Review
Obstetric
Effects of birth spacing on maternal health: a systematic review

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The objective of the study was to explore the association between birth spacing and risk of adverse maternal outcomes. The study was a systematic review of observational studies that examined the relationship between interpregnancy or birth intervals and adverse maternal outcomes. Twenty-two studies met the inclusion criteria. Overall, long interpregnancy intervals, possibly longer than 5 years, are independently associated with an increased risk of preeclampsia. There is emerging evidence that women with long interpregnancy intervals are at increased risk for labor dystocia and that short intervals are associated with increased risks of uterine rupture in women attempting a vaginal birth after previous cesarean delivery and uteroplacental bleeding disorders (placental abruption and placenta previa). Less clear is the association between short intervals and other adverse outcomes such as maternal death and anemia. Long interpregnancy intervals are independently associated with an increased risk of preeclampsia. Both short and long interpregnancy intervals seem to be related to other adverse maternal outcomes, but more research is needed.

Section snippets

Materials and Methods

The systematic review was conducted following a protocol specifically designed for this purpose and reported through use of the checklist proposed by the meta-analysis of Observational Studies in Epidemiology (MOOSE) group for reporting of systematic reviews of observational studies.7

We performed an initial literature search in MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), POPLINE (1980 to March 2006), CINAHL (1982 to March 2006), LILACS (1982 to March 2006), and ECLA (1980 to

Results

The searches produced 653 citations, of which 55 were considered relevant. The computerized search located 53, 1 was found in proceedings of meetings on birth spacing, and the remaining 1 was found through contact with a relevant researcher in the field. Thirty-three studies were excluded, the main reasons being the lack of data on the relationship between birth spacing and adverse outcomes considered (48%) and the lack of adjustment for confounding factors at statistical analysis (36%). A list

Comment

Birth spacing is promoted as an important component of family-planning strategies. However, there has been little information available to quantify the relationship between birth spacing and maternal health. Our systematic review shows that long interpregnancy intervals, possibly longer than 5 years, are independently associated with an increased risk of preeclampsia. There was emerging evidence that women with long interpregnancy intervals are at increased risk for labor dystocia and that

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    Reprints not available from the authors.

    This study was supported by the Office of Population and Reproductive Health, Bureau for Global Health, U.S. Agency for International Development under the terms of Cooperative Agreements HRN-A-00-00-00003-00 and GPO-A-00-05-00027-0 awarded to the CATALYST Consortium.

    The content of the paper has not been influenced by the sponsor.

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