Low birth weight, preterm birth and short interpregnancy interval in Sudan

Short birth interval prevalence, determinants and effects on maternal and child health outcomes in Asia-Pacific region: a systematic review and meta-analysis protocol

BACKGROUND

Short birth interval (SBI) has been linked to an increased risk of adverse maternal, perinatal, infant and child health outcomes. However, the prevalence and maternal and child health impacts of SBI in the Asia-Pacific region have not been well understood. This study aims to identify and summarise the existing evidence on SBI including its definition, measurement prevalence, determinants and association with adverse maternal and child health outcomes in the Asia-Pacific region.

METHODS

Five databases (MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Maternity and Infant Care, and Web of Science (WoS)) will be systematically searched from September 2000 up to May 2023. Data will be extracted, charted, synthesised and summarised based on the outcomes measured, and where appropriate, meta-analysis will be performed. The risk of bias will be assessed using Joanna Briggs Institute quality appraisal. Grading of Recommendation Assessment, Development and Evaluation framework will be used to evaluate the quality of cumulative evidence from the included studies.

ETHICS AND DISSEMINATION

This review does not require ethics approval. Findings will be disseminated through peer-reviewed publications, policy briefs and conference presentations.

PROSPERO REGISTRATION NUMBER

A protocol will be registered on PROSPERO for each separate outcome before performing the review.Cite Now.

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.

Interpregnancy interval and maternal and neonatal morbidity: a nationwide cohort study

This study aimed to assess the association between interpregnancy interval (IPI)-the time from childbirth to conception of the next pregnancy-and maternal and neonatal morbidity. The World Health Organization (WHO) currently recommends an IPI of at least 24 months after a live birth to reduce adverse birth outcomes. However, assessing the relationship between IPI and perinatal outcome is complicated by confounding factors. We conducted a nationwide population-based cohort study using Swedish registry data, allowing for adjustment of maternal characteristics and health at first birth. The study population consisted of all women with a singleton, live, and vaginal first birth with a second singleton birth within five years during 1997-2017, covering 327,912 women and 655,824 neonates. IPI was grouped into six-month intervals with 24-29 months as the reference. The association between IPI and morbidity was examined using multivariate logistic regression. For women having a vaginal delivery at their first birth, intervals < 24-29 months were associated with decreased maternal morbidity and unaffected neonatal morbidity. Intervals > 24-29 months were associated with increased maternal and neonatal morbidity. Our findings question the relevance of WHO's recommendation of an IPI of at least 24 months in a high-income country.

Maternal anemia and baby birth size mediate the association between short birth interval and under-five undernutrition in Ethiopia: a generalized structural equation modeling approach

Background

Studies assessing the association between short birth interval, a birth-to-birth interval of less than 33 months, and under-five undernutrition have produced inconclusive results. This study aimed to assess the relationship between short birth interval and outcomes of stunting, underweight, and wasting among children aged under-five in Ethiopia, and potential mediation of any associations by maternal anemia and baby birth size.

Method

Data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used. Stunting, wasting, and underweight among children aged under-five were outcome variables. Generalized Structural Equation Modeling (GSEM) was used to examine associations between short birth interval and outcomes, and to assess hypothesized mediation by maternal anemia and baby birth size.

Results

Significant associations between short birth interval and stunting (AOR = 1.49; 95% CI = 1.35, 1.66) and underweight (AOR = 1.43; 95% CI = 1.28, 1.61) were found. There was no observed association between short birth interval and wasting (AOR = 1.05; 95% CI = 0.90, 1.23). Maternal anemia and baby birth size had a significant partial mediation effect on the association between short birth interval and stunting (the coefficient reduced from β = 0.337, p < 0.001 to β = 0.286, p < 0.001) and underweight (the coefficient reduced from β = 0.449, p < 0.001 to β = 0.338, p < 0.001). Maternal anemia and baby birth size mediated 4.2% and 4.6% of the total effect of short birth interval on stunting and underweight, respectively.

Conclusion

Maternal anemia and baby birth size were identified as mediators of the association between short birth interval and under-five undernutrition status. Policies and programs targeting the reduction of under-five undernutrition should integrate strategies to reduce maternal anemia and small baby birth size in addition to short birth interval.

