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1.
Pan Afr Med J ; 40: 17, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733385

RESUMO

Introduction: in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Salaam, Tanzania. Methods: a cross-sectional study was conducted in September 2018 at Mnazi Mmoja hospital among women receiving ante-natal care. A total of 530 women were included in the analysis. Analysis was conducted through SPSS version 24 computer program using descriptive analyses to determine the IPI and characteristics thereof, and logistic regression analysis to examine factors associated with IPI among pregnant women. Associations with a p-value < 0.05 were considered statistically significant. Results: twenty-two percent of the women attending ANC in Mnazi Mmoja hospital had short IPI. Short IPI was associated with young (<25years) age (AOR=2.67, 95% CI=1.23-5.79); non-use of a contraceptive method (AOR=2.05, 95%CI=1.22-3.45); breastfeeding for less than 6 months (AOR=3.45, 95% CI=1.17-10.13) and having an antecedent dead child at the time of index conception (AOR=3.38, 95% CI=1.15-9.93). Conclusion: about 1 in every 5 women attending ANC in Dar es Salaam had a short IPI. Addressing short IPI will complement the government´s efforts to improve maternal indicators in Tanzania and areas with similar contexts. Such efforts should emphasize in adherence to recommended infant feeding practices, women at a younger reproductive age group, those with a history of pregnancy loss, and strengthening contraception use among women of reproductive age.


Assuntos
Intervalo entre Nascimentos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Resultado da Gravidez , Cuidado Pré-Natal , Adulto , Fatores Etários , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Gravidez , Tanzânia , Fatores de Tempo , Adulto Jovem
2.
Zhonghua Fu Chan Ke Za Zhi ; 56(10): 677-683, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34823316

RESUMO

Objective: To speculate the effect of birth spacing on the pelvic floor type Ⅰ and Ⅱ fiber muscle strength of postpartum women with parities of two in different delivery modes. Methods: Totally 2 361 parturients who were investigated in Xuzhou Central Hospital from June 2016 to December 2020 were included in the questionnaire, clinical examination and pelvic floor surface electromyography assessment. According to the interval years between two parities and the pelvic floor typeⅠ and Ⅱ fiber muscle strength under different modes of delivery, curve fitting function equation was performed using curve regression method. The accuracy of the equation was verified by the receiver operating characteristic curve and the maximum area under the curve, and calculating the relative error rate. Results: A total of 2 357 parturients were included in the study and were divided into 4 groups based on delivery modes, women with both normal vaginal delivery were assigned to group A (589 cases); women with a first vaginal delivery and a second cesarean section were assigned to group B (480 cases); women with both cesarean deliveries were assigned to group C (1 273 cases); women with a first cesarean section and a second vaginal delivery were assigned to group D (15 cases). All of the curve fitting results were quadratic curves, and the appropriate interval years were selected when the muscle strength of type Ⅰ muscle fibers was>35 µV and that of type Ⅱ muscle fibers was>40 µV: 6-8 years in the group A, 5-10 years in the group B, and 1-11 years in the group C. The peak values of the quadratic curve were as follows: 7-8 years in the group A, 7-8 years in the group B, and 6 years in the group C. The maximum area under the curve of the function equations were all>0.6 (all P<0.05), the average relative error rate was 4.909%. Conclusions: The pelvic floor function of postpartum women with parities of two increases firstly and then decreases over time, showing a quadratic curve shape. In order to protect the pelvic floor function, the appropriate interval of birth spacing is 6-8 years.


Assuntos
Cesárea , Diafragma da Pelve , Intervalo entre Nascimentos , Parto Obstétrico , Feminino , Humanos , Fibras Musculares Esqueléticas , Força Muscular , Período Pós-Parto , Gravidez
3.
BMC Pediatr ; 21(1): 433, 2021 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-34607560

