The Impact of Group Prenatal Care on Interpregnancy Interval

Objective To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months. Study Design We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education. Results Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47–0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62–0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77–1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20–1.57). Conclusion Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care. Key Points

Association between interpregnancy interval and pregnancy complications by history of complications: a population-based cohort study

ObjectiveTo examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications.Design and settingPopulation-based longitudinally linked cohort study in Western Australia (WA).ParticipantsMothers who had their first two (n=252 368) and three (n=96 315) consecutive singleton births in WA between 1980 and 2015.Outcome measuresWe estimated absolute risks (AR) of preeclampsia (PE) and gestational diabetes (GDM) for 3–60 months of IPI according to history of each outcome. We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 3, 6, 12, 24, 36, 48 and 60 months, with 18 months as reference.ResultsRisks of PE and GDM were 9.5%, 2.6% in first pregnancies, with recurrence rates of 19.3% and 41.5% in second pregnancy for PE and GDM, respectively. The AR of GDM ranged from 30% to 43% across the IPI range for mothers with previous GDM compared with 2%–8% for mothers without previous GDM. For mothers with no previous PE, greater risks were observed for IPIs at 3 months (RR 1.24, 95% CI 1.07 to 1.43) and 60 months (RR 1.40, 95% CI 1.29 to 1.53) compared with 18 months. There was insufficient evidence for increased risk of PE at shorter IPIs of <18 months for mothers with previous PE. Shorter IPIs of <18 months were associated with lower risk than at IPIs of 18 months for mothers with no previous GDM.ConclusionsThe associations between IPIs and risk of PE or GDM on subsequent pregnancies are modified by previous experience with these conditions. Mothers with previous complications had higher absolute, but lower RRs than mothers with no previous complications. However, IPI remains a potentially modifiable risk factor for mothers with previous complicated pregnancies.

Association Between Pre-Term Labour and Inter Pregnancy Interval

Objectives: To determine the frequency of preterm labour in association with interpregnancy interval among pregnant women visiting tertiary care Hospital. Subject and Methods: This prospective cross-sectional study was performed at Unit-I, Obstetrics and Gynaecology Department, Civil Hospital Karachi; from June to November 2020. A total of 190 women with singleton pregnancy confirmed by ultrasound were included. After taking detailed medical history regarding previous fetal death and C-section was recorded either patient goes into preterm labour or not and confirmed by history for short and prolong interpregnancy interval (IPI). Data was collected by pre-designed study proforma. Results: The average age of study subjects was 26.27±4.07 years. The frequency of preterm labour among the pregnant women was 51.05%. The rate of preterm was significantly higher in those women who had with short inter interpregnancy interval (p=0.0005). Conclusion: Our findings clearly show that a short interval in inter-pregnancy is a cause of premature birth. Preterm birth can also be indicated by the antenatal care visits, inter-pregnancy complications, and having a birth defect. Premature birth minimization can enhance overall newborn's health and can lead to considerable minimization of neonatal death in the future. Keywords: Preterm labor, prolong pregnancy interval, neonatal health

Short Interpregnancy Interval and Low Birth Weight

Objective: To determine the frequency of Low Birth Weight among women with short interpregnancy interval. Study Design: Descriptive case series. Study Setting: Study was conducted at Department of Gynecology and Obstetrics Unit 1, Civil Hospital, Karachi. Duration of Study: Six months after approval of synopsis from 22-12-15 till 22-06-16. Subjects and Methods: Data was prospectively collected from patients after taking a verbal consent. 384 women with short interval pregnancy were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification chi square test was applied taking p-value of ≤0.05 as significant. Results: Out of 384 patients mean age and BMI in our study was 29.56±3.91 years and 30.72±1.34 kg/m2 respectively. 135 (35.2%) and 249 (64.8%) had and did not have low birth weight respectively. Conclusion: Our study confirmed that short IPI is an independent risk factors for adverse pregnancy outcomes like low birth weight. These finding emphasize the importance of providing support for family planning programs which will support optimal IPI and improve pregnancy outcomes. Keywords: Short interpregnancy interval and low birth weight.