Prevalence and risk factors of short birth interval in Bangladesh: Evidence from the linked data of population and health facility survey

The Sustainable Development Goals 3 targets significant reductions in maternal and under-five deaths by 2030. The prevalence of these deaths is significantly associated with short birth intervals (SBI). Identification of factors associated with SBI is pivotal for intervening with appropriate programmes to reduce occurrence of SBI and associated adverse consequences. This study aimed to determine the factors associated with SBI in Bangladesh. A total of 5,941 women included in the 2017/18 Bangladesh Demographic and Health Survey 2017/18 and 1,524 healthcare facilities included in the 2017 Bangladesh Health Facility were linked and analysed. The sample was selected based on the availability of the birth interval data between the two most recent subsequent live birth. SBI was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization and was the outcome variable. Several individual-, households-, and community-level factors were considered as exposure variables. We used descriptive statistics to summarise respondents' characteristics and multilevel Poisson regression to assess the association between the outcome variable with exposure variables. Around 26% of live births occurred in short intervals, with a further higher prevalence among younger, uneducated, or rural women. The likelihoods of SBI were lower among women aged 20-34 years (PR, 0.14; 95% CI, 0.11-0.17) and ≥35 years (PR, 0.03; 95% CI, 0.02-0.05) as compared to the women aged 19 years or less. Women from households with the richest wealth quintile experienced lower odds of SBI (PR, 0.61; 95% CI, 0.45-0.85) compared to those from the poorest wealth quintile. The prevalences of SBI were higher among women whose second most recent child died (PR, 5.23; 95% CI, 4.18-6.55), those who were living in Chattogram (PR, 1.52; 95% CI, 1.12-2.07) or Sylhet (PR, 2.83, 95% CI, 2.08-3.86) divisions. Availability of modern contraceptives at the nearest healthcare facilities was 66% protective to the occurrence of SBI (PR, 0.34; 95% CI, 0.22-0.78). Also, the prevalence of SBI increased around 85% (PR, 1.85; 95% CI, 1.33-2.18) for every kilometer increase in the distance of nearby health facilities from women's homes. Targeted and tailored regional policies and programmes are needed to increase the awareness of SBI and associated adverse health outcomes and availability of modern contraception in the healthcare facilities.

Effects of short birth interval on neonatal, infant and under-five child mortality in Ethiopia: a nationally representative observational study using inverse probability of treatment weighting

OBJECTIVE

To assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia.

DESIGN

A nationally representative cross-sectional survey.

SETTING

This study used data from the Ethiopia Demographic and Health Survey 2016.

PARTICIPANTS

A total of 8448 women who had at least two live births during the 5 years preceding the survey were included in the analysis.

OUTCOME MEASURES

Neonatal mortality (death of the child within 28 days of birth), infant mortality (death between birth and 11 months) and under-five mortality (death between birth and 59 months) were the outcome variables.

METHODS

Weighted logistic regression analysis based on inverse probability of treatment weights was used to estimate exposure effects adjusted for potential confounders.

RESULTS

The adjusted ORs (AORs) of neonatal mortality were about 85% higher among women with SBI (AOR=1.85, 95% CI=1.19 to 2.89) than those without. The odds of infant mortality were twofold higher (AOR=2.16, 95% CI=1.49 to 3.11) among women with SBI. The odds of under-five child mortality were also about two times (AOR=2.26, 95% CI=1.60 to 3.17) higher among women with SBI.

CONCLUSION

SBI has a significant effect on neonatal, infant and under-five mortality in Ethiopia. Interventions targeting SBI are warranted to reduce neonatal, infant and under-five mortality.

Short birth spacing and its association with maternal educational status, contraceptive use, and duration of breastfeeding in Ethiopia. A systematic review and meta-analysis

Background

Closely spaced birth increases the risk of adverse maternal and child health outcomes. In Ethiopia, the prevalence of short birth spacing was highly variable across studies. Besides, contraceptive use, educational status, and duration of breastfeeding were frequently mentioned factors affecting short birth spacing. Therefore, this meta-analysis aimed to estimate the pooled prevalence of short birth spacing and its association with contraceptive use, educational status, and duration of breastfeeding among reproductive-age women in Ethiopia.

Methods

International databases: Google Scholar, PubMed, CINAHL, Cochrane library, HINARI, and Global Health were searched systematically to identify articles reporting the prevalence of short birth spacing and its association with contraceptive use, educational status, and duration of breastfeeding among reproductive-age women in Ethiopia. The data were analyzed by STATA/SE version-14 statistical software. The random-effect model was used to estimate the pooled prevalence of short birth spacing and the log odds ratio was used to determine the association. Moreover, egger’s test and I-squared statistics were used to assess publication bias and heterogeneity respectively.

Results

After reviewing 511 research articles, a total of nine articles with 5,682 study participants were included in this meta-analysis. The pooled prevalence of short birth spacing in Ethiopia was 46.9% [95% CI: (34.7, 59.1)]. Significant heterogeneity was observed between studies (I² = 98.4, p <0.001). Not using contraceptives [OR = 3.87, 95% CI: (2.29, 6.53)] and duration of breastfeeding < 24 months [OR = 16.9, 95%CI: (2.69, 106.47)] had a significant association with short birth spacing.

