Maternal and Child Health Journal

, Volume 7, Issue 3, pp 169–178 | Cite as

Effect of Interpregnancy Interval on Infant Low Birth Weight: A Retrospective Cohort Study Using the Michigan Maternally Linked Birth Database

Article

Abstract

Objective: To examine the relationship between interpregnancy interval and low birth weight (LBW), using the retrospective cohort design. Methods: We used the maternally linked Michigan livebirth data documented between 1989 and 2000 to evaluate LBW in relation to interpregnancy (i.e., delivery-to-conception) interval, overall and at levels of other reproductive risk factors. We fit separate logistic regression models for pairs of first-second, second-third, third-fourth, and fourth-fifth births to control for confounding. Results: Of the 565,911 infants identified, 5.5% had LBW. Univariate and stratified analyses showed that the risk for LBW was lowest when the interpregnancy interval was 18–23 months, and increased with shorter or longer intervals. This J-shaped relationship persisted after controlling for all risk factors simultaneously. For example, among the first-second birth pairs, the adjusted odds ratios (AORs) for LBW associated with interpregnancy intervals <6, 24–59, 60–95, and 96–136 months were 1.4 (95% confidence interval [CI] = 1.3–1.5), 1.5 (95% CI = 1.3–1.6), 1.1 (95% CI = 1.0–1.1) and 1.5 (95% CI = 1.3–1.8), respectively, compared with an interval of 18–23 months. Among the second-third birth pairs, the AORs were 1.5 (95% CI = 1.3–1.6), 1.3 (95% CI = 1.2–1.4), 1.1 (95% CI = 1.0–1.1), and 1.6 (95% CI = 1.3–2.0), respectively. Among the third-fourth birth pairs, the AORs were 1.2 (95% CI = 1.1–1.4), 1.3 (95% CI = 1.1–1.5), 1.0 (95% CI = 0.9–1.1), and 1.4 (95% CI = 1.0–2.0), respectively. Among the fourth-fifth birth pairs, the AORs were 1.3 (95% CI = 1.1–1.6), 1.2 (95% CI = 0.9–1.5), 1.1 (95% CI = 1.0–1.4), and 1.3 (95% CI = 0.8–2.3), respectively. The population attributable risk associated with interpregnancy intervals shorter than 18 months or longer than 23 months was 9.4%. Conclusion: These data suggest that spacing pregnancies appropriately could be used as a strategy for preventing LBW.

