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  • Title: Interpregnancy interval and subsequent perinatal outcomes among women delaying initiation of childbearing.
    Author: Nabukera SK, Wingate MS, Kirby RS, Owen J, Swaminathan S, Alexander GR, Salihu HM.
    Journal: J Obstet Gynaecol Res; 2008 Dec; 34(6):941-7. PubMed ID: 19012690.
    Abstract:
    AIM: While delayed initiation of childbearing is associated with adverse perinatal outcomes, whether or not risk persists and whether interpregnancy interval (IPI) affects the subsequent pregnancy remains unclear. OBJECTIVES: To examine second-pregnancy perinatal outcomes for women initiating childbearing age > or = 30 compared to those initiating childbearing aged 20-29, specifically examining the distribution of adverse perinatal outcomes, and their associations with the interpregnancy interval. METHODS: Retrospective cohort study using the Missouri maternally linked files 1978-1997. Perinatal outcomes included fetal death, low birthweight, preterm birth and small-for-gestational age. Predictor variables included maternal age at first pregnancy and IPI between the first and second pregnancy. RESULTS: With an increasing maternal age at first pregnancy, rates of very low birthweight (P = 0.0095), preterm delivery (P = 0.0126), moderately preterm (P = 0.0458), and extremely preterm (P = 0.0008) in the second pregnancy increased, while the rate of small-for-gestational age (P < 0.0001) declined. Interpregnancy intervals <6 and > or = 60 months were associated with a higher rate of adverse outcomes after controlling for maternal age at first pregnancy. Intervals of 12-17 months had the lowest rate of adverse outcomes for mothers 35+. Maternal age > or = 35 years at first pregnancy and IPI <6 months were independent risk factors for an adverse outcome in the second pregnancy, however no statistical interaction between these factors was observed. CONCLUSION: Delayed initiation of childbearing is associated with a persistent risk of adverse perinatal outcomes in the second pregnancy, with a short IPI contributing to this risk. As numbers of women delaying childbearing beyond age 30 increase, providers should consider these risks in counseling women about their reproductive plans.
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