RESUMO

BACKGROUND: Globally, approximately 4.1 million infants died, accounting for 75% of all under-five deaths. In sub-Saharan Africa (SSA), infant mortality was 52.7/1000 live births in 2018 This study aimed to assess the pooled estimate of infant mortality rate (IMR), time to death, and its associated factors in SSA using the recent demographic and health survey dataset between 2010 and 2018. METHODS: Data were retrieved from the standard demographic and health survey datasets among 33 SSA countries. A total of 93,765 samples were included. The data were cleaned using Microsoft Excel and STATA software. Data analysis was done using R and STATA software. Parametric shared frailty survival analysis was employed. Statistical significance was declared as a two-side P-value < 0.05. RESULTS: The pooled estimate of IMR in SSA was 51 per 1000 live births (95% Confidence Interval (CI): 46.65-55.21). The pooled estimate of the IMR was 53 in Central, 44 in Eastern, 44 in Southern, and 57 in Western Africa per 1000 live births. The cumulative survival probability at the end of 1 year was 56%. Multiple births (Adjusted Hazard ratio (AHR) = 2.68, 95% CI: 2.54-2.82), low birth weight infants (AHR = 1.28, 95% CI: 1.22-1.34), teenage pregnancy (AHR = 1.19, 95 CI: 1.10-1.29), preceding birth interval <  18 months (AHR = 3.27, 95% CI: 3.10-3.45), birth order ≥ four (AHR = 1.14, 95% CI:1.10-1.19), home delivery (AHR = 1.08, 95% CI: 1.04-1.13), and unimproved water source (AHR = 1.07, 95% CI: 1.01-1.13), female sex (AHR = 0.86, 95% CI: 0.83-0.89), immediately breastfeed (AHR = 0.24, 95% CI: 0.23-0.25), and educated mother (AHR = 0.88, 95% CI: 0.82-0. 95) and educated father (AHR = 0.90, 95% CI: 0.85-0.96) were statistically significant factors for infant mortality. CONCLUSION: Significant number of infants died in SSA. The most common cause of infant death is a preventable bio-demographic factor. To reduce infant mortality in the region, policymakers and other stakeholders should pay attention to preventable bio-demographic risk factors, enhance women education and improved water sources.


Assuntos
Fragilidade , Adolescente , África ao Sul do Saara/epidemiologia , Intervalo entre Nascimentos , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Mortalidade Infantil , Gravidez , Modelos de Riscos Proporcionais
4.
BMC Womens Health ; 21(1): 346, 2021 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600521

RESUMO

BACKGROUND: Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries. METHODS: We analysed cross-sectional data on women aged 15-49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level. RESULTS: The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89-0.97), Ethiopia (aHR = 0.64; CI: 0.61-0.67) and South Africa (aHR = 0.51; CI: 0.47-0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status. CONCLUSION: Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.


Assuntos
Intervalo entre Nascimentos , Anticoncepcionais , Criança , Estudos Transversais , Feminino , Fertilidade , Humanos , Fatores Socioeconômicos , África do Sul
5.
Pediatrics ; 148(5)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34642233

RESUMO

BACKGROUND: A woman's health in the interconception period has an impact on birth outcomes. Pediatric visits offer a unique opportunity to provide interconception care (ICC). Our aim was to screen and provide interconception and safe sleep screening, counseling, and interventions for 50% of caregivers of children <2 years of age in a pediatric medical setting. METHODS: Two pediatric clinics implemented the March of Dimes' Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques (IMPLICIT) toolkit, in addition to standardized safe sleep assessments. A quality improvement learning collaborative was formed with a local "infant mortality champion" leading quality improvement efforts. Monthly webinars with the clinic teams reviewed project successes and challenges. Framework for Reporting Adaptations and Modifications was used to document adaptations. RESULTS: For each individual IMPLICIT domain, clinics screened and provided needed interventions for ICC and safe sleep in >50% of eligible encounters. Over the course of the quality improvement learning collaborative, the number of caregivers screened for at least 4 of the 5 IMPLICIT domains increased from 0% to 95%. CONCLUSIONS: To successfully implement the IMPLICIT toolkit in pediatrics, adaptations were made to the existing model, which had previously been used in family medicine clinics. Pediatricians should consider providing ICC as an innovative way to impact infant mortality rates in their community. Framework for Reporting Adaptations and Modifications can be used to systematically describe the adaptations needed to improve the fit of IMPLICIT in the pediatric clinic, understand the process of change and potential application to local context.


Assuntos
Recém-Nascido de Baixo Peso , Bem-Estar Materno , Pediatria , Cuidado Pré-Concepcional/métodos , Sono , Intervalo entre Nascimentos , Feminino , Humanos , Lactente , Cuidado do Lactente , Mortalidade Infantil , Bem-Estar do Lactente , Recém-Nascido , Cuidado Pré-Concepcional/normas , Nascimento Prematuro/prevenção & controle , Melhoria de Qualidade
6.
PLoS One ; 16(10): e0258297, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34679108

RESUMO

BACKGROUND: The relationship between migration and fertility has vexed demographers for years. One issue missing in the literature is the lack of careful temporal consideration of when women migrate and specifically, the extent to which they do either before or after live births. OBJECTIVE: Here, we opt for a more appropriate methodological approach to help remedy the complexity of the temporal aspect of migration and childbirth processes: regression models using the episode-splitting method. METHODS: This paper applies a rarely used methodological approach (episode-splitting) in the literature of migration-fertility relationship to investigate how internal in-migration is associated with inter-birth intervals among women in Cotonou, the largest city of Benin. Data comes from the 2017-2018 Benin Demographic and Health Survey (DHS) of women aged 15-49. Estimates from exponential regression models with episode-splitting were compared to estimates from exponential regression models without episode-splitting approach. Sensitivity analysis was also conducted to determine the robustness of the comparison between the two methods. Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) were used to identify the method that provides models with best fit. RESULTS: The results from (standard) exponential regression models without episode-splitting show that there is no significant association between migration and interbirth transition rate. However, significant associations between migration and interbirth transition rate emerge after applying the episode splitting method. The hazard ratios (HR) of the transition to the next live birth are higher among migrant women than among nonmigrant women. This trend is persistent even after 10 years spent in Cotonou by migrant women. CONCLUSION: Exponential regression models with episode-splitting were of better fit than exponential regression models without episode-splitting. Sensitivity analysis conducted seems to confirm that models with episode-splitting produce estimates that are accurate, reliable and superior to models without episode-splitting. The results suggest a long-run process adaptation of migrants to lower fertility behaviours in Cotonou and are therefore consistent with the socialization hypothesis.


