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Elhakham D, Wainstock T, Sheiner E, Sergienko R, Pariente G. Inter-pregnancy interval and long-term neurological morbidity of the offspring. Arch Gynecol Obstet 2020; 303:703-708. [PMID: 32935142 DOI: 10.1007/s00404-020-05788-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of our study was to evaluate the effect of IPI on long-term neurological morbidity of the offspring. METHODS In this retrospective cohort study, 144,397 singleton infants born to multiparous mothers, between the years 1991 and 2014 in a tertiary medical center, were evaluated for different perinatal outcomes and were followed until 18 years of age for long-term neurological morbidity according to three IPI groups: Short IPI (< 6 months), long IPI (> 60 months) and intermediate IPI (6-60 months). We used a Kaplan-Meier survival curve to compare cumulative incidence of long-term neurological morbidity, and a Cox regression analysis to control for confounders such as gestational age, birth weight and maternal age. RESULTS Offspring born to mothers with long IPI had higher rates of neurological morbidity (3.62% among offspring born after long IPI vs. 3.18% and 3.19% among offspring born after short and intermediate IPI, respectively, p = 0.041). The cumulative incidence of long-term neurological morbidity was significantly higher in the long IPI group (Kaplan-Meier log-rank test p < 0.001). Being born after a long IPI was found to be an independent risk factor for long-term neurological morbidity of the offspring (adjusted hazard ratio 1.2; 95% confidence interval 1.1-1.4; p < 0.001). CONCLUSION Long IPI is independently associated with an increased risk of long-term neurological morbidity of the offspring.
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Affiliation(s)
- David Elhakham
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O Box 151, 84101, Beer-Sheva, Israel.
| | - Ruslan Sergienko
- Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O Box 151, 84101, Beer-Sheva, Israel
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Schieve LA, Tian LH, Drews-Botsch C, Windham GC, Newschaffer C, Daniels JL, Lee LC, Croen LA, Danielle Fallin M. Autism spectrum disorder and birth spacing: Findings from the study to explore early development (SEED). Autism Res 2018; 11:81-94. [PMID: 29164825 PMCID: PMC5773391 DOI: 10.1002/aur.1887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 12/21/2022]
Abstract
Previous studies of autism spectrum disorder (ASD) and birth spacing had limitations; few examined phenotypic case subtypes or explored underlying mechanisms for associations and none assessed whether other (non-ASD) developmental disabilities (DDs) were associated with birth spacing. We assessed associations between inter-pregnancy interval (IPI) and both ASD and other DDs using data from the Study to Explore Early Development, a multi-site case-control study with rigorous case-finding and case-classification methods and detailed data collection on maternal reproductive history. Our sample included 356 ASD cases, 627 DD cases, and 524 population (POP) controls born in second or later births. ASD and DD cases were further sub-divided according to whether the child had intellectual disability (ID). ASD cases were also sub-divided by ASD symptom severity, and DD cases were subdivided by presence of some ASD symptoms (indicated on an autism screener). Odds ratios, adjusted for maternal-child sociodemographic factors, (aORs) and 95% confidence intervals were derived from logistic regression models. Among term births, ASD was associated with both IPI <18 months (aOR 1.5 [1.1-2.2]) and ≥60 months (1.5 [0.99-2.4]). Both short and long IPI associations were stronger among ASD cases with high severity scores (aORs 2.0 [1.3-3.3] and 1.8 [0.99-3.2], respectively). Associations were unchanged after adding several factors potentially related to the causal pathway to regression models. DD was not associated with either short or long IPI-overall, among term births, or in any subgroup examined. These findings extend those from previous studies and further inform recommendations on optimal pregnancy spacing. Autism Res 2018, 11: 81-94. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY We investigated whether the amount of time between pregnancies was associated autism spectrum disorder (ASD) or other developmental disabilities (DD) in children. ASD was increased in second and later-born children who were conceived less than 18 months or 60 or more months after the mother's previous birth. Other DDs were not associated with birth spacing.
