Factors Associated with Inadequate Birth Intervals in the BRISA Birth Cohort, Brazil

 

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Abstract

Objective To determine the prevalence of inadequate birth interval and its associated factors in the BRISA study.

Methods Cross-sectional study using data from the BRISA cohort. Birth interval was categorized into “adequate” (≥ 2 years or < 5 years between births), “short interval” (< 2 years) and “long interval” (≥ 5 years). The analysis of the factors associated with short and long birth intervals used multinomial logistic regression.

Results The prevalence of adequate birth intervals was 48.3%, of long intervals, 34.6%, and of short intervals, 17.1%. Skin color, age, education level, economic status, type of delivery, number of prenatal visits, parity, blood pressure, diabetes, and anemia (p-value was < 0.2 in the univariate analysis) proceeded to the final model. The variable ≥ 3 births (odds ratio [OR] = 1.29; confidence interval [CI]: 1.01–1.65) was associated with short intervals. Age < 20 years old (OR = 0.48; CI: 0.02–0.12) or ≥ 35 years old (OR = 2.43; CI: 1.82–3.25), ≥ 6 prenatal visits (OR = 0.58; CI: 0.47–0.72), ≥ 3 births (OR = 0.59; CI: 0.49–0.73), and gestational diabetes (OR = 0.38; CI: 0.20–0.75) were associated with long intervals.

Conclusion Older mothers were more likely to have long birth intervals, and higher parity increases the chances of short birth intervals. Furthermore, gestational diabetes and adequate prenatal care presented higher chances of having adequate birth intervals, indicating that health assistance during pregnancy is important to encourage an adequate interval between gestations.

Resumo

Objetivo Determinar a prevalência de intervalo inadequado de nascimento e seus fatores associados no estudo BRISA.

Métodos Estudo transversal com dados da coorte BRISA. O intervalo de nascimento foi categorizado em “adequado” (≥ 2 anos ou < 5 anos entre os nascimentos), “intervalo curto” (< 2 anos) e “intervalo longo” (≥ 5 anos). A análise dos fatores associados aos intervalos de nascimento curtos e longos utilizou regressão logística multinomial.

Resultados A prevalência de intervalos adequados de nascimento foi de 48,3%, longa de 34,6% e curta de 17,1%. A cor da pele, idade, escolaridade, status econômico, tipo de parto, número de consultas pré-natais, paridade, pressão arterial, diabetes e anemia (valor-p < 0,2 na análise univariada) prosseguiram para o modelo final. A variável ≥ 3 nascimentos (odds ratio [OR] = 1,29; intervalo de confiança [IC]: 1,01–1,65) esteve associada a intervalos curtos. Idade < 20 anos (OR = 0.48; CI: 0.02–0.12) ou ≥ 35 anos (OR = 2.43; CI: 1.82–3.25), ≥ 6 consultas pré-natais (OR = 0.58; CI: 0.47–0.72), ≥ 3 nascimentos (OR = 0.59; CI: 0.49–0.73), e diabetes gestacional (OR = 0.38; CI: 0.20–0.75) foram associados a longos intervalos.

Conclusão As mães mais velhas apresentaram maior probabilidade de ter longos intervalos de nascimento, e uma paridade maior aumenta as chances de intervalos curtos de nascimento. Além disso, o diabetes gestacional e o pré-natal adequado apresentaram maiores chances de ter um intervalo adequado ao nascimento, indicando que a assistência à saúde durante a gravidez é importante para incentivar um intervalo adequado entre as gestações.

Contributors

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.

