersectionality, and Standpoint Midwifery, we argue that midwives play a unique role when supporting women who go through child protection processes and should pursue a shift from passive bystander to active upstander to improve care for this group of mothers.

Interpregnancy Interval After Healthy Live Birth and Subsequent Spontaneous Abortion

Importance

Many studies have reported that the interpregnancy interval (IPI) is a potential modifiable risk factor for adverse perinatal outcomes. However, the association between IPI after live birth and subsequent spontaneous abortion (SA) is unclear.

Objective

To investigate the association of IPI after a healthy live birth and subsequent SA.

Design, Setting, and Participants

This prospective cohort study used data from 180 921 women aged 20 to 49 years who had a single healthy live birth and planned for another pregnancy and who participated in the Chinese National Free Prepregnancy Checkups Project from January 1, 2010, to December 31, 2020. Statistical analysis was conducted from June 20 to October 5, 2023.

Exposure

Interpregnancy interval, defined as the interval between the delivery date and conception of the subsequent pregnancy, was categorized as follows: less than 18 months, 18 to 23 months, 24 to 35 months, 36 to 59 months, and 60 months or longer.

Main Outcomes and Measures

The main outcome was SA. Multivariable-adjusted odds ratios (ORs) were calculated by logistic regression models to examine the association between IPI and the risk of SA. Dose-response associations were evaluated by restricted cubic splines.

Results

The analyses included 180 921 multiparous women (mean [SD] age at current pregnancy, 26.3 [2.8] years); 4380 SA events (2.4% of all participants) were recorded. A J-shaped association between IPI levels and SA was identified. In the fully adjusted model, compared with IPIs of 18 to 23 months, both short (<18 months) and long (≥36 months) IPIs showed an increased risk of SA (IPIs of <18 months: OR, 1.15 [95% CI, 1.04-1.27]; IPIs of 36-59 months: OR, 1.28 [95% CI, 1.15-1.43]; IPIs of ≥60 months: OR, 2.13 [95% CI, 1.78-2.56]). Results of the subgroup analysis by mode of previous delivery were consistent with the main analysis.

Conclusions and Relevance

This cohort study of multiparous women suggests that an IPI of shorter than 18 months or an IPI of 36 months or longer after a healthy live birth was associated with an increased risk of subsequent SA. The findings are valuable to make a rational prepregnancy plan and may facilitate the prevention of SA and improvement in neonatal outcomes.

Association between high-risk fertility behaviors and neonatal mortality in Ethiopia: A multilevel mixed-effects logit models from 2019 Ethiopian mini demographic and health survey

Objectives

This study aimed to explore the association between high-risk fertility behaviors and neonatal mortality in Ethiopia.

Study design

A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini-Demographic and Health Survey.

Methods

Mixed-effects logit regression models were fitted to 5527 children nested within 305 clusters. The definition of high-risk fertility behavior was adopted from the 2019 EMDHS. The fixed effects (the association between the outcome variable and the explanatory variables) were expressed as adjusted odds ratios (ORs) with 95 % confidence intervals and measures of variation explained by intra-class correlation coefficients, median odds ratio, and proportional change invariance.

Results

The presence of births with any multiple high-risk fertility behaviors was associated with a 70 % higher risk of neonatal mortality (AOR = 1.7, (95 % CI: 1.2, 2.3) than those with no high-risk fertility behavior. From the combined risks of high-risk fertility behaviors, the combination of preceding birth interval <24 months and birth order four or higher had an 80 % increased risk of neonatal mortality (AOR = 1.8, (95 % CI, 1.2, 2.7) as compared to those who did not have either of the two. The 3-way risks (combination of preceding birth interval <24 months, birth order 4+, and mother's age at birth 34+) were associated with approximately four times increased odds of neonatal mortality (AOR (95 % CI:3.9 (2.1, 7.4)].

Conclusions

High-risk fertility behavior is a critical predictor of neonatal mortality in Ethiopia, with three-way high-risk fertility behaviors increasing the risk of neonatal mortality fourfold. In addition, antenatal follow-up was the only non-high fertility behavioral factor significantly associated with the risk of neonatal mortality in Ethiopia.

Association between concurrence of multiple risk factors and under-5 mortality: a pooled analysis of data from Demographic and Health Survey in 61 low-and-middle-income countries

Background

Exposure to multiple risk factors is prevalent in low-and middle-income countries (LMICs), challenging one-directional strategies to address preventable under-5 mortality (U5M). This study aims to assess the associations between concurrence of multiple risk factors and U5M in LMICs.

Methods

We extracted data from the Demographic and Health Surveys conducted between 2010 and 2021 across 61 LMICs. Our primary outcome was U5M, defined as deaths from birth to 59 months. Binary logistic regression model was applied to ascertain the association between U5M and a total of 20 critical risk factors. Upon identifying the risk factors demonstrating the strongest associations, we investigated the simultaneous presence of multiple risk factors in each individual and assessed their combined effects on U5M with logistic regression models.

Findings

Of the 604,372 under-5 children, 18,166 (3.0%) died at the time of the survey. Unsatisfied family planning needs was the strongest risk factor for U5M (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.9-2.1), followed by short birth interval (<18 months; OR: 2.0, 95% CI: 1.9-2.1), small birth size (OR: 2.0, 95% CI: 1.8-2.1), never breastfed or delayed breastfeeding (OR: 2.0, 95% CI: 1.9-2.0), and low maternal education (OR: 1.6, 95% CI: 1.4-1.8). 66.7% (66.6%-66.8%) of the children had 2 or more leading risk factors simultaneously. Simultaneous presence of multiple leading risk factors was significantly associated with elevated risk of U5M and children presenting with all 5 leading risk factors exhibited an exceedingly high risk of U5M (OR: 5.2, 95% CI: 4.3-6.3); a dose-response relationship between the number of risk factors and U5M was also observed-with the increment of numbers of leading risk factors, the U5M showed an increasing trend (p-trend < 0.001).

Interpretation

Exposure to multiple risk factors is very common in LMICs and underscores the necessity of developing multisectoral and integrated approaches to accelerate progress in reducing U5M in line with the SDG 3.2.

Funding

This research is funded by Research Fund, Vanke School of Public Health, Tsinghua University.

Uterine Cesarean Scar Tissue-An Immunohistochemical Study

Background and Objectives: Wound healing encompasses a multitude of factors and entails the establishment of interactions among components of the basement membrane. The quantification of particle concentrations can serve as valuable biomarkers for assessing biomechanical muscle properties. The objective of this study was to examine the immunoexpression and immunoconcentration of myometrial collagen type VI, elastin, alpha-smooth muscle actin, and smooth muscle myosin heavy chain, as well as the expression of platelets and clusters of differentiation 31 in the uterine scar following a cesarean section (CS). Materials and Methods: A total of 177 biopsies were procured from a cohort of pregnant women who were healthy, specifically during the surgical procedure of CS. The participants were categorized into seven distinct groups. Group 1 consisted of primiparas, with a total of 52 individuals. The subsequent groups were organized based on the duration of time that had elapsed since their previous CS. The analysis focused on the immunoexpression and immunoconcentration of the particles listed. Results: No significant variations were observed in the myometrial immunoconcentration of collagen type VI, elastin, smooth muscle myosin, and endothelial cell cluster of differentiation 31 among the analyzed groups. The concentration of alpha-smooth muscle actin in the myometrium was found to be significantly higher in patients who underwent CS within a period of less than 2 years since their previous CS, compared to those with a longer interval between procedures. Conclusions: Our findings indicate that the immunoconcentration of uterine myometrial scar collagen type VI, elastin, smooth muscle myosin heavy chain, alpha-smooth muscle actin, and endothelial cell marker cluster of differentiation 31 remains consistent regardless of the duration elapsed since the previous CS. The findings indicate that there are no significant alterations in the biomechanical properties of the uterine muscle beyond a period of 13 months following a CS.