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Affiliation(s)
- Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lin H Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Craig Newschaffer
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Julie L Daniels
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC
| | - Li-Ching Lee
- Kaiser Permanente Division of Research, Oakland, CA
| | - Lisa A Croen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - M Danielle Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Coo H, Brownell MD, Ruth C, Flavin M, Au W, Day AG. Interpregnancy Interval and Adverse Perinatal Outcomes: A Record-Linkage Study Using the Manitoba Population Research Data Repository. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:420-433. [PMID: 28363608 DOI: 10.1016/j.jogc.2017.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/20/2016] [Accepted: 01/18/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the association between the interpregnancy interval (IPI) and preterm birth, low birth weight, and SGA birth in a developed country with universal health coverage. METHODS We conducted a secondary analysis of data housed at the Manitoba Centre for Health Policy. All live births in Manitoba hospitals over a 29-year period were identified and consecutive births to the same mother were grouped into sibling pairs to calculate the IPI for the younger siblings. Logistic regression models were fit to examine the association between the IPI and adverse perinatal outcomes, adjusted for potentially confounding sociodemographic and clinical factors. RESULTS In a cohort of more than 171 000 births and relative to IPIs of 18 to 23 months, IPIs shorter than 12 and longer than 23 months were associated with significantly increased odds of preterm birth overall and both medically indicated and spontaneous preterm births, low birth weight, and SGA birth. The strongest association observed was for intervals shorter than 6 months and spontaneous preterm birth (adjusted OR 1.83, 95% CI 1.65-2.03). When the outcome was modelled as GA categories, the strongest association observed was for intervals shorter than 6 months and early preterm birth (<34 weeks' GA; adjusted OR 2.47, 95% CI 2.07-2.94). CONCLUSION If the associations observed between the IPI and adverse perinatal outcomes in this large, population-based cohort are causal, birth spacing could form an important target of public health messaging in Canada.
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Affiliation(s)
- Helen Coo
- Department of Pediatrics, Queen's University, Kingston, ON.
| | - Marni D Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, Winnipeg, MB
| | - Chelsea Ruth
- Manitoba Centre for Health Policy, Winnipeg, MB; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB
| | - Michael Flavin
- Department of Pediatrics, Queen's University, Kingston, ON
| | - Wendy Au
- Manitoba Centre for Health Policy, Winnipeg, MB
| | - Andrew G Day
- Kingston General Hospital Research Institute, Kingston, ON
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Conde-Agudelo A, Rosas-Bermudez A, Norton MH. Birth Spacing and Risk of Autism and Other Neurodevelopmental Disabilities: A Systematic Review. Pediatrics 2016; 137:peds.2015-3482. [PMID: 27244802 DOI: 10.1542/peds.2015-3482] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Both short and long interpregnancy intervals (IPIs) have recently been associated with increased risk of autism spectrum disorder (ASD). However, this association has not been systematically evaluated. OBJECTIVE To examine the relationship between birth spacing and the risk of ASD and other neurodevelopmental disabilities. DATA SOURCES Electronic databases from their inception to December 2015, bibliographies, and conference proceedings. STUDY SELECTION Observational studies with results adjusted for potential confounding factors that reported on the association between IPIs or birth intervals and neurodevelopmental disabilities. DATA EXTRACTION Two reviewers independently extracted data on study characteristics, IPIs/birth intervals, and outcome measures. RESULTS Seven studies (1 140 210 children) reported an association between short IPIs and increased risk of ASD, mainly the former subtype autistic disorder. Compared with children born to women with IPIs of ≥36 months, children born to women with IPIs of <12 months had a significantly increased risk of any ASD (pooled adjusted odds ratio [OR] 1.90, 95% confidence interval [CI] 1.16-3.09). This association was stronger for autistic disorder (pooled adjusted OR 2.62, 95% CI 1.53-4.50). Three of these studies also reported a significant association between long IPIs and increased risk of ASD. Short intervals were associated with a significantly increased risk of developmental delay (3 studies; 174 940 children) and cerebral palsy (2 studies; 19 419 children). LIMITATIONS Substantial heterogeneity, and few studies assessing neurodevelopmental disabilities other than ASD. CONCLUSIONS Short IPIs are associated with a significantly increased risk of ASD. Long IPIs also appear to increase the risk of ASD.
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Affiliation(s)
- Agustín Conde-Agudelo
- World Health Organization Collaborating Centre in Human Reproduction, Universidad del Valle, Cali, Colombia; and
| | - Anyeli Rosas-Bermudez
- World Health Organization Collaborating Centre in Human Reproduction, Universidad del Valle, Cali, Colombia; and
| | - Maureen H Norton
- Office of Population and Reproductive Health, Bureau for Global Health, US Agency for International Development, Washington, District of Columbia
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Inter-Pregnancy Intervals and the Risk of Autism Spectrum Disorder: Results of a Population-Based Study. J Autism Dev Disord 2016; 45:2056-66. [PMID: 25636677 DOI: 10.1007/s10803-015-2368-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent studies have reported an increased risk of autism among second-born children conceived <12 versus >36 months after the birth of a sibling. Confirmation of this finding would point to inter-pregnancy interval (IPI) as a potentially modifiable risk factor for autism. This study evaluated the relationship between IPI and autism spectrum disorder (ASD) risk in a Wisconsin birth cohort of 31,467 second-born children, of whom 160 resided in the study area and were found to have ASD at age 8 years. In adjusted analyses, both short (<12) and long (>84 month) IPIs were associated with a two-fold risk of ASD relative to IPIs of 24-47 months (p < 0.05). The long IPI association was partially confounded by history of previous pregnancy loss.
