Developing evidence-based recommendations for optimal interpregnancy intervals in high-income countries: Protocol for an international cohort study
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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.
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Association between interpregnancy interval and adverse birth outcomes in women with a previous stillbirth: an international cohort studyRegan, Annette ; Gissler, M.; Magnus, M.C.; Håberg, S.E.; Ball, Stephen ; Malacova, Eva ; Nassar, N.; Leonard, H.; Pereira, Gavin (2019)Background: WHO recommends that women wait at least 2 years after a livebirth and at least 6 months after a miscarriage or induced abortion before conceiving again, to reduce the risk of adverse birth outcomes in the ...
Effects of interpregnancy interval on pregnancy complications: protocol for systematic review and meta-analysisGebremedhin, Amanuel Tesfay; Regan, A.; Malacova, E.; Marinovich, M.; Ball, S.; Foo, D.; Pereira, Gavin (2018)Introduction: Interpregnancy interval (IPI) is the length of time between a birth and conception of the next pregnancy. Evidence suggests that both short and long IPIs are at increased risk of adverse pregnancy and perinatal ...
Interpregnancy intervals and adverse birth outcomes in high-income countries: An international cohort study.Tessema, Gizachew ; Marinovich, Luke ; Håberg, Siri E; Gissler, Mika; Mayo, Jonathan A; Nassar, Natasha; Ball, Stephen ; Betrán, Ana Pilar; Gebremedhin, Amanuel ; de Klerk, Nick; Magnus, Maria C; Marston, Cicely; Regan, Annette ; Shaw, Gary M; Padula, Amy M; Pereira, Gavin (2021)BACKGROUND: Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women ...