Birth Spacing and Parents' Physical and Mental Health: An Analysis Using Individual and Sibling Fixed Effects

An extensive literature has examined the relationship between birth spacing and subsequent health outcomes for parents, particularly for mothers. However, this research has drawn almost exclusively on observational research designs, and almost all studies have been limited to adjusting for observable factors that could confound the relationship between birth spacing and health outcomes. In this study, we use Norwegian register data to examine the relationship between birth spacing and the number of general practitioner consultations for mothers' and fathers' physical and mental health concerns immediately after childbirth (1-5 and 6-11 months after childbirth), in the medium term (5-6 years after childbearing), and in the long term (10-11 years after childbearing). To examine short-term health outcomes, we estimate individual fixed-effects models: we hold constant factors that could influence parents' birth spacing behavior and their health, comparing health outcomes after different births to the same parent. We apply sibling fixed effects in our analysis of medium- and long-term outcomes, holding constant mothers' and fathers' family backgrounds. The results from our analyses that do not apply individual or sibling fixed effects are consistent with much of the previous literature: shorter and longer birth intervals are associated with worse health outcomes than birth intervals of approximately 2-3 years. Estimates from individual fixed-effects models suggest that particularly short intervals have a modest negative effect on maternal mental health in the short term, with more ambiguous evidence that particularly short or long intervals might modestly influence short-, medium-, and long-term physical health outcomes. Overall, these results are consistent with small to negligible effects of birth spacing behavior on (non-pregnancy-related) parental health outcomes.

Association between interpregnancy interval and risk of autism spectrum disorder: a systematic review and Bayesian network meta-analysis

Although the risk of autism spectrum disorder (ASD) has been reported to be associated with interpregnancy intervals (IPIs), their association remains debatable due to inconsistent findings in existing studies. Therefore, the present study aimed to explore their association. PubMed, Embase, Web of Science, and the Cochrane Library were systematically retrieved up to May 25, 2022. An updated search was performed on May 25, 2023, to encompass recent studies. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Our primary outcome measures were expressed as adjusted odds ratios (ORs). Given various control measures for IPI and diverse IPI thresholds in the included studies, a Bayesian network meta-analysis was performed. Eight studies were included, involving 24,865 children with ASD and 2,890,289 children without ASD. Compared to an IPI of 24 to 35 months, various IPIs were significantly associated with a higher risk of ASD (IPIs < 6 months: OR = 1.63, 95% CI 1.53-1.74, n = 5; IPIs of 6-11 months: OR = 1.50, 95% CI 1.42-1.59, n = 4; IPIs of 12-23 months: OR = 1.19, 95% CI 1.12-1.23, n = 10; IPIs of 36-59 months: OR = 0.96, 95% CI 0.94-0.99, n = 2; IPIs of 60-119 months: OR = 1.15, 95% CI 1.10-1.20, n = 4; IPIs > 120 months: OR = 1.57, 95% CI 1.43-1.72, n = 4). After adjusting confounding variables, our analysis delineated a U-shaped restricted cubic spline curve, underscoring that both substantially short (< 24 months) and excessively long IPIs (> 72 months) are significantly correlated with an increased risk of ASD.  Conclusion: Our analysis indicates that both shorter and longer IPIs might predispose children to a higher risk of ASD. Optimal childbearing health and neurodevelopmental outcomes appear to be associated with a moderate IPI, specifically between 36 and 60 months. What is Known: • An association between autism spectrum disorder (ASD) and interpregnancy intervals (IPIs) has been speculated in some reports. • This association remains debatable due to inconsistent findings in available studies. What is New: • Our study delineated a U-shaped restricted cubic spline curve, suggesting that both shorter and longer IPIs predispose children to a higher risk of ASD. • Optimal childbearing health and neurodevelopmental outcomes appear to be associated with a moderate IPI, specifically between 36 and 60 months.

Association of interpregnancy interval with adverse pregnancy outcomes according to the outcomes of the preceding pregnancy: a longitudinal study with 4.7 million live births from Brazil

Background

Earlier studies have proposed a link between the Interpregnancy Interval (IPI) and unfavorable birth outcomes. However, it remains unclear if the outcomes of previous births could affect this relationship. We aimed to investigate whether the occurrence of adverse outcomes-small for gestational age (SGA), preterm birth (PTB), and low birth weight (LBW)-at the immediately preceding pregnancy could alter the association between IPI and the same outcomes at the subsequent pregnancy.

Methods

We used a population-based linked cohort from Brazil (2001-2015). IPI was measured as the difference, in months, between the preceding birth and subsequent conception. Outcomes included SGA (<10th birthweight percentile for gestational age and sex), LBW (<2500 g), and PTB (gestational age <37 weeks). We calculated risk ratios (RRs), using the IPI of 18-22 months as the reference IPI category, we also stratified by the number of adverse birth outcomes at the preceding pregnancy.

Findings

Among 4,788,279 births from 3,804,152 mothers, absolute risks for subsequent SGA, PTB, and LBW were higher for women with more adverse outcomes in the preceding delivery. The RR of SGA and LBW for IPIs <6 months were greater for women without previous adverse outcomes (SGA: 1.44 [95% Confidence Interval (CI): 1.41-1.46]; LBW: 1.49 [1.45-1.52]) compared to those with three previous adverse outcomes (SGA: 1.20 [1.10-1.29]; LBW: 1.24 [1.15-1.33]). IPIs ≥120 months were associated with greater increases in risk for LBW and PTB among women without previous birth outcomes (LBW: 1.59; [1.53-1.65]; PTB: 2.45 [2.39-2.52]) compared to women with three adverse outcomes at the index birth (LBW: 0.92 [0.78-1.06]; PTB: 1.66 [1.44-1.88]).

Interpretation

Our study suggests that women with prior adverse outcomes may have higher risks for adverse birth outcomes in subsequent pregnancies. However, risk changes due to differences in IPI length seem to have a lesser impact compared to women without a prior event. Considering maternal obstetric history is essential in birth spacing counseling.

Funding

Wellcome Trust225925/Z/22/Z.

Interactions between long interpregnancy interval and advanced maternal age on neonatal outcomes

BACKGROUND

After the implementation of the universal two-child policy in China, it was more frequent to have long interpregnancy intervals (IPIs) and advanced maternal age. However, the interactions between long IPIs and advanced maternal age on neonatal outcomes are unknown.

METHODS

The study subjects of this historical cohort study were multiparas with singleton live births between October 1st, 2015, and October 31st, 2020. IPI was defined as the interval between delivery and conception of the subsequent pregnancy. Logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the risks of preterm birth (PTB), low birth weight (LBW), small for gestation age, and 1-min Apgar score ≤ 7 in different IPI groups. Relative excess risk due to interaction (RERI) was used to evaluate the additive interaction between long IPIs and advanced maternal age.

RESULTS

Compared with the 24 ≤ IPI ≤ 59 months group, the long IPI group (IPI ≥ 60 months) was associated with a higher risk of PTB (aOR, 1.27; 95% CI: 1.07-1.50), LBW (aOR, 1.32; 95% CI 1.08-1.61), and one-minute Apgar score ≤ 7 (aOR, 1.46; 95% CI 1.07-1.98). Negative additive interactions (all RERIs < 0) existed between long IPIs and advanced maternal age for these neonatal outcomes. Meanwhile, IPI < 12 months was also associated with PTB (aOR, 1.51; 95% CI 1.13-2.01), LBW (aOR, 1.50; 95% CI 1.09-2.07), and 1-min Apgar score ≤ 7 (aOR, 1.93; 95% CI 1.23-3.04).

CONCLUSIONS

Both short and long IPIs are associated with an increased risk of adverse neonatal outcomes. Appropriate IPI should be recommended to women planning to become pregnant again. In addition, better antenatal care might be taken to balance the inferiority of advanced maternal age and to improve neonatal outcomes.

Inter-pregnancy interval and placental weight. A population based follow-up study in Norway

INTRODUCTION

We studied changes in placental weight from the first to the second delivery according to length of the inter-pregnancy interval.

METHODS

We followed all women in Norway from their first to their second successive singleton pregnancy during the years 1999-2019, a total of 271 184 women. We used data from the Medical Birth Registry of Norway and studied changes in placental weight (in grams (g)) according to the length of the inter-pregnancy. Adjustments were made for year and maternal age at first delivery, changes in the prevalence of maternal diseases (hypertension and diabetes), and a new father to the second pregnancy.

RESULTS

Mean placental weight increased from 655 g at the first delivery to 680 g at the second. The adjusted increase in placental weight was highest at inter-pregnancy intervals <6 months; 38.2 g (95 % CI 33.0g-43.4 g) versus 23.2 g (95 % CI 18.8g-27.7 g) at inter-pregnancy interval 6-17 months. At inter-pregnancy intervals ≥18 months, placental weight remained higher than at the first delivery, but was non-different from inter-pregnancy intervals 6-17 months. Also, after additional adjustment for daily smoking and body mass index in sub-samples, we found the highest increase in placental weight at the shortest inter-pregnancy interval. We estimated no difference in gestational age at delivery or placental to birthweight ratio according to inter-pregnancy interval.

DISCUSSION

Placental weight increased from the first to the second pregnancy, and the increase was most pronounced at short inter-pregnancy intervals. The biological causes and implications of such findings remain to be studied.

Birth spacing and risk of adverse pregnancy and birth outcomes: A systematic review and dose-response meta-analysis

INTRODUCTION

The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing.

MATERIAL AND METHODS

We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random-effects model, and the dose-response relationships were evaluated using generalized least squares trend estimation.

RESULTS

A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18-23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08-1.56; p < 0.05). The dose-response analyses further confirmed these J-shaped relationships (pnon-linear  < 0.001-0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon-linear  < 0.005 and pnon-linear  < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon-linear  < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04-2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose-response analyses (pnon-linear  = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76-1.21; p > 0.05).

CONCLUSIONS

Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18-23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months.

Association between inter-pregnancy interval and risk of adverse birth outcomes in subsequent pregnancy: A retrospective study from Jordan

BACKGROUND

Adverse birth outcomes, such as preterm birth and low birth weight (LBW), are leading causes of neonatal morbidity and mortality. In this study, we aimed to estimate the association between inter-pregnancy interval (IPI) and the risks of adverse birth outcomes in a subsequent pregnancy.

METHODS

We conducted a retrospective analysis involving 630 mothers who delivered a singleton live infant at a leading tertiary hospital in northern Jordan from March to August 2021. Outcome variables were preterm birth (<37 weeks of gestation) and LBW (<2.5 kg). Using multivariable logistic regression, the association between IPI and these two adverse birth outcomes was investigated.

RESULTS

The rates of preterm birth and LBW were 12.4% and 16.8%, respectively. Compared with an optimal IPI (24-36 months), a short IPI (<24 months) was positively associated with preterm birth (aOR: 4.09; 95% CI: 1.48-6.55) and LBW (aOR: 3.58; 95% CI: 1.57-5.15). Infants conceived after a long IPI (≥ 60 months) had increased odds of preterm birth (aOR: 3.78; 95% CI: 1.12-5.78) and LBW (aOR: 2.65; 95% CI: 1.67-4.03). Preterm delivery was also significantly associated with the mother's age (aOR: 1.10; 95% CI: 1.04-1.17), history of multiple cesarean births (aOR: 2.67; 95% CI: 1.14-4.29), prolonged rupture of membranes (aOR: 2.46; 95% CI: 1.10-5.52), and perinatal death (aOR: 3.42; 95% CI: 1.10-5.49). A mother's history of prior LBW (aOR: 4.39; 95% CI: 1.08-6.80), hypertensive disorders (aOR: 1.95; 95% CI: 1.03-3.89), and multiple cesarean births (aOR: 4.35; 95% CI: 2.10-6.99) was associated with LBW.

CONCLUSIONS

Both short and long IPIs were related to preterm delivery and LBW. Optimal birth spacing is recommended to improve birth outcomes and must be considered when designing effective family planning programs.

Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers' schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi: the PROMOTE Project pilot randomized controlled trial protocol

INTRODUCTION

Girls' and women's health as well as social and economic wellbeing are often negatively impacted by early childbearing. In many parts of Africa, adolescent girls who get pregnant often drop out of school, resulting in widening gender inequalities in schooling and economic participation. Few interventions have focused on education and economic empowerment of adolescent mothers in the region. We aim to conduct a pilot randomized controlled trial in Blantyre (Malawi) and Ouagadougou (Burkina Faso) to examine the acceptability and feasibility of three interventions in improving educational and health outcomes among adolescent mothers and to estimate the effect and cost-effectiveness of the three interventions in facilitating (re)entry into school or vocational training. We will also test the effect of the interventions on their sexual and reproductive health (SRH) and mental health.

INTERVENTIONS

The three interventions we will assess are: a cash transfer conditioned on (re)enrolment into school or vocational training, subsidized childcare, and life skills training offered through adolescent mothers' clubs. The life skills training will cover nurturing childcare, SRH, mental health, and financial literacy. Community health workers will facilitate the clubs. Each intervention will be implemented for 12 months.

METHODS

We will conduct a baseline survey among adolescent mothers aged 10-19 years (N = 270, per site) enrolled following a household listing in select enumeration areas in each site. Adolescent mothers will be interviewed using a structured survey adapted from a previous survey on the lived experiences of pregnant and parenting adolescents in the two sites. Following the baseline survey, adolescent mothers will be individually randomly assigned to one of three study arms: arm one (adolescent mothers' clubs only); arm two (adolescent mothers' clubs + subsidized childcare), and arm three (adolescent mothers' clubs + subsidized childcare + cash transfer). At endline, we will re-administer the structured survey and assess the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training attendance during the intervention period. We will also compare baseline and endline measures of SRH and mental health outcomes. Between the baseline and endline survey, we will conduct a process evaluation to examine the acceptability and feasibility of the interventions and to track the implementation of the interventions.

DISCUSSION

Our research will generate evidence that provides insights on interventions that can enable adolescent mothers to continue their education, as well as improve their SRH and mental health. We aim to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings. Trial registration number AEARCTR-0009115, May 15, 2022.

Scoping review protocol: exploration of the barriers and facilitators to the uptake of early postnatal contraception

INTRODUCTION

It is well documented that many women do not desire a short interpregnancy interval. Medical societies, government agencies and leaders in the field recommend that contraception should be part of maternity care. Short spaced and unplanned pregnancies increase the chances of mortality and morbidity in the mother and child. The WHO recommends a 24-month interpregnancy interval; however, short pregnancy intervals remain common. The goal of this scoping review will be to explore barriers and facilitators to the uptake of early postnatal contraception. A review of globally published literature relating to the implementation of a postnatal contraception service provision globally will be carried out which will highlight evidence gaps, strengths and weaknesses of studies associated with uptake and known barriers and facilitators to the uptake of early postnatal contraception.

METHODS AND ANALYSIS

This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The search strategy aims to locate both published and unpublished studies. An initial limited search of PubMed and CINAHL was undertaken to identify articles on the provision of postnatal contraception. The search strategy will be adapted for each included database CINAHL, SCOPUS, MEDLINE, PROSPERO and COCHRANE from 1 January 1993 to 1 January 2023 and reviewed by two reviewers. The data will be analysed and presented in tables, diagrams and text.

ETHICS AND DISSEMINATION

Ethical approval is not required. This review is a retrospective review of widely and publicly available evidence. The review findings will be disseminated via publication in peer-reviewed journals, as part of a PhD thesis and conference presentation.

SCOPING REVIEW QUESTION

What are the barriers and facilitators to early postnatal contraception provision and uptake?

The influence of birth outcomes and pregnancy complications on interpregnancy interval: a quantile regression analysis

PURPOSE

To ascertain whether adverse pregnancy outcomes at first pregnancy influence subsequent interpregnancy intervals (IPIs) and whether the size of this effect varies with IPI distribution METHODS: We included 251,892 mothers who gave birth to their first two singletons in Western Australia, from 1980 to 2015. Using quantile regression, we investigated whether gestational diabetes, hypertension, or preeclampsia in the first pregnancy influenced IPI to subsequent pregnancy and whether effects were consistent across the IPI distribution. We considered intervals at the 25th centile of the distribution as 'short' and the 75th centile as 'long'.

RESULTS

The average IPI was 26.6 mo. It was 0.56 mo (95% CI: 0.25-0.88 mo) and 1.12 mo (95% CI: 0.56 - 1.68 mo) longer after preeclampsia, and gestational hypertension respectively. There was insufficient evidence to suggest that the association between previous pregnancy complications and IPI differed by the extent of the interval. However, associations with marital status, race/ethnicity and stillbirth contributed to either shortening or prolonging IPIs differently across the distribution of IPI.

CONCLUSION

Mothers with preeclampsia and gestational hypertension had slightly longer subsequent IPIs than mothers whose pregnancies were not complicated by these conditions. However, the extent of the delay was small (<2 mo).

Socio-demographic and antenatal care-related factors associated with early post-partum family planning use in Ethiopia: evidence from Ethiopian Demographic and Health Survey 2016 data

Introduction

Initiation of family planning in the early post-partum period is a strategic move to reduce maternal, neonatal, and child mortality due to the negative consequences of short interbirth interval and the complications of unintended pregnancy. Antenatal care (ANC) is the noteworthy predictor of scaling up early initiation of post-partum family planning (PPFP) and preventing unintended pregnancy before menses resume. Despite the great role of ANC, information is scant about the effect of content, timing, and the number of ANC visits on the early initiation of PPFP in Ethiopia.

