Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: Methodological quality of existing studies and future directions for research

Katherine A Ahrens¹, Jennifer A Hutcheon², Cande V Ananth^{3

4}, Olga Basso^{5

6}, Peter A Briss⁷, Cynthia D Ferré⁸, Brittni N Frederiksen¹, Sam Harper⁶, Sonia Hernández-Díaz⁹, Ashley H Hirai¹⁰, Russell S Kirby¹¹, Mark A Klebanoff¹², Laura Lindberg¹³, Sunni L Mumford¹⁴, Heidi D Nelson¹⁵, Robert W Platt⁶, Lauren M Rossen¹⁶, Alison M Stuebe¹⁷, Marie E Thoma¹⁸, Catherine J Vladutiu¹⁰, Susan Moskosky¹

Affiliations

¹ Office of Population Affairs, Office of the Assistant Secretary for Health, Rockville, Maryland.
² Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
⁴ Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York.
⁵ Department of Obstetrics and Gynecology, Royal Victoria Hospital, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
⁶ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
⁷ National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁸ Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁹ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
¹⁰ US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville, Maryland.
¹¹ Department of Community and Family Health, University of South Florida College of Public Health, Tampa, Florida.
¹² Center for Perinatal Research, Departments of Pediatrics and Obstetrics and Gynecology and Division of Epidemiology, The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
¹³ Guttmacher Institute, New York, New York.
¹⁴ Division of Intramural Population Health Research, Epidemiology Branch, National Institute of Child Health and Human Development, Bethesda, Maryland.
¹⁵ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
¹⁶ Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
¹⁷ Department of Obstetrics and Gynecology, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
¹⁸ Department of Family Science, University of Maryland, College Park, Maryland.

PMID: 30300948
PMCID: PMC6378402
DOI: 10.1111/ppe.12504

Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: Methodological quality of existing studies and future directions for research

Katherine A Ahrens et al. Paediatr Perinat Epidemiol. 2019 Jan.

. 2019 Jan;33(1):O5-O14.

doi: 10.1111/ppe.12504. Epub 2018 Oct 9.

Authors

Affiliations

¹ Office of Population Affairs, Office of the Assistant Secretary for Health, Rockville, Maryland.
² Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
⁴ Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York.
⁵ Department of Obstetrics and Gynecology, Royal Victoria Hospital, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
⁶ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
⁷ National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁸ Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁹ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
¹⁰ US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville, Maryland.
¹¹ Department of Community and Family Health, University of South Florida College of Public Health, Tampa, Florida.
¹² Center for Perinatal Research, Departments of Pediatrics and Obstetrics and Gynecology and Division of Epidemiology, The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
¹³ Guttmacher Institute, New York, New York.
¹⁴ Division of Intramural Population Health Research, Epidemiology Branch, National Institute of Child Health and Human Development, Bethesda, Maryland.
¹⁵ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
¹⁶ Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
¹⁷ Department of Obstetrics and Gynecology, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
¹⁸ Department of Family Science, University of Maryland, College Park, Maryland.

PMID: 30300948
PMCID: PMC6378402
DOI: 10.1111/ppe.12504

Abstract

Background: The World Health Organization (WHO) recommends that women wait at least 24 months after a livebirth before attempting a subsequent pregnancy to reduce the risk of adverse maternal, perinatal, and infant health outcomes. However, the applicability of the WHO recommendations for women in the United States is unclear, as breast feeding, nutrition, maternal age at first birth, and total fertility rate differs substantially between the United States and the low- and middle-resource countries upon which most of the evidence is based.

Methods: To inform guideline development for birth spacing specific to women in the United States, the Office of Population Affairs (OPA) convened an expert work group meeting in Washington, DC, on 14-15 September 2017 among reproductive, perinatal, paediatric, social, and public health epidemiologists; obstetrician-gynaecologists; biostatisticians; and experts in evidence synthesis related to women's health.

Results: Presentations and discussion topics included the methodological quality of existing studies, evaluation of the evidence for causal effects of short interpregnancy intervals on adverse perinatal and maternal health outcomes, good practices for future research, and identification of research gaps and priorities for future work.

Conclusions: This report provides an overview of the presentations, discussions, and conclusions from the expert work group meeting.

Keywords: birth spacing; confounding; contraception; interpregnancy interval; maternal health; neonatal health; preterm birth; study design.

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Figures

**Figure 1**
Causal diagram: simplified directed acyclic graph showing key factors to consider for analyses of short interpregnancy interval on adverse pregnancy outcomes

**Figure 2**
Factors influencing length of interpregnancy interval between livebirth and subsequent pregnancy with perinatal outcomes

See this image and copyright information in PMC

References

1. Report of a WHO Technical Consultation on Birth Spacing: Geneva, Switzerland 13‐15 June 2005. Department of Reproductive Health and Research (RHR). Geneva, Switzerland World Health Organization; 2006. http://apps.who.int/iris/bitstream/10665/69855/1/WHO_RHR_07.1_eng.pdf. Accessed March 15, 2018.
1. Conde‐Agudelo A, Rosas‐Bermudez A, Kafury‐Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta‐analysis. J Am Med Assoc. 2006;295:1809‐1823. - PubMed
1. UNICEF . Breastfeeding: A mother's gift, for every child. Nutrition Section, Programme Division, Data and Analytics Section, Division of Data, Research and Policy, and Division of Communication. 3 United Nations Plaza, New York, NY 10017, USA: Nutrition Section, Programme Division, UNICEF; 2018 https://www.unicef.org/publications/files/UNICEF_Breastfeeding_A_Mothers.... Accessed May 10, 2018.
1. World Health Organization, UNICEF . Global Breastfeeding Collective, Global Breastfeeding Scorecard. Geneva, Switzerland: Word Health Organization; 2017. https://www.unicef.org/nutrition/index_100585.html. Accessed March 15, 2018.
1. World Health Assembly, 65 . Nutrition of women in the preconception period, during pregnancy and the breastfeeding period. Report by the Secretariat. Geneva, Switzerland: World Health Organization; 2012. http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_11-en.pdf. Accessed March 15, 2018.

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Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: Methodological quality of existing studies and future directions for research

Affiliations

Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: Methodological quality of existing studies and future directions for research

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources