Ahrens Katherine A, Nelson Heidi, Stidd Reva L, Moskosky Susan, Hutcheon Jennifer A
Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Rockville, Maryland.
Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
Paediatr Perinat Epidemiol. 2019 Jan;33(1):O25-O47. doi: 10.1111/ppe.12503. Epub 2018 Oct 24.
This systematic review summarises association between short interpregnancy intervals and adverse perinatal health outcomes in high-resource settings to inform recommendations for healthy birth spacing for the United States.
Five databases and a previous systematic review were searched for relevant articles published between 1966 and 1 May 2017. We included studies meeting the following criteria: (a) reporting of perinatal health outcomes after a short interpregnancy interval since last livebirth; (b) conducted within a high-resource setting; and (c) estimates were adjusted for maternal age and at least one socio-economic factor.
Nine good-quality and 18 fair-quality studies were identified. Interpregnancy intervals <6 months were associated with a clinically and statistically significant increased risk of adverse outcomes in studies of preterm birth (eg, aOR ≥ 1.20 in 10 of 14 studies); spontaneous preterm birth (eg, aOR ≥ 1.20 in one of two studies); small-for-gestational age (eg, aOR ≥ 1.20 in 5 of 11 studies); and infant mortality (eg, aOR ≥ 1.20 in four of four studies), while four studies of perinatal death showed no association. Interpregnancy intervals of 6-11 and 12-17 months generally had smaller point estimates and confidence intervals that included the null. Most studies were population-based and few included adjustment for detailed measures of key confounders.
In high-resource settings, there is some evidence showing interpregnancy intervals <6 months since last livebirth are associated with increased risks for preterm birth, small-for-gestational age and infant death; however, results were inconsistent. Additional research controlling for confounding would further inform recommendations for healthy birth spacing for the United States.
本系统评价总结了高资源环境下短生育间隔与不良围产期健康结局之间的关联，以为美国健康生育间隔的建议提供依据。
检索了五个数据库及一篇既往系统评价，查找1966年至2017年5月1日期间发表的相关文章。我们纳入了符合以下标准的研究：(a) 报告自上次活产以来短生育间隔后的围产期健康结局；(b) 在高资源环境中进行；(c) 估计值针对产妇年龄和至少一个社会经济因素进行了调整。
确定了9项高质量和18项中等质量的研究。在早产研究中，生育间隔<6个月与不良结局的临床和统计学显著风险增加相关（例如，14项研究中有10项的调整后比值比≥1.20）；自发性早产（例如，两项研究中有一项的调整后比值比≥1.20）；小于胎龄儿（例如，11项研究中有5项的调整后比值比≥1.20）；以及婴儿死亡率（例如，四项研究中的四项调整后比值比≥1.20），而四项围产期死亡研究未显示出关联。6 - 11个月和12 - 17个月的生育间隔通常点估计值和置信区间较小，且包含无效值。大多数研究基于人群，很少有研究对关键混杂因素的详细测量进行调整。
在高资源环境中，有一些证据表明自上次活产以来生育间隔<6个月与早产、小于胎龄儿和婴儿死亡风险增加相关；然而，结果并不一致。进一步控制混杂因素的研究将为美国健康生育间隔的建议提供更多信息。