• References

• 1 World Health Organization. Report of a WHO technical consultation on birth spacing: Geneva, Switzerland 13–15 June 2005. Geneva: World Health Organization; 2007
  Google Scholar
• 2 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 (04) 297-308 . Doi: 10.1016/j.ajog.2006.05.055
  CrossrefPubMedGoogle Scholar
• 3 Conde-Agudelo A, Rosas-Bermudez A, Castaño F, Norton MH. Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. Stud Fam Plann. 2012; 43 (02) 93-114 . Doi: 10.1111/j.1728-4465.2012.00308.x
  CrossrefPubMedGoogle Scholar
• 4 King JC. The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies. J Nutr. 2003; 133 (05) (Suppl. 02) 1732S-1736S . Doi: 10.1093/jn/133.5.1732S
  CrossrefPubMedGoogle Scholar
• 5 Razzaque A, Da Vanzo J, Rahman M, Gausia K, Hale L, Khan MA. , et al. Pregnancy spacing and maternal morbidity in Matlab, Bangladesh. Int J Gynaecol Obstet. 2005; 89 (Suppl. 01) S41-S49 . Doi: 10.1016/j.ijgo.2005.01.003
  CrossrefPubMedGoogle Scholar
• 6 Erickson JD, Bjerkedal T. Interval between pregnancies. Lancet. 1979; 1 (8106): 52 . Doi: 10.1016/s0140-6736(79)90502-6
  CrossrefPubMedGoogle Scholar
• 7 Rousso D, Panidis D, Gkoutzioulis F, Kourtis A, Mavromatidis G, Kalahanis I. Effect of the interval between pregnancies on the health of mother and child. Eur J Obstet Gynecol Reprod Biol. 2002; 105 (01) 4-6 . Doi: 10.1016/s0301-2115(02)00077-5
  CrossrefPubMedGoogle Scholar
• 8 Klebanoff MA. The interval between pregnancies and the outcome of subsequent births. N Engl J Med. 1999; 340 (08) 643-644 . Doi: 10.1056/NEJM199902253400809
  CrossrefPubMedGoogle Scholar
• 9 Conde-Agudelo A, Belizán JM, Norton MH, Rosas-Bermúdez A. Effect of the interpregnancy interval on perinatal outcomes in Latin America. Obstet Gynecol. 2005; 106 (02) 359-366 . Doi: 10.1097/01.AOG.0000171118.79529.a3
  CrossrefPubMedGoogle Scholar
• 10 Wendt A, Gibbs CM, Peters S, Hogue CJ. Impact of increasing inter-pregnancy interval on maternal and infant health. Paediatr Perinat Epidemiol. 2012; 26 (Suppl. 01) 239-258 . Doi: 10.1111/j.1365-3016.2012.01285.x
  CrossrefPubMedGoogle Scholar
• 11 Winikoff B. The effects of birth spacing on child and maternal health. Stud Fam Plann. 1983; 14 (10) 231-245
  CrossrefPubMedGoogle Scholar
• 12 Li DK, Wi S. Changing paternity and the risk of preeclampsia/eclampsia in the subsequent pregnancy. Am J Epidemiol. 2000; 151 (01) 57-62 . Doi: 10.1093/oxfordjournals.aje.a010122
  CrossrefPubMedGoogle Scholar
• 13 Teitler JO, Das D, Kruse L, Reichman NE. Prenatal care and subsequent birth intervals. Perspect Sex Reprod Health. 2012; 44 (01) 13-21 . Doi: 10.1363/4401312
  CrossrefPubMedGoogle Scholar
• 14 Liu CM, Chang SD, Cheng PJ. Relationship between prenatal care and maternal complications in women with preeclampsia: implications for continuity and discontinuity of prenatal care. Taiwan J Obstet Gynecol. 2012; 51 (04) 576-582 . Doi: 10.1016/j.tjog.2012.09.013
  CrossrefPubMedGoogle Scholar
• 15 de Oliveira RL, da Fonseca CR, Carvalhaes MABL, Parada CMGL. Evaluation of pre-natal care from the perspective of different models in primary care. Rev Lat Am Enfermagem. 2013; 21 (02) 546-553 . Doi: 10.1590/S0104-11692013000200011
  CrossrefPubMedGoogle Scholar
• 16 Lutenbacher M, Gabbe PT, Karp SM, Dietrich MS, Narrigan D, Carpenter L. , et al. Does additional prenatal care in the home improve birth outcomes for women with a prior preterm delivery? A randomized clinical trial. Matern Child Health J. 2014; 18 (05) 1142-1154 . Doi: 10.1007/s10995-013-1344-4
  CrossrefPubMedGoogle Scholar
• 17 Associação Brasileira de Empresas de Pesquisa [Internet]. Critério Brasil 2008. 2010 [cited 2018 Dec 10]. Available from: http://www.abep.org/criterio-brasil