Objective

This study aimed to assess the association of ANC services with the early initiation of PPFP in Ethiopia.

Methods

The study was based on Ethiopian Demographic and Health Survey 2016 data, which was a cross-sectional survey from 18 January 2016 to 27 June 2016. A total weighted sample size of 2,920 post-partum women was included. A multilevel logistic regression model was used because of the hierarchical data, and variables with a p-value of ≤0.2 in the bivariable multilevel analysis were taken to multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval (CI) was used to declare both the direction and strength of the association, and variables with a p-value of <0.05 were considered as statistically significant for the outcome variable.

Results

The early initiation of PPFP was 20.4%. Women with at least four ANC visits [adjusted odds ratio (AOR) = 1.31; CI 1.12-2.32], women who started ANC within the first trimester (AOR = 1.25; CI 1.10-2.23), complete routine ANC (AOR = 1.11; CI 1.01-2.03), post-natal care (AOR = 1.45; CI 1.19-1.87), resumption of menses (AOR = 1.67; CI 1.18-1.93), urban residency (AOR = 2.14; CI 1.18-2.51), and high community women's education (AOR = 1.71; CI 1.51-2.11) were variables significantly associated with the early initiation of PPFP.

Conclusion

The early initiation of PPFP in Ethiopia was very low. Attention needs to be given to the quality of ANC, post-natal care, resumption of menses, residency, and community-level education of women to increase the prevalence of the early initiation of PPFP in Ethiopia. Therefore, the government should design a program targeting the quality of ANC in rural communities, considering women without menses and scaling up the education of women at the community level to the culture of the early initiation of PPFP in order to achieve reduced maternal, neonatal, and child mortality.

Examining the linkages between maternity services and postpartum modern contraceptive adoption among young women in India: Insights from the 2015-16 and 2019-21 National Family Health Survey

BACKGROUND

The adoption of maternity services and postpartum modern contraception are the two most crucial components that help in reducing maternal and infant mortality; still, India is consistently struggling with it. This paper, therefore, aimed to examine the linkages between use of maternity services and postpartum modern contraceptive adoption.

DATA AND METHODS

The required reproductive calendar data were extracted from the 2015-16 and 2019-21 National Family Health Survey (NFHS) datasets. The assessment was made based on a sample of currently married women aged 15-24 years who had given most recent childbirth in five years preceding the survey. For the analysis, a time-to-event approach was applied using the Kaplan-Meier survival statistic, Log-Rank Chi-square test and Cox-Proportional Hazard (Cox-PH) models.

RESULTS

The results revealed that the proportion of postpartum modern contraceptive uptake among young users increased by 9%, from 33% in 2015-16 to 42% in 2019-21. The Cox-PH models revealed that, in both NFHS waves, the associations between various components of maternity services and postpartum modern contraceptive uptake were strongly significant, even after controlling for selected socio-economic and demographic correlates.

CONCLUSIONS

The findings of this study reinforced urgent need for implementing integrated maternal-child health and family planning programmes and for boosting effective family planning counselling by health professionals to promote and motivate young women with a desire to early adoption of modern contraception in subsequent months after a recent childbirth.

Impact of the interpregnancy interval after cesarean delivery on subsequent perinatal risks: a retrospective study

PURPOSE

To assess the impact of the interpregnancy interval (IPI) after cesarean delivery on the risks of adverse perinatal events during subsequent pregnancies.

METHODS

We retrospectively examined perinatal outcomes of subsequent pregnancies of women whose most recent birth experience involved cesarean delivery at our hospital between January 2014 and December 2019. IPI was defined as the time between live birth and subsequent conception. Three IPI groups: < 18 months, 18-60 months, and > 60 months, were assessed. The risks of preterm birth, preeclampsia, placenta previa, placental abruption, fetal growth restriction, and successful vaginal birth were compared among the three IPI groups using uni- and multivariate analyses.

RESULTS

We registered 592 births after cesarean delivery: 178, 288, and 126 in the IPI < 18 months, 18-60 months, and > 60 months groups, respectively. The groups did not differ significantly regarding perinatal outcomes. The multivariate analysis revealed no significant differences in the risks of adverse perinatal outcomes among all groups. The odds ratios (ORs) for preterm birth at < 37 weeks of gestation were 1.24 and 1.64 for those in the < 18 months and > 60 months groups, respectively (P = 0.362 and P = 0.055, respectively). The groups did not differ significantly regarding vaginal birth success rate (ORs 1.72 for the < 18 months group, 0.49 for the > 60 months group; P = 0.486 and P = 0.446, respectively).

CONCLUSION

After cesarean delivery, IPIs shorter than 18 months and longer than 60 months do not significantly impact the risks of adverse perinatal outcomes or successful vaginal birth compared with IPIs of 18-60 months.

Scoping review into models of interconception care delivered at well-child visits for the Australian context

BACKGROUND

The interconception period provides an opportunity to address women's health risks and optimise birth spacing before the next pregnancy. This scoping review aimed to identify models of interconception care (ICC) delivered at well-child visits (WCVs) around the world, review the impacts of ICC delivered, and what the feasibility and applicability of these models were.

METHODS

The global review included clinical studies that that were identified using medical subject headings (MeSH) and keyword combinations. Studies were included if they met the criteria: were clinical studies; examined a model of ICC; were conducted by a registered health professional; and examined women who had given birth within the last 24-months. The following databases were searched: Medline (OVID); CINAHL (EBSCO); PubMed; and Embase (OVID). Relevant studies were screened in Covidence and the data was then extracted using a narrative analysis.

RESULTS

Fifteen studies met the inclusion criteria. The benefits of ICC delivered at WCVs included screening for maternal health behaviours and conditions and increase women's uptake of interventions. The studies identified that implementing ICC at WCVs was acceptable to women. Identified challenges included lack of time for health providers, lack of education among women and health providers, and limited funding for WCVs.

CONCLUSION

ICC interventions found in this review included family planning counselling and provision of long-acting contraception; health promotion of folic acid; and postpartum depression screening. The research concluded that ICC delivered at WCVs contributes to improving health behaviours for future pregnancies. Increased capacity for this care at WCVs could be achieved with targeted resources and time allocation.

Spatial distribution of short birth interval and associated factors among reproductive age women in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey

BACKGROUND

Short Birth Interval negatively affects the health of both mothers and children in developing countries. Studies conducted in Ethiopia on the spatial variation and determinants of individual and community-level factors about short birth intervals were limited. Thus, this study was intended to assess the spatial variation of the short birth interval and its determinants in Ethiopia.

METHODS

This study is a secondary analysis of the Ethiopian Demographic and Health Survey (mini EDHS 2019). A total of 1784 reproductive-age women were included in the analysis. The global spatial autocorrelation (Global Moran's I) and the Getis-Ord statistics tool were used to detect the presence of clustering and the high/low hotspot areas of SBI respectively. Ordinary kriging was used to interpolate short birth intervals, and spatial scan statistics were employed to identify spatial clusters with high and low SBI. A multilevel multivariable model was used to identify predictors of a short birth interval.

RESULTS

The prevalence of SBI was 62.89% (95%CI: 59.3, 69.7) in Ethiopia. High clustering of SBI was observed in all parts of Somali, in Afar (zones 1, 3, 4, &5), Oromia (Guje, Bale, & West Harerge), and northern Tigray. The most likely significant primary cluster was observed in the Somali region. Women who lived in the primary cluster were 24% more likely to have a short birth interval than those who lived outside the window. In the multilevel mixed-effect analysis age 25-34 [(AOR = 0.40, 95% CI: 0.35, 0.45)], 35-49 [(AOR = 0.44, 95% CI: 0.38, 0.51)], Muslim religion follower [(AOR = 3.5, 95% CI: 2.7, 4.69)], no formal education [(AOR = 0.5, 95% CI: 0.37, 0.70)], primary education[(AOR = 0.4, 95%CI: 0.28, 0.53)], and secondary education [(AOR = 0.3, 95% CI: 0.24, 0.48)], middle [(AOR: 1.3, 95% CI: 1.2, 1.52)], rich wealth status [(AOR: 1.4, 95% CI: 1.3, 1.68)], female sex children [(AOR: 1.2, 95% CI: 1.09, 1.42)], and two or fewer ideal number of children [(AOR = 0.2, 95% CI: 0.25, 0.32)] were found to be significant predictors of SBI.