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Conde-Agudelo A, Rosas-Bermudez A, Castaño F, Norton MH. Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. Stud Fam Plann 2013; 43:93-114. [PMID: 23175949 DOI: 10.1111/j.1728-4465.2012.00308.x] [Citation(s) in RCA: 305] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This systematic review of 58 observational studies identified hypothetical causal mechanisms explaining the effects of short and long intervals between pregnancies on maternal, perinatal, infant, and child health, and critically examined the scientific evidence for each causal mechanism hypothesized. The following hypothetical causal mechanisms for explaining the association between short intervals and adverse outcomes were identified: maternal nutritional depletion, folate depletion, cervical insufficiency, vertical transmission of infections, suboptimal lactation related to breastfeeding-pregnancy overlap, sibling competition, transmission of infectious diseases among siblings, incomplete healing of uterine scar from previous cesarean delivery, and abnormal remodeling of endometrial blood vessels. Women's physiological regression is the only hypothetical causal mechanism that has been proposed to explain the association between long intervals and adverse outcomes. We found growing evidence supporting most of these hypotheses.
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Affiliation(s)
- Agustín Conde-Agudelo
- World Health Organization Collaborating Centre in Human Reproduction, Universidad del Valle, Cali, Colombia.
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Efficacy of a randomized cell phone-based counseling intervention in postponing subsequent pregnancy among teen mothers. Matern Child Health J 2012; 15 Suppl 1:S42-53. [PMID: 21809218 DOI: 10.1007/s10995-011-0860-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Adolescent mothers in Washington, DC have a high rate of subsequent teen pregnancies, often within 24 months. Children of teen mothers are at risk for adverse psychosocial outcomes. When adolescents are strongly attached to parents, schools, and positive peers, they may be less likely to repeat a pregnancy. This study tested the efficacy of a counseling intervention delivered by cell phone and focused on postponing subsequent teen pregnancies by strengthening healthy relationships, reproductive practices, and positive youth assets. The objective of this study was to compare time to a repeat pregnancy between the intervention and usual care groups, and, secondarily, to determine whether treatment intensity influenced time to subsequent conception. Primiparous pregnant teens ages 15-19, were recruited in Washington, DC. Of 849 teens screened, 29.3% (n = 249) met inclusion criteria, consented to participate, and completed baseline measures. They were then randomized to the intervention (N = 124) or to usual care (N = 125). Intervention group teens received cell phones for 18 months of counseling sessions, and quarterly group sessions. Follow-up measures assessed subsequent pregnancy through 24 months post-delivery. A survival analysis compared time to subsequent conception in the two treatment groups. Additional models examined the effect of treatment intensity. By 24 months, 31% of the intervention and 36% of usual care group teens had a subsequent pregnancy. Group differences were not statistically significant in intent-to-treat analysis. Because there was variability in the degree of exposure of teens to the curriculum, a survival analysis accounting for treatment intensity was performed and a significant interaction with age was detected. Participants who were aged 15-17 years at delivery showed a significant reduction in subsequent pregnancy with increased levels of intervention exposure (P < 0.01), but not those ≥ 18 years. Adolescents ≥ 18 years faced considerable challenges to treatment success. Individual, social, and contextual factors are all important to consider in the prevention of repeat teen pregnancy. Cell phone-based approaches to counseling may not be the most ideal for addressing complex, socially-mediated behaviors such as this, except for selective subgroups. A lack of resources within the community for older teens may interfere with program success.
