The time
elapsed since last pregnancy may be one of the many factors that affects the
fate of the current pregnancy. The optimum interpregnancy interval (IPI)
following a delivery or miscarriage to avoid adverse pregnancy outcome has
always been debated. Both longer and shorter IPI have been associated with
adverse pregnancy outcome. IPI interval can be modified by women to improve the
pregnancy outcome. But, to determine the role played by IPI as a single
modifiable factor in pregnancy outcome is a difficult task because of multiple
confounding factors.
Usually a
shorter interpregnancy interval following a term delivery is believed to be
associated with an adverse outcome. Meta-analysis of Studies conducted in Latin
America have shown that IPI of 24 months is optimal and shorter (< 18
months) and longer (> 5 years) is associated with poor pregnancy outcome. [1]
[2]
But, studies documenting the optimal IPI after a miscarriage are few and
inconsistent. Spontaneous miscarriage is a common event affecting 1 in 20 pregnancies.
[3]
The WHO has
recommended avoiding pregnancy for 6 months after a miscarriage for a good
pregnancy outcome in next pregnancy. WHO recommendations also state that IPI of
less than 6 months is associated with elevated risks of premature rupturing of
membranes, anemia and bleeding, pre-term and very pre-term births, and low
birth weight, compared with longer intervals.[4]
A systemic
review and meta-analysis published online on November 17,2016 in Journal Human Reproduction Update aims to determine whether a shorter (< 6 months) IPI is
associated with poor reproductive outcome in next pregnancy.
Two
investigators independently worked on the project and selected 16 studies from
PubMed, Embase and Medline with no language or time restrictions. Studies
comprising women with at least one miscarriage comparing pregnancy outcome in
subsequent pregnancy with IPI less than 6 months and more than 6 months formed the
part of the analysis.
The meta-analysis
analyzed the risk of recurrent miscarriage, premature labor, stillbirth,
pre-eclampsia and low birthweight babies in the subsequent pregnancy following a
shorter or longer IPI.
A total of 977
972 women from 10 studies met the inclusion criteria. IPI of less than 6 months
is associated with 18% less risk of subsequent miscarriage, 11% less risk of
preterm birth when compared to IPI of more than 6 months. The risks of still
births, low birthweight and preeclampsia were independent of IPI.
Thissystemic review and meta-analysis clearly documented that IPI of less than 6
months following a miscarriage is not associated with adverse pregnancy outcome
of in the form of recurrent miscarriage and preterm delivery in subsequent
pregnancy. Outcomes such as still births, preeclampsia and low birth weight
babies in next pregnancies are independent of time elapsed since last mishap.
[1] Conde-Agudelo
A, Rosas-Bermúdez A, Kafury-Goeta AC. Effects of birth spacing on maternal
health: a systematic review. Am J Obstet Gynecol. 2007;196(4):297–308.
[2] Conde-Agudelo
A, Rosas-Bermúdez A, Kafury-Goeta AC. Birth spacing and risk of adverse
perinatal outcomes: A meta-analysis. JAMA. 2006;295(15):1809–23.
[3] http://whe.sagepub.com/content/7/2/139.full
[4] http://www.who.int/maternal_child_adolescent/documents/birth_spacing.pdf
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