Conclusions

Although a minimum inter-pregnancy interval of two years was recommended by the World Health Organization (WHO), significant numbers of women still practiced short birth spacing in Ethiopia. Duration of breastfeeding and non-use of contraceptives were factors significantly associated with short birth spacing. So, efforts should be made to improve breastfeeding practice and contraceptive utilization among women in Ethiopia.

Socioeconomic inequality in short birth interval in Ethiopia: a decomposition analysis

BACKGROUND

Short birth interval, defined as a birth-to-birth interval less than 33 months, is associated with adverse maternal and child outcomes. Evidence regarding the association of maternal socioeconomic status and short birth interval is inconclusive. Factors contributing to the socioeconomic inequality of short birth interval have also not been investigated. The current study assessed socioeconomic inequality in short birth interval and its contributing factors in Ethiopia.

METHODS

Data from 8448 women collected in the 2016 Ethiopia Demographic and Health survey were included in the study. Socioeconomic inequality in short birth interval was the outcome variable. Erreygers normalized concentration index (ECI) and concentration curves were used to measure and illustrate socioeconomic-related inequality in short birth interval, respectively. Decomposition analysis was performed to identify factors explaining the socioeconomic-related inequality in short birth interval.

RESULTS

The Erreygers normalized concentration index for short birth interval was - 0.0478 (SE = 0.0062) and differed significantly from zero (P < 0.0001); indicating that short birth interval was more concentrated among the poor. Decomposition analysis indicated that wealth quintiles (74.2%), administrative regions (26.4%), and not listening to the radio (5.6%) were the major contributors to the pro-poor socioeconomic inequalities in short birth interval.

CONCLUSION

There was a pro-poor inequality of short birth interval in Ethiopia. Strengthening the implementation of poverty alleviation programs may improve the population's socioeconomic status and reduce the associated inequality in short birth interval.

Predictors of low birth weight and preterm birth in rural Uganda: Findings from a birth cohort study

BACKGROUND

Approximately 20.5 million infants were born weighing <2500 g (defined as low birthweight or LBW) in 2015, primarily in low- and middle-income countries (LMICs). Infants born LBW, including those born preterm (<37 weeks gestation), are at increased risk for numerous consequences, including neonatal mortality and morbidity as well as suboptimal health and nutritional status later in life. The objective of this study was to identify predictors of LBW and preterm birth among infants in rural Uganda.

METHODS

Data were derived from a prospective birth cohort study conducted from 2014-2016 in 12 districts across northern and southwestern Uganda. Birth weights were measured in triplicate to the nearest 0.1 kg by trained enumerators within 72 hours of delivery. Gestational age was calculated from the first day of last menstrual period (LMP). Associations between household, maternal, and infant characteristics and birth outcomes (LBW and preterm birth) were assessed using bivariate and multivariable logistic regression with stepwise, backward selection analyses.

RESULTS

Among infants in the study, 4.3% were born LBW (143/3,337), and 19.4% were born preterm (744/3,841). In multivariable analysis, mothers who were taller (>150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were ≥20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended ≥4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds.

CONCLUSIONS

In rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted.

Application of geographically weighted regression analysis to assess predictors of short birth interval hot spots in Ethiopia

Background

Birth interval duration is an important and modifiable risk factor for adverse child and maternal health outcomes. Understanding the spatial distribution of short birth interval, an inter-birth interval of less than 33 months, and its predictors are vital to prioritize and facilitate targeted interventions. However, the spatial variation of short birth interval and its underlying factors have not been investigated in Ethiopia.

Objective

This study aimed to assess the predictors of short birth interval hot spots in Ethiopia.

Methods

The study used data from the 2016 Ethiopia Demographic and Health Survey and included 8,448 women in the analysis. The spatial variation of short birth interval was first examined using hot spot analysis (Local Getis-Ord Gi* statistic). Ordinary least squares regression was used to identify factors explaining the geographic variation of short birth interval. Geographically weighted regression was used to explore the spatial variability of relationships between short birth interval and selected predictors.

Results

Statistically significant hot spots of short birth interval were found in Somali Region, Oromia Region, Southern Nations, Nationalities, and Peoples’ Region and some parts of Afar Region. Women with no education or with primary education, having a husband with higher education (above secondary education), and coming from a household with a poorer wealth quintile or middle wealth quintile were predictors of the spatial variation of short birth interval. The predictive strength of these factors varied across the study area. The geographically weighted regression model explained about 64% of the variation in short birth interval occurrence.