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Rodrigues T, Barros H. Short interpregnancy interval and risk of spontaneous preterm delivery. Eur J Obstet Gynecol Reprod Biol 2007; 136:184-8. [PMID: 17490802 DOI: 10.1016/j.ejogrb.2007.03.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 03/17/2007] [Accepted: 03/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Short interpregnancy intervals are related to increased prevalence of adverse perinatal outcomes. However, the reported association with preterm birth might be due to confounding by factors such as previous pregnancy outcomes, socioeconomic level or lifestyles. The objective of this study was to evaluate the effect of short interpregnancy interval on the occurrence of spontaneous preterm delivery. STUDY DESIGN The prevalence of a short interpregnancy interval, defined as six or less months between a preceding delivery or abortion and the last menstrual period before index pregnancy, was compared between 263 spontaneous preterm (<37 weeks) and 299 term (37-42 weeks) consecutive births. Separate analyses were performed for early (<34 weeks) and late (34-36 weeks) preterm deliveries. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated using unconditional logistic regression. RESULTS There was a significant association between short interpregnancy interval and spontaneous early preterm delivery, both crude (OR=3.9; 95% CI: 1.91-8.10) and adjusted for maternal age, school education, previous birth outcomes, antenatal care, smoking habits, body mass index and gestational weight gain (adj(OR)=3.6; 95% CI: 1.41-8.98). No significant effect on spontaneous late preterm delivery was found (crude(OR)=0.8; 95% CI: 0.32-1.83). CONCLUSIONS This study showed that short interpregnancy intervals significantly increased the risk of early spontaneous preterm birth but no such effect was evident for late preterm deliveries.
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Affiliation(s)
- Teresa Rodrigues
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
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Abstract
Two of every 1000 live-born children develop cerebral palsy (CP). The aetiology of CP is often unclear and because CP is a symptom complex rather than a disease, clinically defined at 4-5 years of age, it is not surprising that there are considerable problems associated with epidemiological studies of its aetiology. The only reason for the CP concept is that it emanates from an insult to a growing, developing brain and a dynamic clinical picture from static pathology. Evidence suggests that 70-80% of CP cases are due to prenatal factors and that birth asphyxia plays a relatively minor role (<10%). Some antenatal risk factors are repeatedly observed to be related to CP: low gestational age, male gender, multiple gestation, intrauterine viral infections and maternal thyroid abnormalities. Recently, intrauterine infection/inflammation with a maternal response (consisting of chorioamnionitis) and a fetal inflammatory response (consisting of funicitis or elevated interleukin-6 in fetal plasma) has been found to be related to white matter injury and CP. Some risk factors are associated with CP at all gestational ages whereas others mostly affect term or preterm infants, e.g. intrauterine growth restriction seems to be a risk factor in term infants. There also seems to be an association between autoimmune and coagulation disorders and CP.
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Affiliation(s)
- Bo Jacobsson
- Department of Obstetrics and Gynaecology, Institute for the Health of Women and Children, Perinatal Centre, Sahlgrenska University Hospital/East, SE-416 85 Göteborg, Sweden.
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Reddihough DS, Collins KJ. The epidemiology and causes of cerebral palsy. THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY 2003; 49:7-12. [PMID: 12600249 DOI: 10.1016/s0004-9514(14)60183-5] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cerebral palsy is the commonest physical disability in childhood, occurring in 2.0 to 2.5 per 1000 live births. Although the total number of children with cerebral palsy has remained stable or increased slightly since 1970, there has been a consistent rise in the proportion of cerebral palsy associated with preterm and very preterm births. Known causes of cerebral palsy--whether prenatal, perinatal or postnatal--must be distinguished from risk factors or associations. Much is known about such risk factors which, alone or in combination, may indirectly result in cerebral palsy. Causes and risk factors implicated in cerebral palsy are discussed in detail, together with directions for future research.
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Rousso D, Panidis D, Gkoutzioulis F, Kourtis A, Mavromatidis G, Kalahanis I. Effect of the interval between pregnancies on the health of mother and child. Eur J Obstet Gynecol Reprod Biol 2002; 105:4-6. [PMID: 12270555 DOI: 10.1016/s0301-2115(02)00077-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David Rousso
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 46-48 Mitropoleos Street, 54623, Thessaloniki, Greece.
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Abstract
Research from the last two decades provides directions for efforts to prevent CP in VLBW infants. The pathogenesis of CP seems to involve factors operating both during pregnancy and in the neonatal period. The most important prenatal factor appears to be intrauterine infection. Perinatal infection and other risk factors, such as the death of a co-twin, placental abruption, and cerebral ischemia, could trigger a cytokine cascade resulting in damage to the developing brain. The low frequency of intrauterine infection in mothers with preeclampsia might explain the apparent protective effect of this disorder. If the brain damage attributed to intrauterine infection and other risk factors involves cytokines as intermediates, then blockade of the proinflammatory cascade or promotion of endogenous inhibitors might prevent CP. Other potentially preventive strategies include corticosteroids given to mothers (but not those given to neonates) and thyroid hormone.
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Affiliation(s)
- T M O'Shea
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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