CONCLUSION

Overall, SBI was high and significantly clustered across the region of Ethiopia. Age, religion, education, wealth status, the sex of the indexed child, and the ideal number of children were found to be significantly associated with short birth intervals. Hence, the government should design a health promotion strategy and public health awareness in the identified hotspot areas of SBI and should scale up family planning and the wealth status of reproductive-age women.

Short Interpregnancy Interval Following a Multifetal Pregnancy: Maternal and Neonatal Outcomes

Objective: To evaluate the maternal and neonatal outcomes of women with short interpregnancy intervals (IPI < 6 months) following a multifetal pregnancy. Study design: A multicenter retrospective cohort study of women with an index multifetal delivery and a subsequent singleton gestation between 2005 and 2021. The obstetrical outcomes of pregnancies following short IPI (<6 months) were compared to those with an IPI of 18–48 months. Additional analyses were also conducted for the other IPI groups: 7–17 months, and longer than 49 months, while women with an IPI of 18–48 months served as the reference group. The primary outcome was preterm birth (<37 weeks) rate. Secondary outcomes were other adverse maternal and neonatal outcomes. Univariate and multiple logistic regression analyses were performed. Results: Overall, 2514 women had a primary multifetal delivery with a subsequent singleton gestation at our medical centers; 160 (6.4%) had a short IPI, and 1142 (45.4%) had an optimal IPI. Women with a singleton gestation following a short IPI were younger, with lower rates of previous cesarean and fertility treatments. Women in the short IPI group had significantly higher rates of preterm birth <37 weeks, anemia (Hb < 11 gr%) on admission to the delivery room, and placental abruption. Multivariable logistic regression analysis demonstrated that short IPI is associated with an increased risk for preterm birth (aOR 2.39, 95% CI 1.12–5.11, p = 0.03). Conclusion: Short IPI following a multifetal gestation is associated with an increased risk for preterm birth in subsequent singleton pregnancy.

Integrating postpartum IUD counselling and insertion into routine maternity care in Nepal: Assessing trends over time

To meet the postpartum family planning (PPFP) needs of women in Nepal, an intervention was launched to integrate PPFP counselling and postpartum IUD (PPIUD) insertion into maternity care. Women delivering in study hospitals over a period of 18 months were interviewed at the time of delivery and at 15 months following the end of the study enrollment period to assess if the impact of the intervention observed at the end of the study was maintained. Data were collected prior to the intervention, at the middle month of the intervention roll out, at the end of the enrollment period and 15 months after the end of the enrollment period. We compared PPFP counselling and insertion rates before, during, at the end of and after the intervention study period, using cross-tabulation and chi-square tests. Overall, PPFP counselling rates increased from 11% at the baseline month to 45% at the end of the enrollment in February 2017 and remained the same 15 months later in July 2018. PPIUD uptake, however, rose from a negligible 0.1% at the baseline to 4.3% in February 2017, but declined to 3.4% in July 2018. PPIUD uptake among women who were counselled showed a similar trend, increasing from 1.9% at the baseline to 9.6% in February 2017 and declining to 6.0% in July 2018. The intervention had an appreciable continued impact on PPIUD counselling rates and although PPIUD uptake rose during the intervention, this trend was not observed in the 15 months post-study follow up. The impact of the intervention was greater and persistent in hospitals that had a longer period of exposure to intervention. The results suggest that counselling was well integrated with the maternity care, though uptake of PPIUD dropped after intervention activities such as active monitoring, technical supervision, provision of IUDs and training were withdrawn.

Trial registration: This study has been registered with Clinical Trial.gov. The registration number is NCT 02718222. Details about the study design have been published by Canning et al, 2016.

Attitudes and perceptions towards postpartum contraceptive use among seroconcordant partners with HIV in rural Mozambique: a qualitative study

BACKGROUND

Postpartum contraceptive uptake reduces short interpregnancy intervals, unintended pregnancies, and their negative sequalae: poor maternal and fetal outcomes. Healthy timing and spacing of pregnancy in people living with HIV (PLHIV) also allows time to achieve viral suppression to reduce parent-to-child HIV transmission. There is scant understanding about how couples-based interventions impact postpartum contraceptive uptake among PLHIV in sub-Saharan Africa.

METHODS

We interviewed 38 recently pregnant people and 26 of their partners enrolled in the intervention arm of the Homens para Saúde Mais (HoPS+) [Men for Health Plus] trial to assess their perceptions of, attitudes towards, and experiences with contraceptive use. Individuals in the HoPS+ intervention arm received joint-as opposed to individual-HIV-related services during pregnancy and postpartum periods, six counseling and skills sessions, and nine sessions with a peer support couple. Our thematic analysis of the 64 in-depth interviews generated 14 deductive codes and 3 inductive codes across themes within the Information, Motivation, and Behavior Model of health behavior change.

RESULTS

Participants reported accurate and inaccurate information about birth spacing and contraceptive methods. They described personal (health, economic, and religious) and social (gender norms, desired number of children) motivations for deciding whether to use contraceptives-with slightly different motivations among pregnant and non-pregnant partners. Finally, they explained the skills needed to overcome barriers to contraceptive use including how engagement in HoPS+ improved their shared decision-making skills and respect amongst partners-which facilitated postpartum contraceptive uptake. There were also several cases where non-pregnant partners unilaterally made family planning decisions despite disagreement from their partner.

CONCLUSIONS

These findings suggest that couples-based interventions during pregnancy and post-partum periods aimed at increasing postpartum contraceptive uptake must center pregnant partners' desires. Specifically, pregnant partners should be allowed to titrate the level of non-pregnant partner involvement in intervention activities to avoid potentially emboldening harmful gender-based intercouple decision-making dynamics.

Pregnancy risks and contraceptive use among postpartum mothers in Cameroon: implications for improving the coverage of postpartum family planning services

BACKGROUND

The health hazards of short inter-birth intervals are severe in Cameroon. One-quarter of inter-birth intervals are less than 24 months and the probability of death before age 5 for children born after a short interval is double that associated with intervals of 36-47 months. We examine the risk of an unintended pregnancy in the 18 months following childbirth in Cameroon, taking into account the protective effects of lactational amenorrhea, delayed resumption of sex as well as contraceptive use.

METHODS

Data from 3007 postpartum women in the nationally representative 2018 Cameroon Demographic and Health Survey were used. Risk of an unintended pregnancy was defined from current status information on resumption of sex and menses, contraceptive use, desire for another child within 12 months, and, for the minority of pregnant women, whether the conception was intended. Predictors of risk, and of modern method use, were assessed by bivariate and multivariate analysis.

RESULTS

In the first 6 postpartum months, only 8% of women were fully at risk (i.e., sex and menses resumed but no contraceptive use), rising to 24% at 6-11 postpartum months, and further to 30% at months 12-17. Though 89% wanted to delay the next birth by at least 1 year, only 17% were currently using a modern method. Menstruating women were much more likely to be users than amenorrheic women: 27% versus 15% at months 12-17 postpartum. Urban and better educated women recorded higher contraceptive use but lower protection from other factors than rural, less educated women, with the net result that risk differed little across these population strata. Uptake of maternal and child health (MCH) services was high but only one-third of women had discussed family planning at a facility visit during the preceding 12 months.

CONCLUSIONS

These results underscore the need for improved postpartum family planning services by means of closer integration with mainstream health services. In view of evidence from other sources of heavy workload and weak motivation of health staff, this will require strong leadership. A related priority is to increase the number of staff trained in provision of long-acting methods, such as implants.

Effect of Package of Interventions on the Use and Quality of Postpartum Family Planning Services at Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia

Background

Postpartum Family Planning (PPFP), which aims to prevent high risk unintended and closely spaced pregnancies during the first year following childbirth, is one of the highest impact interventions to avoid increased risk of premature birth, low birth weight, fetal and neonatal death, and adverse maternal health outcomes. This study aimed to assess the combined effect of a package of interventions on the use and quality of PPFP services at Y12HMC, Addis Ababa Ethiopia.

Method

Cross-sectional study design was conducted to evaluate the effect of the package of chosen interventions: creating a private counseling space near the postpartum ward and providing training for health care providers on the WHO decision tool kit and Long Acting Contraceptive Methods (LACM). Interviews were conducted with 470 women (235 before and 235 after the intervention). Frequency tables and graphs were used to describe the study variables and statistical significance between pre and post intervention indicators was declared at P value <.05.