Conclusion

Residing in a geographic area where a high proportion of women had either no education or only primary education, had a husband with higher education, or were from a household in the poorer or middle wealth quintile increased the risk of experiencing short birth interval. Our detailed maps of short birth interval hot spots and its predictors will assist decision makers in implementing precision public health.

Determinants of preterm birth among mothers who gave birth in East Africa: systematic review and meta-analysis

BACKGROUND

Preterm birth (PTB) can be caused by different factors. The factors can be classified into different categories: socio demographic, obstetric, reproductive health, medical, behavioral and nutritional related. The objective of this review was identifying determinants of PTB among mothers who gave birth in East African countries.

METHODS

We have searched the following electronic bibliographic databases: PubMed, Google scholar, Cochrane library, AJOL (African journal online). Cross sectional, case control and cohort study published in English were included. There was no restriction on publication period. Studies with no abstracts and or full texts, editorials, and qualitative in design were excluded. Funnel plot was used to check publication bias. I-squared statistic was used to check heterogeneity. Pooled analysis was done by using fixed and random effect model. The Joanna Briggs Critical Appraisal Tools for review and meta-analysis was used to check the study quality.

RESULTS

A total of 58 studies with 134,801 participants were used to identify determinants of PTB. On pooled analysis, PTB was associated with age < 20 years (AOR 1.76, 95% CI: 1.33-2.32), birth interval less than 24 months (AOR 2.03, 95% CI 1.57-2.62), multiple pregnancy (AOR 3.44,95% CI: 3.02-3.91), < 4 antenatal care (ANC) visits (AOR 5.52, 95% CI: 4.32-7.05), and absence of ANC (AOR 5.77, 95% CI: 4.27-7.79). Other determinants of PTB included: Antepartum hemorrhage (APH) (AOR 4.90, 95% CI: 3.48-6.89), pregnancy induced hypertension (PIH) (AOR 3.10, 95% CI: 2.34-4.09), premature rupture of membrane (PROM) (AOR 5.90, 95% CI: 4.39-7.93), history of PTB (AOR 3.45, 95% CI: 2.72-4.38), and history of still birth/abortion (AOR 3.93, 95% CI: 2.70-5.70). Furthermore, Anemia (AOR 4.58, 95% CI: 2.63-7.96), HIV infection (AOR 2.59, 95% CI: 1.84-3.66), urinary tract infection (UTI) (AOR 5.27, 95% CI: 2.98-9.31), presence of vaginal discharge (AOR 5.33, 95% CI: 3.19-8.92), and malaria (AOR 3.08, 95% CI: 2.32-4.10) were significantly associated with PTB.

CONCLUSIONS

There are many determinants of PTB in East Africa. This review could provide policy makers, clinicians, and program officers to design intervention on preventing occurrence of PTB.

Holliday E, Loxton D. Individual and community level determinants of short birth interval in Ethiopia: A multilevel analysis

Background

The World Health Organization recommends a minimum of 33 months between two consecutive live births to reduce the risk of adverse maternal and child health outcomes. However, determinants of short birth interval have not been well understood in Ethiopia.

Objective

The aim of this study was to assess individual- and community-level determinants of short birth interval among women in Ethiopia.

Methods

A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was performed. A total of 8,448 women were included in the analysis. A two-level multilevel logistic regression analysis was used to identify associated individual- and community-level factors and estimate between-community variance.

Results

At the individual-level, women aged between 20 and 24 years at first marriage (AOR = 1.37; 95% CI: 1.18–1.60), women aged between 25 and 29 years at first marriage (AOR = 1.65; 95% CI: 1.20–2.25), having a husband who attended higher education (AOR = 1.32; 95% CI: 1.01–1.73), being unemployed (AOR = 1.16; 95% CI: 1.03–1.31), having an unemployed husband (AOR = 1.23; 95% CI: 1.04–1.45), being in the poorest wealth quintile (AOR = 1.82; 95% CI: 1.39–2.39), being in the poorer wealth quintile (AOR = 1.58; 95% CI: 1.21–2.06), being in the middle wealth quintile (AOR = 1.61; 95% CI: 1.24–2.10), being in the richer wealth quintile (AOR = 1.54; 95% CI: 1.19–2.00), increased total number of children born before the index child (AOR = 1.07; 95% CI: 1.03–1.10) and death of the preceding child (AOR = 1.97; 95% CI: 1.59–2.45) were associated with increased odds of short birth interval. At the community-level, living in a pastoralist region (AOR = 2.01; 95% CI: 1.68–2.39), being a city dweller (AOR = 1.75; 95% CI: 1.38–2.22), high community-level female illiteracy (AOR = 1.23; 95% CI: 1.05–1.45) and increased distance to health facilities (AOR = 1.32; 95% CI: 1.11–1.56) were associated with higher odds of experiencing short birth interval. Random effects showed significant variation in short birth interval between communities.

