The impact of birth spacing on subsequent feto-infant outcomes among community enrollees of a federal healthy start project.

Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA.
Journal of Community Health (Impact Factor: 1.28). 06/2011; 37(1):137-42. DOI: 10.1007/s10900-011-9427-x
Source: PubMed

ABSTRACT Numerous studies have shown an association between shorter birth intervals, and several adverse fetal outcomes, including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). However, there is little evidence on the effectiveness of interconception care on fetal outcomes associated with sub-optimal interpregnancy interval (IPI). The purpose of this study is to examine the influence of the Federal Healthy Start's interconception care services on IPI and fetal growth outcomes. This is a retrospective cohort study used records from the Central Hillsborough Healthy Start program in Tampa, Florida linked to Florida vital statistics data covering the period 2002-2009. Only first and second pregnancies were considered, and interpregnancy interval (IPI), the exposure of interest, was categorized in months as 0-5, 6-17, 18-23, and ≥24. The following feto-infant morbidities were considered as primary outcomes: LBW, PTB, and SGA. A composite variable coding the presence of any of the aforementioned adverse fetal events was also created. Multivariate logistic regression modeling was applied Overall, mothers with the shortest IPI (0-5 months: AOR = 1.39, 95% CI 1.23-1.56) and longest IPI (≥60 months: AOR = 1.13, 95% CI 1.03-1.23) were at a greater risk for adverse fetal growth outcomes, compared to the referent category (18-23 months). Our findings support the need for inter conception care that addresses IPI and delayed childbearing among women.

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    ABSTRACT: The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small-for-gestational age. Previous research has shown that the Central Hillsborough Healthy Start project (CHHS)-a federally funded initiative in Tampa, Florida-has improved birth outcomes. This study explores the effectiveness of the CHHS project in ameliorating the adverse effects of fathers' absence during pregnancy. This retrospective cohort study used CHHS records linked to vital statistics and hospital discharge data (1998-2007). The study population consisted of women who had a singleton birth with an absent father during pregnancy. Women were categorized based on residence in the CHHS service area. Propensity score matching was used to match cases (CHHS) to controls (rest of Florida). Conditional logistic regression was employed to generate odds ratios (OR) and 95 % confidence intervals (CI) for matched observations. Women residing in the CHHS service area were more likely to be high school graduates, black, younger (<35 years), and to have adequate prenatal care compared to controls (p < 0.01). These differences disappeared after propensity score matching. Mothers with absent fathers in the CHHS service area had a reduced likelihood of LBW (OR 0.76, 95 % CI 0.65-0.89), PTB (OR 0.72, 95 % CI 0.62-0.84), very low birth weight (OR 0.50, 95 % CI 0.35-0.72) and very preterm birth (OR 0.48, 95 % CI 0.34-0.69) compared to their counterparts in the rest of the state. This study demonstrates that a Federal Healthy Start project contributed to a significant reduction in adverse fetal birth outcomes in families with absent fathers.
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    ABSTRACT: To assess the influence of birth spacing on neonatal morbidity, stratified by gestational age at birth.Study DesignPopulation-based retrospective cohort study using Ohio birth records, 2006-2011. We compared various interpregnancy interval (IPI) lengths in multiparous mothers with the rate and risk of adverse newborn outcomes. The frequency of neonatal intensive care unit (NICU) admission or neonatal transport to a tertiary care facility was calculated for births occurring after IPI lengths: <6, 6 to <12, 12 to <24, 24 to <60 and ≥60 months, and stratified by week of gestational age. Neonatal morbidity risk was calculated for each IPI compared to 12 to <24 months (referent), and adjusted for the concomitant influences gestational age at birth, maternal race, age and prior preterm birth.ResultsWe analyzed 395,146 birth outcomes of singleton non-anomalous neonates born to multiparous mothers. The frequency and adjusted odds of neonatal morbidity were lowest following IPI of 12 to <24 months (4.1%) compared to short IPIs of <6 months (5.7%, adjOR 1.40, 95% CI 1.32,1.49), 6 to <12 months (4.7%, adjOR 1.19, CI 1.13-1.25), and long IPIs 24 to <60 months (4.6%, adjOR 1.12, CI 1.08-1.17) and ≥60 months (5.8%, adjOR 1.34, CI 1.28-1.40), despite adjustment for important confounding factors including gestational age at birth. The lowest frequency of adverse neonatal outcomes occurred at 40-41 weeks for all IPI groups.The frequency of other individual immediate newborn morbidities were also increased following short and long IPIs compared to birth following a 12 to <24 month IPI.Conclusions Interpregnancy interval length is a significant contributor to neonatal morbidity, independent of gestational age at birth. Counseling women to plan an optimal amount of time between pregnancies is important for newborn health.
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