Results

From 470 participants, 421 respondents participated which makes response rate of 90%. The majority of the participants were in the age category 20 to 29 years, married/lived together, completed at least primary education and had more than one child both at baseline and post intervention. The proportion of women who chose PPFP increased from 55.8% at baseline to 69% after the intervention. The most preferred contraceptive method was implant. The overall service satisfaction level of the study participants was 95.4% post intervention, significantly higher than at baseline (78%, P < .05). Providers indicated that clients are satisfied with the service and that the institutional structure is appropriate for delivering integrated services following the intervention.

Conclusion

This study demonstrated that quality improvement interventions like creating a private counseling space and providing training using WHO decision tool kit can achieve significant improvement on satisfaction of clients and PPFP uptake.

Effects of short birth interval on different forms of child mortality in Bangladesh: Application of propensity score matching technique with inverse probability of treatment weighting

BACKGROUND

The prevalence of Short Birth Interval (SBI) is higher in Low- and Middle-Income countries (LMICs), including Bangladesh. Previous studies in LMICs have estimated the effects of SBI on child mortality by comparing two unequal groups of mothers based on their socio-economic status. This approach may lead to overestimation or underestimation of the true effect of birth interval on child mortality, particularly when sample sizes are relatively small.

OBJECTIVE

We determined the effects of SBI on several forms of child mortality in Bangladesh by comparing two equal groups created by applying the propensity score matching technique.

METHODS

This study analyzed data from 5,941 mothers and 1,594 health facilities extracted from the 2017/18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. The exposure variable was SBI (defined as the interval between two subsequent births <33 months: yes, no), while the outcome variables were neonatal mortality (defined as mortality within 28 days of birth: yes, no), infant mortality (defined as mortality within 1 year of birth: yes, no), and under-five mortality (defined as mortality within 5 years of birth: yes, no). Multilevel Poisson regression based on inverse probability treatment weights was used to determine the association between exposure and outcome variables.

RESULTS

The prevalence rates of neonatal, infant, and under-five mortality were 48.8, 30.8, and 23.1 per 1000 live births, respectively. Newborns of SBI mothers were found to have a 63% higher likelihood of neonatal mortality (aPR, 1.63; 95% CI, 1.08-2.46) compared to newborns of non-SBI mothers. Furthermore, the prevalence of infant mortality and under-five mortality was 1.45 times higher (aPR, 1.45; 95% CI, 1.01-2.08) and 2.82 times higher (aPR, 2.82; 95% CI, 2.16-3.70), respectively, among babies born in a short interval of their immediately preceding sibling as compared to babies born in a normal interval of their immediately preceding sibling.

CONCLUSIONS

Findings of this study indicate that SBI is an important predictor of child mortality. Consequently, around 1 million children born in a short interval every year in Bangladesh are at risk of dying before reaching their fifth birthday. This indicates a challenge for Bangladesh to achieve the SDG 3 target to reduce neonatal and under-five mortality to 12 and 25 deaths per 1000 live births, respectively. Hence, awareness-building programs about the adverse effects of SBI and strengthening existing healthcare facilities are important.

Association of interpregnancy interval and gestational diabetes mellitus

OBJECTIVE

To evaluate the association between interpregnancy interval (IPI) and risk for gestational diabetes mellitus (GDM).

METHODS

We conducted a retrospective cohort study among singleton, non-anomalous, live birth pregnancies of 5,705,812 pregnant individuals in the United States from 2016 to 2018. We examined IPI of 4-<6 months, 6-11 months, 12-17 months, 24-35 months, 36-47 months, 48-59 months, 60-71 months, and ≥72 months in comparison to the reference interval of 18-23 months in relation to risk for GDM. We used logistic regression to evaluate the association between IPI and risk for GDM.

RESULTS

There is a significantly increased risk for GDM associated with IPIs of 6-11 months and 12-17 months compared to the reference of 18-23 months (adjusted Odds Ratio [aOR] 1.05, 95% CI: 1.03-1.07; aOR 1.02, 95% CI: 1.01-1.03). The risk for GDM is greater for longer IPIs (36-47 months aOR 1.10, 95% CI: 1.05-1.08; 48-59 months aOR 1.11, 95% CI: 1.09-1.13; 60-71 months aOR 1.14, 95% CI: 1.12-1.16; ≥72 months aOR 1.31, 95% CI: 1.30-1.33).

CONCLUSION

Our findings support the growing evidence that shorter and longer IPI increase the risk of GDM in pregnant individuals. Screening guidelines for detection of GDM may need to be re-evaluated and updated to include longer IPIs (≥36 months) as a risk factor for earlier screening prior to current recommendation of 24 weeks gestational age.

Short interpregnancy interval can lead to adverse pregnancy outcomes: A meta-analysis

BACKGROUND

The evidence of some previous papers was insufficient in studying the causal association between interpregnancy interval (IPI) and adverse pregnancy outcomes. In addition, more literature have been updated worldwide during the last 10 years.

METHODS

English and Chinese articles published from January 1980 to August 2021 in the databases of PubMed, Cochrane Library, Ovid, Embase, China Biology Medicine disc (CBM), and China National Knowledge Infrastructure (CNKI) were searched. Then following the inclusion and exclusion criteria, we screened the articles. Utilizing the Newcastle-Ottawa Scale (NOS), we evaluated the quality of the included articles. The literature information extraction table was set up in Excel, and the meta-analysis was performed with Stata 16.0 software (Texas, USA).

RESULTS

A total of 41 articles were included in the meta-analysis, and NOS scores were four to eight. The short IPI after delivery was the risk factor of preterm birth (pooled odds ratio 1.49, 95% confidence interval 1.42-1.57), very preterm birth (pooled OR: 1.82, 95% CI: 1.55-2.14), low birth weight (pooled OR: 1.33, 95% CI: 1.24-1.43), and small for gestational age (pooled OR: 1.14, 95% CI: 1.07-1.21), offspring death (pooled OR: 1.60, 95% CI: 1.51-1.69), NICU (pooled OR: 1.26, 95% CI: 1.01-1.57), and congenital abnormality (pooled OR: 1.10, 95% CI: 1.05-1.16), while was not the risk factor of gestational hypertension (pooled OR: 0.95, 95% CI: 0.93-0.98) or gestational diabetes (pooled OR: 1.06, 95% CI: 0.93-1.20).

CONCLUSION

Short IPI (IPI < 6 months) can lead to adverse perinatal outcomes, while it is not a risk factor for gestational diabetes and gestational hypertension. Therefore, more high-quality studies covering more comprehensive indicators of maternal and perinatal pregnancy outcomes are needed to ameliorate the pregnancy policy for women of childbearing age.

The effects of birth spacing on early childhood development in high-income nations: A systematic review

Objective

This study aimed to systematically review the literature on the associations between birth spacing and developmental outcomes in early childhood (3-10 years of age). Studies examining the associations between interpregnancy intervals and child development outcomes during and beyond the perinatal period have not been systematically reviewed.

Methods

We searched Ovid/MEDLINE, Global Health, PsycINFO, EMBASE, CINAHL Plus, Educational Source, Research Starters, ERIC, Scopus, PubMed, Social Science Research Network database, and ProQuest's Social Sciences Databases for relevant articles published between 1 January 1989 and 25 June 2021. Studies published in English, conducted in populations residing in high-income countries with any measure of birth spacing, and child development outcomes among children aged <10 years were included. Two authors independently assessed the eligibility of studies and extracted data on the study design, setting and population, birth spacing, outcomes, and results.

Results

The search yielded 1,556 records, of which seven studies met the inclusion criteria. Five of these seven studies used birth intervals as the exposure measure. Definitions of exposure differed between the studies. Three studies reported an association between short birth spacing and poorer child development outcomes, and two studies reported an association between long birth spacing and poorer child development outcomes.

Conclusion

Currently, limited evidence suggests that the adverse effects of sub-optimal birth spacing are observable beyond infancy.