Conclusion

Determinants of short birth interval are varied and complex. Multifaceted intervention approaches supported by policy initiatives are required to prevent short birth interval.

Factors associated with low birth weight in Afghanistan: a cross-sectional analysis of the demographic and health survey 2015

OBJECTIVES

This study aimed to investigate the factors associated with low birth weight (LBW) in Afghanistan.

DESIGN

Cross-sectional study.

SETTING

This study used data collected from the Afghanistan Demographic and Health Survey 2015.

PARTICIPANTS

Facility-based data from 2773 weighted live-born children enrolled by a two-stage sampling strategy were included in our analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was LBW, defined as birth weight <2.5kg.

RESULTS

Out of 2773 newborns, 15.5% (n=431) had LBW. Most of these newborns were females (58.3%, n=251), had a mother with no formal schooling (70.5%, n=304), lived in urban areas (63.4%, n=274) or lived in the Central region of Afghanistan (59.7%, n=257). In multivariable analysis, residence in Central (adjusted OR (AOR): 3.4; 95% CI 1.7 to 6.7), Central Western (AOR: 3.0; 95% CI 1.5 to 5.8) and Southern Western (AOR: 4.0; 95% CI 1.7 to 9.1) regions had positive association with LBW. On the other hand, male children (AOR: 0.5; 95% CI 0.4 to 0.8), newborns with primary maternal education (AOR: 0.5; 95% CI 0.3 to 0.8), birth interval ≥48 months (AOR: 0.4; 95% CI 0.1 to 0.8), belonging to the richest wealth quintile (AOR: 0.2; 95% CI 0.1 to 0.6) and rural residence (AOR: 0.3; 95% CI 0.2 to 0.6) had decreased odds of LBW.

CONCLUSIONS

Multiple factors had association with LBW in Afghanistan. Maternal, Neonatal and Child Health programmes should focus on enhancing maternal education and promoting birth spacing to prevent LBW. To reduce the overall burden of LBW, women of the poorest wealth quintiles, and residents of Central, Central Western and South Western regions should also be prioritised. Further exploration is needed to understand why urban areas are associated with higher likelihood of LBW. In addition, research using nationally representative samples are required.

Developing evidence-based recommendations for optimal interpregnancy intervals in high-income countries: protocol for an international cohort study

INTRODUCTION

Short interpregnancy interval (IPI) has been linked to adverse pregnancy outcomes. WHO recommends waiting at least 2 years after a live birth and 6 months after miscarriage or induced termination before conception of another pregnancy. The evidence underpinning these recommendations largely relies on data from low/middle-income countries. Furthermore, recent epidemiological investigations have suggested that these studies may overestimate the effects of IPI due to residual confounding. Future investigations of IPI effects in high-income countries drawing from large, population-based data sources are needed to inform IPI recommendations. We aim to assess the impact of IPIs on maternal and child health outcomes in high-income countries.

METHODS AND ANALYSIS

This international longitudinal retrospective cohort study will include more than 18 million pregnancies, making it the largest study to investigate IPI in high-income countries. Population-based data from Australia, Finland, Norway and USA will be used. Birth records in each country will be used to identify consecutive pregnancies. Exact dates of birth and clinical best estimates of gestational length will be used to estimate IPI. Administrative birth and health data sources with >99% coverage in each country will be used to identify maternal sociodemographics, pregnancy complications, details of labour and delivery, birth and child health information. We will use matched and unmatched regression models to investigate the impact of IPI on maternal and infant outcomes, and conduct meta-analysis to pool results across countries.

ETHICS AND DISSEMINATION

Ethics boards at participating sites approved this research (approval was not required in Finland). Findings will be published in peer-reviewed journals and presented at international conferences, and will inform recommendations for optimal IPI in high-income countries. Findings will provide important information for women and families planning future pregnancies and for clinicians providing prenatal care and giving guidance on family planning.

Low birth weight and its associated factors in Ethiopia: a systematic review and meta-analysis

Background

Different primary studies in Ethiopia showed the burden of low birth weight. However, variation among those studies was seen. This study was aimed to estimate the national prevalence and associated factors of low birth weight in Ethiopia.

Methods

PubMed, Web of Science, Cochrane library, and Google Scholar were searched. A funnel plot and Egger’s regression test were used to see publication bias. I-squared statistic was applied to check heterogeneity of studies. A weighted inverse variance random-effects model was applied to estimate the national prevalence and the effect size of associated factors. The subgroup analysis was conducted by region, study design, and year of publication.