low birth weight birth interval pregnancy spacing cohort study 

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References

  1. 1.
    Woodbury RM, U.S. Department of Labor, Children's Bureau. Causal factors in infant mortality. A statistical study based on investigations in eight cities. Bureau Publication, No. 142. Washington, DC: Government Printing Office, 1925.Google Scholar
  2. 2.
    Eastman NJ. The effect of interval between births on maternal and fetal outlook. Am J Obstet Gynecol 1944;47:445-66.Google Scholar
  3. 3.
    Fedrick J, Adelstein P. Influence of pregnancy spacing on outcome of pregnancy. Br Med J 1973;4(5895):753-6.Google Scholar
  4. 4.
    Erickson JD, Bjerkedal T. Interpregnancy interval. Association with birth weight, still birth, and neonatal death. J Epidemiol Community Health 1978;32:124-30.Google Scholar
  5. 5.
    Winikoff B. The effects of birth spacing on child and maternal health. Stud Fam Plann 1983;14:231-45.Google Scholar
  6. 6.
    Brody DJ, Bracken MB. Short interpregnancy interval: A risk factor for low birthweight. Am J Perinatol 1987;4:50-4.Google Scholar
  7. 7.
    Lieberman E, Lang JM, Ryan KJ, Monson RR, Schoenbaum SC. The association of interpregnancy interval with small for gestational age births. Obstet Gynecol 1989;74:1-5.Google Scholar
  8. 8.
    Lang JM, Lieberman E, Ryan KJ, Monson RR. Interpregnancy interval and risk of preterm labor. Am J Epidemiol 1990;132:304-9.Google Scholar
  9. 9.
    Rawlings JS, Rawlings VB, Read JA. Prevalence of low birth weight and preterm delivery in relation to the interval between pregnancies among white and black women. N Engl J Med 1995;332:69-74.Google Scholar
  10. 10.
    Adams MM, Delaney KM, Stupp PW, McCarthy BJ, Rawlings JS. The relationship of interpregnancy interval to infant birthweight and length of gestation among low-risk women, Georgia. Paediatr Perinat Epidemiol 1997;11(Suppl 1):48-62.Google Scholar
  11. 11.
    Khoshnood B, Lee K-S, Wall S, Hsieh H-L, Mittendorf R. Short interpregnancy intervals and the risk for adverse birth outcomes among five racial/ethnic groups in the United States. Am J Epidemiol 1998;148:798-805.Google Scholar
  12. 12.
    Shults RA, Arndt V, Olshan AF, Martin CF, Royce RA. Effects of short interpregnancy interval on small-for-gestational age and preterm births. Epidemiology 1999;10:250-4.Google Scholar
  13. 13.
    James AT, Bracken MB, Cohen AP, Saftlas A, Lieberman E. Interpregnancy interval and disparity in term small for gestational age births between black and white women. Obstet Gynecol 1999;93:109-12.Google Scholar
  14. 14.
    Zhu BP, Rolfs RT, Nangle BE, Horan JM. Effect of the interval between pregnancies on perinatal outcomes. N Engl J Med 1999;340:589-94.Google Scholar
  15. 15.
    Zhu BP, Haines KM, Le T, McGrath-Miller K, Boulton M. Effect of the interval between pregnancies on perinatal outcomes among white and black women. Am J Obstet Gynecol 2001;185:1403-10.Google Scholar
  16. 16.
    Golding J. The epidemiology of perinatal death. In: Kiely M, editor. Reproductive and perinatal epidemiology. Boca Raton, FL: CRC Press, 1991;406-8.Google Scholar
  17. 17.
    Ventura SJ, Martin JA, Curtin SC, Mathews TJ. Report of final natality statistics, 1995. Mon Vital Stat Rep 1997;45(11):1-84.Google Scholar
  18. 18.
    Nelson WE, Behrman RE, Kliegman RM, Arvin AM. Nelson Textbook of Pediatrics, 15th edn. Philadelphia: W.B. Saunders, 1996:454-62.Google Scholar
  19. 19.
    Kramer MS. Determinants of low birth weight: Methodological assessment and meta-analysis. Bull World Health Organ 1987;65:663-737.Google Scholar
  20. 20.
    Bakketeig LS, Hoffman HJ, Titmuss Oakley AR. Perinatal mortality. In: Bracken MB, editor. Perinatal epidemiology. New York: Oxford University Press, 1984:99-151.Google Scholar
  21. 21.
    Institute of Medicine. Preventing low birth weight. Washington, DC: National Academy Press, 1985.Google Scholar
  22. 22.
    Weinberg CR, Wilcox AJ. Reproductive epidemiology. In: Rothman KJ, Greenland S, editors. Modern epidemiology, 2nd edn. Philadelphia: Lippincott-Raven Publishers, 1998.Google Scholar
  23. 23.
    Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 1994;84:1414-20.Google Scholar
  24. 24.
    Gaudino JA Jr, Jenkins B, Rochat RW. No fathers' names: A risk factor for infant mortality in the State of Georgia, USA. Soc Sci Med 1999;48:253-65.Google Scholar
  25. 25.
    Hosmer DW Jr, Lemeshow S. Applied logistic regression, 2nd edn. New York: Wiley, 2000.Google Scholar
  26. 26.
    Last JM. A dictionary of epidemiology, 3rd edn. New York: Oxford University Press, 1995.Google Scholar
  27. 27.
    SAS/STAT User's Guide (Version 6), 4th edn. Cary, NC: SAS Institute, Inc., 1990.Google Scholar
  28. 28.
    Watier L, Richardson S. Accounting for pregnancy dependence in epidemiologic studies of reproductive outcomes. Epidemiology 1997;8:629-36.Google Scholar
  29. 29.
    Diggle PJ, Liang K-Y, Zeger SL. Analysis of longitudinal data. Oxford: Oxford University Press, 1994.Google Scholar
  30. 30.
    Alexander GR, Tompkins ME, Petersen DJ, Hulsey TC, Mor. J. Discordance between LMP-based and clinically estimated gestational age: Implications for research, programs, and policy. Public Health Rep 1995;110:395-402.Google Scholar
  31. 31.
    Miller JE. Birth intervals and perinatal health: An investigation of three hypotheses. Fam Plann Perspect 1991;23:62-70.Google Scholar
  32. 32.
    Winkvist A, Rasmussen KM, Habicht J-P. A new definition of maternal depletion syndrome. Am J Public Health 1992;82:691-4.Google Scholar
  33. 33.
    Smits LJ, Essed GG. Short interpregnancy intervals and unfavourable pregnancy outcome: Role of folate depletion. Lancet 2001;358:2074-7.Google Scholar
  34. 34.
    Jongbloet PH. Prepregnancy care: Background biological effects. In: Chamberlain G, Lumey J, editor. Prepregnancy care: A manual for practice. New York: Wiley, 1986.Google Scholar
  35. 35.
    Henriksen TB, Baird DD, Olsen J, Hedegaard M, Secher NJ, Wilcox AJ. Time to pregnancy and preterm delivery. Obstet Gynecol 1997;89:594-9.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  1. 1.Applied Sciences Branch, Division of Reproductive HealthNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlanta
  2. 2.Michigan Department of Community HealthDivision of Epidemiology ServicesLansing

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