Tedde João Guilherme G, Cerqueira-Silva Thiago, Lagrosa Garcia Sidney A, Amira Brenda V, Rodrigues Laura C, Barreto Mauricio L, Rocha Aline S, de Cássia Ribeiro-Silva Rita, Falcão Ila R, Paixao Enny S
School of Medicine, Federal University of Grande Dourados, Brazil.
Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.
Lancet Reg Health Am. 2024 Feb 1;30:100687. doi: 10.1016/j.lana.2024.100687. eCollection 2024 Feb.
Earlier studies have proposed a link between the Interpregnancy Interval (IPI) and unfavorable birth outcomes. However, it remains unclear if the outcomes of previous births could affect this relationship. We aimed to investigate whether the occurrence of adverse outcomes-small for gestational age (SGA), preterm birth (PTB), and low birth weight (LBW)-at the immediately preceding pregnancy could alter the association between IPI and the same outcomes at the subsequent pregnancy.
We used a population-based linked cohort from Brazil (2001-2015). IPI was measured as the difference, in months, between the preceding birth and subsequent conception. Outcomes included SGA (<10th birthweight percentile for gestational age and sex), LBW (<2500 g), and PTB (gestational age <37 weeks). We calculated risk ratios (RRs), using the IPI of 18-22 months as the reference IPI category, we also stratified by the number of adverse birth outcomes at the preceding pregnancy.
Among 4,788,279 births from 3,804,152 mothers, absolute risks for subsequent SGA, PTB, and LBW were higher for women with more adverse outcomes in the preceding delivery. The RR of SGA and LBW for IPIs <6 months were greater for women without previous adverse outcomes (SGA: 1.44 [95% Confidence Interval (CI): 1.41-1.46]; LBW: 1.49 [1.45-1.52]) compared to those with three previous adverse outcomes (SGA: 1.20 [1.10-1.29]; LBW: 1.24 [1.15-1.33]). IPIs ≥120 months were associated with greater increases in risk for LBW and PTB among women without previous birth outcomes (LBW: 1.59; [1.53-1.65]; PTB: 2.45 [2.39-2.52]) compared to women with three adverse outcomes at the index birth (LBW: 0.92 [0.78-1.06]; PTB: 1.66 [1.44-1.88]).
Our study suggests that women with prior adverse outcomes may have higher risks for adverse birth outcomes in subsequent pregnancies. However, risk changes due to differences in IPI length seem to have a lesser impact compared to women without a prior event. Considering maternal obstetric history is essential in birth spacing counseling.
Wellcome Trust225925/Z/22/Z.
早期研究提出了妊娠间隔（IPI）与不良分娩结局之间的联系。然而，先前分娩的结局是否会影响这种关系仍不清楚。我们旨在调查在前次妊娠时出现不良结局——小于胎龄儿（SGA）、早产（PTB）和低出生体重（LBW）——是否会改变IPI与随后妊娠时相同结局之间的关联。
我们使用了来自巴西的基于人群的关联队列（2001 - 2015年）。IPI以先前分娩与随后受孕之间的月数差异来衡量。结局包括SGA（胎龄和性别的出生体重低于第10百分位数）、LBW（<2500克）和PTB（胎龄<37周）。我们计算风险比（RRs），将18 - 22个月的IPI作为参考IPI类别，我们还按前次妊娠时不良分娩结局的数量进行分层。
在来自3,804,152名母亲的4,788,279例分娩中，前次分娩不良结局越多的女性，随后发生SGA、PTB和LBW的绝对风险越高。与有三次先前不良结局的女性相比，前次无不良结局的女性，IPI<6个月时SGA和LBW的RR更高（SGA：1.44 [95%置信区间（CI）：1.41 - 1.46]；LBW：1.49 [1.45 - 1.52]）（SGA：1.20 [1.10 - 1.29]；LBW：1.24 [1.15 - 1.33]）。与索引分娩时有三次不良结局的女性相比，前次无分娩不良结局的女性中，IPI≥120个月与LBW和PTB风险的更大增加相关（LBW：1.59；[1.53 - 1.65]；PTB：2.45 [2.39 - 2.52]）（LBW：0.92 [0.78 - 1.06]；PTB：1.66 [1.44 - 1.88]）。
我们的研究表明，有先前不良结局的女性在随后妊娠中出现不良分娩结局的风险可能更高。然而，与无前次事件的女性相比，由于IPI长度差异导致的风险变化影响较小。在生育间隔咨询中考虑母亲的产科病史至关重要。
惠康信托基金225925/Z/22/Z。
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