Result

A total of 30 studies with 55,085 participants were used for prevalence estimation. The pooled prevalence of LBW was 17.3% (95% CI: 14.1–20.4). Maternal age < 20 years (AOR = 1.7; 95% CI:1.5–2.0), pregnancy interval < 24 months (AOR = 2.8; 95%CI: 1.4–4.2), BMI < 18.5 kg/m² (AOR = 5.6; 95% CI: 1.7–9.4), and gestational age < 37 weeks at birth (AOR = 6.4; 95% CI: 2.5–10.3) were identified factors of LBW.

Conclusions

The prevalence of low birth weight in Ethiopia remains high. This review may help policy-makers and program officers to design low birth weight preventive interventions.

Effect of Interpregnancy Interval on Adverse Perinatal Outcomes in Southern China: A Retrospective Cohort Study, 2000-2015

BACKGROUND

In January 2016, a universal two-child policy was introduced in China. The association of interpregnancy interval (IPI) with perinatal outcomes has not previously been assessed among Chinese population. We investigated the effect of IPI after live birth on the risks of preterm delivery, and small, and large for gestational age births in China.

METHODS

We conducted a cohort study among 227 352 Chinese women with their first and second delivery during 2000 to 2015. IPI was calculated as months from first live delivery to conception of the second pregnancy. Poisson regression models with robust variance were fit to evaluate associations of IPI with risk of adverse perinatal outcomes, adjusted for potential confounders.

RESULTS

Compared to IPI of 24- <30 months, IPI <18 months was associated with higher risks of preterm birth (PTB) and small for gestational age (SGA). For IPI <6 months, the adjusted relative risks (RR) for PTB and SGA were 2.04 (95% confidence interval [CI] 1.83, 2.27) and 1.43 (95% CI 1.31, 1.57), respectively. Women with IPI ≥60 months had higher risks of PTB and large for gestational age (LGA). For IPI ≥120 months, the adjusted RRs for PTB and LGA were 1.67 (95% CI 1.43, 1.94) and 1.10 (95% CI 0.97, 1.26).

CONCLUSIONS

Women with IPI <18 months after live birth had higher risk of PTB and SGA, and IPI ≥60 months was associated with higher risk of PTB and LGA. These findings may provide information to Chinese couples about the appropriate interpregnancy interval for a second pregnancy.

Interpregnancy interval, maternal age, and offspring's BMI and blood pressure at 7 years of age

Interpregnancy interval and maternal age are associated with birth outcomes. However, it is unknown regarding their long-term effects on child health. We aim to assess the associations between interpregnancy interval and offspring’s body mass index (BMI) and blood pressure (BP) at age of 7 years and to examine the role of maternal age in the associations. A secondary analysis was performed among 2604 mother-infant pairs in the prospective National Collaborative Perinatal Project, in which the children were followed up until 7 yrs of age. Interpregnancy interval was positively associated with offspring’s diastolic BP at 7 yrs (β = 0.053, 95% CI: 0.004–0.102) after adjusting for maternal and perinatal characteristics, feeding pattern, rapid weight gain in the first year of life, and current BMI z score and height z score. The inclusion of maternal age in the model did not change the effect size. Maternal age was independently associated with offspring’s BMI z score at 7 yrs (β = 0.014, 95% CI: 0.001–0.027). An interaction between interpregnancy interval and maternal age was present in the association with diastolic BP (P = 0.019), and the increasing maternal age aggravated the effects of long interpregnancy interval. Our finding suggests long interpregnancy interval is a risk factor for higher diastolic BP of the offspring. Increasing maternal age could amplify the impact. Our study challenges the current WHO recommendation for ideal interpregnancy interval, and we would suggest lowering the recommendation to <24 months and even shorter for women of advanced age.

Folic acid level and preterm birth among Sudanese women

BACKGROUND

Preterm birth (PTB) is the major health problem world-wide; there are few published studies on PTB and folic acid.

METHODS

The study was conducted to assess the serum level of folic acid in PTB. A case-control study was conducted at Saad Abualila maternity hospital (Khartoum, Sudan) during the period of March through December 2015. Women who delivered live singleton babies were dived in two groups; the cases were women who had PTB "delivery before completed 37weeks but after 24 weeks of pregnancy" and the controls were women who delivered at term (37-42 weeks). Medical and obstetrics history was gathered using questionnaire. Serum folic acid was measured.

RESULTS

One hundred and twelve (56 in arm of the study) women were enrolled to the study. There was no significant difference between the cases and the controls in their age, parity, hemoglobin, body mass index, education and occupation. The median (interquartile) level of folic acid was significantly lower in the cases (PTB) than the level in the controls, 4.8(2.8-8.2) vs. 9.5(8.6-12.0) ng/ml. In binary regression, folic acid level was associated with lower risk of PTB (OR=0.64; 95%=0.53-0.77, P < 0.001). There was a significant positive correlation between gestational age and folic acid level (r = 0.447, P<0.001).

