By C. Vidya Shankar, MD
Birth intervals of less than 18 months are associated with a high risk of stillbirth and infant deaths, according to the results of a study from India.
While the link between short birth intervals and infant deaths is well established, its link to stillbirths has not been clear, Dr. Emma Williams from the Johns Hopkins Bloomberg School of Public Health in Baltimore and colleagues point out in the advance access publication of the Journal of Tropical Pediatrics.
Williams and her team from Jabalpur and Lucknow in north India evaluated data collected as part of the government-sponsored Integrated Child Development Scheme in the province of Uttar Pradesh. The detailed pregnancy outcomes of 33 111 married women were recorded by trained health workers during their home visits during the period between 1992 and 2002. During the study period, a total of 80 164 births and 78 186 live births were reported.
After adjusting the data for potential and known risk factors, the incidence of stillbirth was significantly greater when birth intervals were less than 18 months; between 18 and 35 months; and greater than 60 months with odds ratios of 3.44, 1.52 and 1.44, respectively, the researchers report.
Additional risk factors were maternal age of 35 years or older, which increased the risk of still birth by 34 percent and multiple births, which increased the stillbirth risk of more than four-times, they note.
Infant deaths were also significantly greater with birth intervals of less than 18 months and 18 to 35 months with odds ratios of 4.39 and 1.81 respectively, the team found.
"Shorter birth intervals may be cyclic," Williams and colleagues write. "That is, a stillbirth or child death leads to another pregnancy soon thereafter, which is at increased risk both because of short birth interval and other unmeasured factors," they explain.
A birth-to-pregnancy interval of 24 months is optimal, Williams and her team recommend. "Postpartum family planning should be promoted for all women and methods both for spacing and limiting birth should be widely accessible," the researchers conclude.