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Interpregnancy Interval After Termination of Pregnancy and the Risks of Adverse Outcomes in Subsequent Birth

Männistö, Jaana MD; Bloigu, Aini BSc; Mentula, Maarit MD, PhD; Gissler, Mika MSocSc, PhD; Heikinheimo, Oskari MD, PhD; Niinimäki, Maarit MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000001836
Contents: Original Research
Abstract

OBJECTIVE: To assess whether the length of the interpregnancy interval after termination of pregnancy influences the risk of preterm birth, low birth weight, and small-for-gestational-age neonates in a subsequent pregnancy.

METHODS: In this register-based study, we included all women (N=19,894) who underwent termination of pregnancy between 2000 and 2009 and whose subsequent pregnancy ended in live singleton delivery. The women were divided into five groups depending on the interpregnancy interval between termination of pregnancy and subsequent conception: interpregnancy interval less than 6 months (n=2,956), 6 to less than 12 months (n=3,203), 12 to less than 18 months (n=2,623), 18 to less than 24 months (n=2,076), and 24 months or greater (n=9,036). The incidences and unadjusted and adjusted risks of preterm birth, low birth weight, and small-for-gestational-age neonates were calculated in relation to the different interpregnancy interval lengths, the reference group being that with an interpregnancy interval of 18 to less than 24 months.

RESULTS: There was a significant difference in the rate of preterm birth between the group with the interpregnancy interval less than 6 months and the reference group (5.6% compared with 4.0%, respectively, P=.008). After adjusting for nine background factors, an interpregnancy interval of less than 6 months was associated with an increased risk of preterm birth (adjusted odds ratio 1.35, 95% confidence interval 1.02–1.77). No such association emerged in longer interpregnancy interval groups or regarding other adverse events. The possibility of unmeasured confounding cannot be ruled out.

CONCLUSION: Slightly but significantly increased estimated risk of preterm delivery in subsequent pregnancy was seen when the interpregnancy interval after termination of pregnancy was less than 6 months. These data emphasize the need for prompt initiation of effective contraception after termination and enable counseling the patient for optimal conception interval.

In Brief

Only an interpregnancy interval of less than 6 months after termination of pregnancy is associated with an increased risk of subsequent preterm birth.

Author Information

Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, the National Institute for Health and Welfare, Oulu, the Department of Obstetrics and Gynecology, University of Helsinki, Kätilöopisto Hospital, Helsinki University Hospital, and the National Institute for Health and Welfare, Helsinki, Finland; and the Karolinska Institutet, Stockholm, Sweden.

Corresponding author: Jaana Männistö, MD, Department of Obstetrics and Gynecology, University Hospital of Oulu, P.O. Box 23, 90029-OYS, Oulu, Finland; email: jaana.mannisto@student.oulu.fi.

Supported by Oulu University Hospital.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.