CONCLUSION

Thus serum folic acid level was significantly lower in women with PTB. Folic acid level was associated with lower risk of PTB.

The effect of interpregnancy interval on obesity/overweight among women in the first trimester of pregnancy

OBJECTIVE

To determine the effect of interpregnancy interval (IPI) on obesity/overweight among pregnant Sudanese women in early pregnancy.

METHODS

A cross-sectional study was conducted at Saad Abu-Alela Hospital, Khartoum, Sudan, from January to December 2015. Women with a singleton pregnancy and at least one previous pregnancy were enrolled in the first trimester. A questionnaire was used to collect clinical and sociodemographic data from the participants, and current body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters.

RESULTS

Among 1045 participants, 344 (32.9%), 424 (40.6%), and 277 (26.5%) women had short (<18 months), normal (18-30 months), and long IPIs (>30 months), respectively. BMI indicated 18 (1.7%), 408 (39.0%), 381 (36.5%), and 238 (22.8%) women were underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0), respectively. Age and proportion using contraceptives were increased among women with long IPI (both P<0.001). When compared with women of normal weight, overweight women and obese women were more likely to have a long IPI (odds ratio 1.72, 95% confidence interval 1.08-2.93; and 1.71, 1.05-2.94, respectively).

CONCLUSION

Long IPI was associated with obesity and overweight, which were prevalent among pregnant Sudanese women.

Effect of interpregnancy interval on adverse pregnancy outcomes in northern Tanzania: a registry-based retrospective cohort study

Background

Both short and long interpregnancy intervals have been associated with an increased risk of adverse pregnancy outcomes. There is limited information about the impact of interpregnancy interval on pregnancy (IPI) outcomes in Tanzania. The objective of this study was to assess the effect of IPI on adverse pregnancy outcomes.

Methods

We performed a retrospective cohort study using maternally-linked data from Kilimanjaro Christian Medical Centre (KCMC) birth registry. A total of 17,030 singlet births from women who delivered singleton infant at KCMC from 2000 to 2010 were studied. Women with multi-fetal gestations and those who were referred from rural areas for various medical reasons were excluded. Outcome variables were preterm birth, low birth weight infants and perinatal death. A multiple logistic regression was used to assess the association between IPI and pregnancy outcomes.

Results

The median IPI was 36 months. Compared with IPIs of 24–36 months (referent group), short interpregnancy intervals (<24 months) was associated with preterm delivery (OR 1 · 52; 95 % CI 1.31–1.74); low birth weight (OR 1 · 61; 95 % CI 1 · 34–1.72) and perinatal death, (OR 1 · 63; 95 % CI 1.22–1.91). The IPI of 37–59 months or longer were also associated with higher risks of preterm birth and low birth weight, but not with perinatal death.

Conclusions

Our study confirmed that both short and long IPI are independent risk factors for adverse pregnancy outcomes. These finding emphasize the importance of providing support for family planning programs which will support optimal IPI and improve pregnancy outcomes.

Maternal Risk Exposure and Adult Daughters' Health, Schooling, and Employment: A Constructed Cohort Analysis of 50 Developing Countries

This study analyzes the relationships between maternal risk factors present at the time of daughters' births-namely, young mother, high parity, and short preceding birth interval-and their subsequent adult developmental, reproductive, and socioeconomic outcomes. Pseudo-cohorts are constructed using female respondent data from 189 cross-sectional rounds of Demographic and Health Surveys conducted in 50 developing countries between 1986 and 2013. Generalized linear models are estimated to test the relationships and calculate cohort-level outcome proportions with the systematic elimination of the three maternal risk factors. The simulation exercise for the full sample of 2,546 pseudo-cohorts shows that the combined elimination of risk exposures is associated with lower mean proportions of adult daughters experiencing child mortality, having a small infant at birth, and having a low body mass index. Among sub-Saharan African cohorts, the estimated changes are larger, particularly for years of schooling. The pseudo-cohort approach can enable longitudinal testing of life course hypotheses using large-scale, standardized, repeated cross-sectional data and with considerable resource efficiency.

Birthweight Related Factors in Northwestern Iran: Using Quantile Regression Method

INTRODUCTION

Birthweight is one of the most important predicting indicators of the health status in adulthood. Having a balanced birthweight is one of the priorities of the health system in most of the industrial and developed countries. This indicator is used to assess the growth and health status of the infants. The aim of this study was to assess the birthweight of the neonates by using quantile regression in Zanjan province.