Understanding the associations between maternal high-risk fertility behaviour and child nutrition levels in India: evidence from the National Family Health Survey 2015-2016

Anthropometric markers are the most important aspect of a child's health assessment. Using large-scale nationally representative data from the National Family Health Survey (NFHS-4), 2015-2016, this study aimed to investigate the relationship between children born to women with high-risk fertility behaviours and children's health outcomes. The sample consisted of 2,55,726 children of currently married women aged 15-49 years in India. The key explanatory variable, high-risk fertility behaviour was defined by women's age at birth (below 18 or above 34 years), birth interval (less than 24 months), and higher birth orders (four and above). The key outcome variables for assessing child health outcomes were stunting, wasting, and underweight in children aged 0-59 months. We used descriptive statistics, Pearson's chi-square test and logistic regression models to analyse the objectives. Approximately 33% of children were born with any single high-risk condition in the last 5 years in India. The bivariate analysis showed that all three components of child health, stunting, wasting, and underweight, were higher among children born to women with high-risk fertility behaviour. The findings from the multivariable analysis suggest that children born with a high risk fertility behaviour were suffering from stunting (AOR = 1.30; 95% CI 1.27-1.33) and underweight (AOR = 1.23; 95% CI 1.20-1.27). In addition, children born to women of multiple high-risk categories had higher odds of stunting (AOR = 1.53; 95% CI 1.46-1.59) and underweight (AOR = 1.38; 95% CI 1.32-1.44) as compared to children born to women with no risk. Our findings highlight an urgent need for effective legislation to prevent child marriage that would be helpful in increasing the maternal age at birth. The government should also focus on the interventions in health education and improvement of reproductive healthcare to promote optimal birth spacing.

Factors associated with early pregnancy anemia in rural Sri Lanka: Does being 'under care' iron out socioeconomic disparities?

Globally, more than a third of pregnant women are anemic, and progress in its prevention and control is slow. Sri Lanka is a lower-middle-income country with a unique public health infrastructure that provides multiple interventions across the lifecycle for anemia prevention, despite which anemia in pregnancy remains a challenge. Studying the factors associated with maternal anemia in this context would provide unique information on challenges and opportunities encountered as low-and-middle-income countries attempt to control anemia by improving health care coverage. All first-trimester pregnant women registered for antenatal care in the Anuradhapura district between July 2019 to September 2019 were invited to participate in the baseline of a cohort study. Interviewer-administered and self-completed questionnaires were used. Anemia was defined using a full blood count. A hierarchical logistic regression model was built to identify factors associated with anemia. Out of 3127 participants, 451 (14.4%) were anemic. According to the regression model (Chi-square = 139.3, p<0.001, n = 2692), the odds of being anemic increased with the Period of gestation (PoG) (OR = 1.07, 95% CI = 1.01-1.13). While controlling for PoG, age and parity, history of anemia (OR = 3.22, 95%CI = 2.51-4.13), being underweight (OR = 1.64, 95%CI = 1.24-2.18), having the last pregnancy five or more years back (OR = 1.57,95%CI = 1.15-2.15) and having used intrauterine devices for one year or more (OR = 1.63, 95%CI = 1.16-2.30) increased the odds of anemia. Breast feeding during the last year (OR = 0.66, 95%CI = 0.49-0.90) and having used contraceptive injections for one year or more (OR = 0.61,95%CI = 0.45-0.83) reduced the risk of anemia. Proxy indicators of being in frequent contact with the national family health program have a protective effect over the socioeconomic disparities in preventing early pregnancy anemia. Maintaining the continuum of care through the lifecycle, especially through optimizing pre and inter-pregnancy care provision should be the way forward for anemia control.

Knowledge, Attitude and Practices of Postpartum Females Regarding the Acceptance of Immediate Postpartum Contraception: A Cross-Sectional Study From North India

The immediate postpartum period is a great time to encourage the acceptance of contraceptive methods; the time is influenced by both emotional and physical factors. At this stage, the administration of intrauterine contraceptives is relatively easier with lesser complications due to the prior obstetric event. A single-center cross-sectional study was conducted using a self-constructed questionnaire-based interview on 331 women in their immediate postpartum period who had delivered a healthy live-born infant. The majority (59.8%) of study participants had unplanned pregnancies. We conducted behavior change communication sessions for postpartum family planning which resulted in 89% of participants accepting the methods with the prime reasons for acceptance being temporary child spacing (41%) and a definitive desire for no more children (34%). The odds were higher in women with more than five pregnancies [adjusted odds ratio (AOR) = 1.951, 95% CI = 1.389-2.925] and women whose last pregnancy was planned [AOR = 1.248, 95% CI = 1.002-3.215].The hindrance to adopt and adhere to postpartum contraception stems from a variety of socio-economic factors which are unique to low-income countries. Individually tailored behavior change communication/counseling approaches may help overcome misconceptions and meet the heterogeneous needs for family planning in the immediate postpartum phase.

Influence of family planning and immunization services integration on contraceptive use and family planning information and knowledge among clients: A cross-sectional analysis in urban Nigeria

Reproductive autonomy necessitates that women have access to high quality family planning information and services. Additionally, closely spaced pregnancies increase maternal and infant morbidity and mortality. Although integrating family planning into child immunization services may increase access to information and services and postpartum contraceptive use, evidence on how integration affects service delivery and health outcomes is scarce. One limitation of previous studies is the use of binary integration measures. To address this limitation, this study applied Provider and Facility Integration Index scores to estimate associations between integration and contraceptive use, receipt of family planning information, and knowledge of family planning services availability. This study leveraged pooled cross-sectional health facility client exit interview data collected from 2,535 women in Nigeria. Provider and Facility Integration Index scores were calculated (0–10, 0 = low, 10 = high) for each facility (N = 94). The Provider Integration Index score measures provider skills and practices that support integrated service delivery; the Facility Integration Index score measures facility norms that support integrated service delivery. Logistic regression models identified associations between Provider and Facility Integration Index scores and (a) contraceptive use among postpartum women, (b) receipt of family planning information during immunization visits, and (c) correct identification of family planning service availability. Overall, 46% of women were using any method of contraception, 51% received family planning information during the immunization appointment, and 83% correctly identified family planning service availability at the facility. Mean Provider and Facility Integration Index scores were 6.46 (SD = 0.21) and 7.27 (SD = 0.18), respectively. Provider and Facility Integration Index scores were not significantly associated with postpartum contraceptive use. Facility Integration Index scores were negatively associated with receipt of family planning information. Provider Integration Index scores were positively associated with correct identification of family planning service availability. Our results challenge the position that integration provides a clear path to improved outcomes. The presence of facility and provider attributes that support integration may not result in the delivery of integrated care.

Negative effects of short birth interval on child mortality in low- and middle-income countries: A systematic review and meta-analysis

Methods

Eight databases, PubMed, CINAHL, Web of Science, Embase, PsycINFO, Cochrane Library, Popline, and Maternity and Infant Care, were searched, covering the period of January 2000 to January 2022. Studies that had examined the association between SBI and any form of child mortality were included. The findings of the included studies were summarized through fixed-effects or random-effects meta-analysis and the model was selected based on the heterogeneity index.

Results

A total of 51 studies were included. Of them, 19 were conducted in Ethiopia, 10 in Nigeria and 7 in Bangladesh. Significant higher likelihoods of stillbirth (odds ratio (OR) = 2.11; 95% confidence interval (CI) = 1.32-3.38), early neonatal mortality (OR = 1.58; 95% CI = 1.04-2.41), perinatal mortality (OR = 1.71; 95% CI = 1.32-2.21), neonatal mortality (OR = 1.85; 95% CI = 1.68-2.04), post-neonatal mortality (OR = 3.01; 95% CI = 1.43-6.33), infant mortality (OR = 1.92; 95% CI = 1.77-2.07), child mortality (OR = 1.67; 95% CI = 1.27-2.19) and under-five mortality (OR = 1.95; 95% CI = 1.56-2.44) were found among babies born in short birth intervals than those who born in normal intervals.

Conclusions

SBI significantly increases the risk of child mortality in LMICs. Programmes to reduce pregnancies in short intervals need to be expanded and strengthened. Reproductive health interventions aimed at reducing child mortality should include proper counselling on family planning, distribution of appropriate contraceptives and increased awareness of the adverse effects of SBI on maternal and child health.

Using machine learning to understand determinants of IUD use in India: Analyses of the National Family Health Surveys (NFHS-4)

Intra-uterine devices (IUDs) are a safe and effective method to delay or space pregnancies and are available for free or at low cost in the Indian public health system; yet, IUD uptake in India remains low. Limited quantitative research using national data has explored factors that may affect IUD use. Machine Learning (ML) techniques allow us to explore determinants of low prevalence behaviors in survey research, such as IUD use. We applied ML to explore the determinants of IUD use in India among married women in the 4th National Family Health Survey (NFHS-4; N = 499,627), which collects data on demographic and health indicators among women of childbearing age. We conducted ML logistic regression (lasso and ridge) and neural network approaches to assess significant determinants and used iterative thematic analysis (ITA) to offer insight into related variable constructs generated from a series of regularized models. We found that couples’ shared family planning (FP) goals were the strongest determinants of IUD use, followed by receipt of FP services and desire for no more children, higher wealth and education, and receipt of maternal and child health services. Findings highlight the importance of male engagement and family planning services for IUD uptake and the need for more targeted efforts to support awareness of IUD as an option for spacing, especially for those of lower SES and with lower access to care.