  PubMedGoogle Scholar
• 18 Schwandt HM, Skinner J, Hebert LE, Cobb L, Saad A, Odeku M. Inadequate birth spacing is perceived as riskier than all family planning methods, except sterilization and abortion, in a qualitative study among urban Nigerians. BMC Womens Health. 2017; 17 (01) 80 . Doi: 10.1186/s12905-017-0439-2
  CrossrefPubMedGoogle Scholar
• 19 Silva AAM, Batista RFL, Simões VMF, Thomaz EB, Ribeiro CC, Lamy-Filho F. , et al. Changes in perinatal health in two birth cohorts (1997/1998 and 2010) in São Luís, Maranhão State, Brazil. Cad Saude Publica. 2015; 31 (07) 1437-1450 . Doi: 10.1590/0102-311X00100314
  CrossrefPubMedGoogle Scholar
• 20 Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Área Técnica Saúde da Pessoa com Deficiência. A pessoa com deficiência e o Sistema Único de Saúde. Brasília (DF): Editora do Ministério da Saúde; 2006
  Google Scholar
• 21 Almeida MMG. Intervalo entre partos: condiconantes e consequência. Salvador-Bahia. Rev Baiana Enferm.. 1995; 8 (1/2): 37-55
  PubMedGoogle Scholar
• 22 Zhu BP, Grigorescu V, Le T, Lin M, Copeland G, Barone M. , et al. Labor dystocia and its association with interpregnancy interval. Am J Obstet Gynecol. 2006; 195 (01) 121-128 . Doi: 10.1016/j.ajog.2005.12.016
  CrossrefPubMedGoogle Scholar
• 23 Bener A, Saleh NM, Salameh KMK, Basha B, Joseph S, Samson N. , et al. The impact of the interpregnancy interval on birth weight and other pregnancy outcomes. Rev Bras Saúde Mater Infant. 2012; 12 (03) 233-241 . Doi: 10.1590/S1519-38292012000300003
  CrossrefPubMedGoogle Scholar
• 24 Osamor PE, Grady C. Women's autonomy in health care decision-making in developing countries: a synthesis of the literature. Int J Womens Health. 2016; 8: 191-202 . Doi: 10.2147/IJWH.S105483
  CrossrefPubMedGoogle Scholar
• 25 Singh K, Fong YF, Arulkumaran S. Anaemia in pregnancy--a cross-sectional study in Singapore. Eur J Clin Nutr. 1998; 52 (01) 65-70 . Doi: 10.1038/sj.ejcn.1600517
  CrossrefPubMedGoogle Scholar
• 26 Allen AJ, Snowden JM, Lau B, Cheng Y, Caughey AB. Type-2 diabetes mellitus: does prenatal care affect outcomes?. J Matern Fetal Neonatal Med. 2018; 31 (01) 93-97 . Doi: 10.1080/14767058.2016.1276558
  CrossrefPubMedGoogle Scholar
• 27 Ickovics JR, Lewis JB, Cunningham SD, Thomas J, Magriples U. Transforming prenatal care: Multidisciplinary team science improves a broad range of maternal-child outcomes. Am Psychol. 2019; 74 (03) 343-355 . Doi: 10.1037/amp0000435
  CrossrefPubMedGoogle Scholar
• 28 Kozuki N, Walker N. Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison. BMC Public Health. 2013; 13 (Suppl. 03) S6 . Doi: 10.1186/1471-2458-13-S3-S6
  CrossrefPubMedGoogle Scholar
• 29 Hutcheon JA, Nelson HD, Stidd R, Moskosky S, Ahrens KA. Short interpregnancy intervals and adverse maternal outcomes in high-resource settings: An updated systematic review. Paediatr Perinat Epidemiol. 2019; 33 (01) O48-O59 . Doi: 10.1111/ppe.12518
  CrossrefPubMedGoogle Scholar
• 30 De Oliveira AC, De Barros AM, Ferreira RC. [Risk factors associated among anemia in pregnancy women of network public health of a capital of Brazil Northeastern]. Rev Bras Ginecol Obstet. 2015; 37 (11) 505-511 . Doi: 10.1590/SO100-720320150005400
  PubMedGoogle Scholar
• 31 Ye L, Cao W, Yao J, Peng G, Zhou R. Systematic review of the effects of birth spacing after cesarean delivery on maternal and perinatal outcomes. Int J Gynaecol Obstet. 2019; 147 (01) 19-28 . Doi: 10.1002/ijgo.12895
  CrossrefPubMedGoogle Scholar
• 32 Haight SC, Hogue CJ, Raskind-Hood CL, Ahrens KA. Short interpregnancy intervals and adverse pregnancy outcomes by maternal age in the United States. Ann Epidemiol. 2019; 31: 38-44 . Doi: 10.1016/j.annepidem.2018.12.002
  CrossrefPubMedGoogle Scholar