METHODS

This analytical descriptive study was carried out using pre-registered (March 2010 - March 2012) data of neonates in urban/rural health centers of Zanjan province using multiple-stage cluster sampling. Data were analyzed using multiple linear regressions andquantile regression method and SAS 9.2 statistical software.

RESULTS

From 8456 newborn baby, 4146 (49%) were female. The mean age of the mothers was 27.1±5.4 years. The mean birthweight of the neonates was 3104 ± 431 grams. Five hundred and seventy-three patients (6.8%) of the neonates were less than 2500 grams. In all quantiles, gestational age of neonates (p<0.05), weight and educational level of the mothers (p<0.05) showed a linear significant relationship with the i of the neonates. However, sex and birth rank of the neonates, mothers age, place of residence (urban/rural) and career were not significant in all quantiles (p>0.05).

CONCLUSION

This study revealed the results of multiple linear regression and quantile regression were not identical. We strictly recommend the use of quantile regression when an asymmetric response variable or data with outliers is available.

The impact of the interpregnancy interval on birth weight and other pregnancy outcomes

OBJECTIVES: to investigate the relationship between the interpregnancy interval and low birth weight and other pregnancy outcomes. METHODS: this case-control study was carried out in hospitals from January 2010 to April 2011. For cases, mothers of 1216 newborns with birth weight<2500 g were approached and 854 mothers participated (70.2%). For controls, mothers of 1158 newborns with >2500 g were approached and 854 mothers participated in this study (73.7%). Face-to-face interviews were conducted to complete the questionnaires. RESULTS: of the newborn babies with low birth weight, the risk was higher among mothers with a short interpregnancy interval (40.3%), whereas for infants with normal birth weight, the majority of the mothers had a longer interpregnancy interval of 24 months (44.7%). A short interpregnancy interval of 612 months was more common among women of <25years (49.4%; p<0.001) and those who were illiterate (13.1%; p=0.043) with a higher risk of low birth weight compared to the controls. Prenatal care during the 1st trimester was lower in women with low birth weight children (p<0.001). Normal delivery was observed less in women with a short birth interval among cases (58.7%) compared to controls (79%) (p=0.001). A J-shaped association was observed between low birth weight and the interpregnancy interval. CONCLUSIONS: a short interpregnancy interval is associated with an increased risk of low birth weight, especially in younger and illiterate women.

Contraception and health

Increasing contraceptive use in developing countries has cut the number of maternal deaths by 40% over the past 20 years, merely by reducing the number of unintended pregnancies. By preventing high-risk pregnancies, especially in women of high parities, and those that would have ended in unsafe abortion, increased contraceptive use has reduced the maternal mortality ratio--the risk of maternal death per 100,000 livebirths--by about 26% in little more than a decade. A further 30% of maternal deaths could be avoided by fulfilment of unmet need for contraception. The benefits of modern contraceptives to women's health, including non-contraceptive benefits of specific methods, outweigh the risks. Contraception can also improve perinatal outcomes and child survival, mainly by lengthening interpregnancy intervals. In developing countries, the risk of prematurity and low birthweight doubles when conception occurs within 6 months of a previous birth, and children born within 2 years of an elder sibling are 60% more likely to die in infancy than are those born more than 2 years after their sibling.

Racial disparities in preterm birth rates and short inter-pregnancy interval: an overview

OBJECTIVE

We seek to expand on a biopsychosocial framework underlying the etiology of excess preterm birth experienced by African-American women by exploring short inter-pregnancy intervals as a partial explanatory factor.

DESIGN

We conducted a qualitative analyses of published studies that met specified criteria for assessing the association of inter-pregnancy interval and preterm birth.

METHODS

We determine whether inter-pregnancy interval is associated with preterm birth, what the underlying causal mechanism may be, whether African-American women are more likely than Caucasian women to have short intervals, and whether achieving an optimal interval will result in reduced African-American-Caucasian gap in preterm births.

MAIN OUTCOME MEASURES

Crude and adjusted odds ratios for preterm birth, with the referent group being the interval closest to the 'ideal' of 18-23 months and the exposed group having intervals <12 months or some subset of that inter-pregnancy interval. Results. Inter-pregnancy interval less than six months increases preterm birth by about 40%. The mechanism may be through failure to replenish maternal nutritional stores. While there may not be an interaction between race and short inter-pregnancy interval, short intervals can explain about 4% of the African-American-Caucasian gap in preterm birth because African-American women are approximately 1.8 times as likely to have inter-pregnancy intervals of less than six months. Limited studies indicate that optimal intervals can be achieved through appropriate counseling and health care.

CONCLUSIONS

Excess risk for preterm birth may be reduced by up to 8% among African-Americans and up to 4% among Caucasians through increasing inter-pregnancy intervals to the optimal length of 18-23 months.