•

Prevalence of IUD use has remained extremely low in India for the past two decade.

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This paper used machine learning models with iterative thematic analysis to explore potential predictors of IUD use among currently married women in India.

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The strongest predictor of IUD use was shared marital family planning goals between the male and female partners.

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Prior access to Family Planning services and couples' desire for no more children were also found to be predictive of IUD use in India.

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Findings also highlight the importance of male engagement and family planning services for IUD uptake.

Short birth interval and associated factors among women who gave birth in the last three years in Dembecha district, Northwest Ethiopia

Background

Maternal and child mortality remains a major public health problem in Ethiopia. Improving short birth interval practice is a main strategy to reduce neonatal mortality, maternal mortality, adverse pregnancy outcomes, high fertility rate, and enhance economic development efforts. However, there has been limited study done regarding short birth intervals in the study area. Therefore, this study aimed to assess short birth intervals and associated factors among women who gave birth in the last three years in Dembecha district, Northwest Ethiopia, 2019.

Method

A community-based cross-sectional study was conducted among 880 reproductive-age multipara mothers using a stratified cluster sampling technique. The data were collected by face-to-face interviews through pretested and semi-structured questionnaires. Bivariable and multivariable logistic regression model was fitted. Variables with a p-value ≤0.05 were considered statistically significant factors. Adjusted odds ratio with a 95% confidence interval was used to report the association between predictors and the outcome variable.

Results

The prevalence of short birth interval was found to be 43.4% (95% CI: 40.2, 46.9). Husband education (able to read and write) [AOR:2.81,(95% CI:1.04,7.85)], wealth index (lowest quartile) [AOR:3.75,(95% CI:2.35,5.97), residence (urban) [AOR:3.20,(95% CI:1.62,6.33)],age at first marriage (15–17 years old) [AOR: 1.65,(95% CI:1.15, 2.26),and non-use of contraceptive [AOR: 8.78, (95% CI: 6.18, 12.47) were statistically significant variables.

Conclusion

The study revealed that the prevalence of short birth intervals among multipara women is found to be high. Husband education, wealth index, urban residence, age at first marriage, and non-use of contraceptives were variables significantly associated with short birth intervals. Hence, to overcome the problem the focus should be on increasing family planning utilization, avoiding early marriage, strengthening paternal education, and improving family income.

Effect of integrating maternal and child health services, nutrition and family planning services on postpartum family planning uptake at 6 months post-partum in Burkina Faso, Cote d’Ivoire and Niger: a quasi-experimental study protocol

Background

Although several interventions integrating maternal, neonatal, child health and nutrition with family planning have been implemented and tested, there is still limited evidence on their effectiveness to guide program efforts and policy action on health services integration. This study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition and family planning services, compared with the general standard of care in Burkina Faso, Cote d'Ivoire, and Niger.

Methods

This is a quasi experimental study with one intervention group and one control group of 3 to 4 health facilities in each country. Each facility was matched to a control facility of the same level of care that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning. The study participants are pregnant women (up to 28 weeks of gestational age) coming for their first antenatal care visit. They will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccines. The analyzes will be carried out by intention to treat, using generalized linear models (binomial log or log Poisson) to assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women unevenly distributed at inclusion).

Discussion

This longitudinal study, with the provision of family planning services integrated into the whole maternal care continuum, a sufficiently long observation time and repeated measurements, will make it possible to better understand the timeline and the factors influencing women’s decision-making on the use of post-partum family planning services. The results will help to increase the body of knowledge regarding the impact of maternal and child health services integration on the utilization of post-partum family planning taking into account the specific context of sub-Saharan Africa French speaking countries where such information is very needed.

One strategy to improve the utilization of health services by mothers and their children is the integration of maternal and child health services. For instance, a pregnant woman coming for an antenatal care visit would also receive counseling on post-partum family planning services and maternal nutrition. Similarly, a woman coming for her infant’s vaccines would be offered counseling on post-partum family planning, maternal nutrition and breastfeeding. Although several interventions have been implemented and tested, there is still limited evidence on the conditions and factors required for successful maternal and child health services integration strategies. This study aims to assess the effectiveness of an intervention integrating maternal and child health services, nutrition and family planning services. For the purpose of the evaluation, 2 distincts groups of health facilities will be selected in each country, one group of 3 or 4 health facilities where the intervention will be implemented, and another group of 3 or 4 health facilities with the general standard of care. The study participants are pregnant women (up to 28 weeks of gestational age), coming for their first antenatal care visit, who will be followed up to 6 months after childbirth.The analyzes will be carried out to assess the effect of the intervention on contraceptive use prevalence between the two groups of health facilities. This study will make it possible to better understand the timeline and the factors influencing women’s decision-making on the use of post-partum family planning services.

Comparison of Placenta Previa and Placenta Accreta Spectrum Disorder Following Previous Cesarean Section between Women with a Short and Normal Interpregnancy Interval

Objectives

The aim of this study is to determine the effect of interpregnancy interval (IPI) on the incidence of placenta previa and placenta accreta spectrum disorders in women with a previous cesarean section.

Methods

A prospective cohort three-center study involving parturients who had previous cesarean section was conducted. Participants were included if pregnancy has lasted up to 34 weeks. Parturients with co-existing uterine fibroids, multiple gestations, premature rupture of membranes, and those with prior postcesarean delivery wound infection were excluded. The eligible women recruited were distributed into two groups, namely, short (<18 months) and normal (18–36 months) IPI. The outcome measures were incidences of placenta previa and placenta accreta spectrum disorder and factors associated with the occurrence of placenta previa. A univariate analysis was performed using the chi-square test or Mann–Whitney U test, wherever appropriate, to examine the significance of the differences in clinical variables.

Results

A total of 248 women met the inclusion criteria. The incidence of placenta previa by ultrasound was 8.9% and 4.0% for short and normal IPI (odds ratios = 2.32; 95% confidence intervals = 0.78–6.88; p = 0.13), respectively. The incidence of placenta accreta spectrum disorder was 1.6% and 0.8% for short and normal IPI (odds ratios = 2.02; 95% confidence intervals = 0.18–22.13; p = 0.57), respectively. The only observed significant difference between the clinical variables and placenta previa is the number of cesarean sections (p = 0.02) in women with short IPI.

Conclusion

A short interpregnancy interval does not significantly affect the incidence of placenta previa and placenta accreta spectrum disorder following a cesarean section. There is a need for further study with large numbers to corroborate these findings in low- and middle-income settings.

Couples-based interventions and postpartum contraceptive uptake: A systematic review

OBJECTIVE

Systematically review the existing evidence about couples-based interventions and postpartum contraceptive uptake and generate recommendations for future research.

DATA SOURCES

PubMed, Web of Science, PsycINFO, Embase, and CINAHL through June 7, 2021.

STUDY SELECTION AND DATA EXTRACTION

Studies with a couples-based intervention assessing postpartum contraceptive uptake. Two independent reviewers screened studies, extracted data, and assessed risk of bias with RoB-2 (Cochrane Risk of Bias 2) for randomized and ROBINS-I (Risk of Bias in Non-Randomized Studies - Interventions) for observational studies. Data were synthesized in tables, figures, and a narrative review.

RESULTS

A total of 925 papers were identified, 66 underwent full text review, and 17 articles, which included 18 studies - 16 randomized, 2 observational - were included. The lack of intervention and outcome homogeneity precluded meta-analysis and isolating the effect of partner involvement. Four studies were partner-required, where partner involvement was a required component of the intervention, and 14 were partner-optional. Unadjusted risk differences ranged from 0.01 to 0.51 in favor of couples-based interventions increasing postpartum contraceptive uptake versus standard of care. Bias assessment of the 16 randomized studies classified 8, 3, and 5 studies as at a high, some concern, and low risk of bias. Common sources of bias included intervention non-adherence and missing outcome data. One observational study was at a high and the other at a low risk of bias.

CONCLUSIONS

Future studies that assess couples-based interventions must clearly define and measure how partners are involved in the intervention and assess how intervention adherence impacts postpartum contraceptive uptake.