Assuntos
Demografia , Inquéritos Epidemiológicos , Migração Humana , Adulto , Benin , Intervalo entre Nascimentos , Intervalos de Confiança , Humanos , Modelos Estatísticos
7.
Am J Obstet Gynecol MFM ; 3(6): 100484, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34517145

RESUMO

BACKGROUND: Short interpregnancy intervals have been associated with poor maternal and infant outcomes. Contraception access could affect the short interpregnancy interval rates. OBJECTIVE: To assess the influence of Medicaid on short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy intervals. STUDY DESIGN: Using the United States birth certificate data, we performed a population-based retrospective cohort study including multiparous women who had live births in 2012 and 2016, which is before and after Medicaid expansion had been implemented in 2014. Multivariate logistic regression estimated the influence of Medicaid expansion on short interpregnancy intervals (<12 months). The rate differences of short interpregnancy intervals in 2012 and 2016 were compared between Medicaid expansion vs non-Medicaid expansion states. RESULTS: There were a total of 7,916,908 live births in 2012 and 2016 in the United States, of which 3,362,904 (42.5%) were in multiparous women with data on interpregnancy intervals (n=1,961,683 [58.3%]) in Medicaid expansion states and in non-Medicaid expansion states (n=1,401,221 [41.7%]). The rate of short interpregnancy intervals in the United States was slightly lower in 2016 (17.3%) than in 2012 (17.4%), P=.0006; rate difference 0.13% (95% confidence interval, 0.05-0.20). Short interpregnancy intervals occurred more frequently in non-Medicaid expansion states than in Medicaid expansion states in both 2012 (18.1% vs 16.6%, respectively; P<.001) and 2016 (18.1% vs 16.4%, respectively; P<.001). The rate of short interpregnancy intervals decreased by 0.11% (95% confidence interval, 0.01-0.22) in Medicaid expansion states and increased by 0.04% (95% confidence interval, 0.09-0.17) in non-Medicaid expansion states. In 2016, living in a Medicaid expansion state was associated with a modestly decreased risk of short interpregnancy intervals (adjusted relative risk, 0.97; 95% confidence interval, 0.97-0.98), even after adjustment for coexisting risks. CONCLUSION: The risk of short interpregnancy intervals decreased in the Medicaid expansion states even after adjusting for risk factors. Moreover, the short interpregnancy interval rates increased in nonexpansion states but decreased in Medicaid expansion states. If non-Medicaid expansion states had experienced the same rate of decrease in short interpregnancy intervals as Medicaid expansion states, 1122 fewer women would have had a short interpregnancy interval in 2016. Considering the known association between short interpregnancy intervals and adverse maternal and infant outcomes, these findings indicate that Medicaid expansion could improve perinatal outcomes.


Assuntos
Intervalo entre Nascimentos , Medicaid , Estudos de Coortes , Anticoncepção , Feminino , Humanos , Lactente , Gravidez , Estudos Retrospectivos , Estados Unidos/epidemiologia
8.
PLoS One ; 16(8): e0255613, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34339456

RESUMO

BACKGROUND: Short inter-pregnancy interval is an interval of <24 months between the dates of birth of the preceding child and the conception date of the current pregnancy. Despite its direct effects on the perinatal and maternal outcomes, there is a paucity of evidence on its prevalence and determinant factors, particularly in Ethiopia. Therefore, this study assessed the prevalence and associated factors of short inter-pregnancy interval among pregnant women in Debre Berhan town, Northern Ethiopia. METHODS: A community based cross-sectional study was conducted among a randomly selected 496 pregnant women in Debre Berhan town from February 9 to March 9, 2020. The data were collected by using an interviewer-administered questionnaire and analyzed using STATA (14.2) statistical software. To identify the predictors of short inter-pregnancy interval, multivariable binary logistic regression was fitted and findings are presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). RESULT: The overall prevalence of short inter-pregnancy interval (<24 months) among pregnant women was 205 (40.9%). Being over 30 years of age at first birth (AOR = 3.50; 95% CI: 2.12-6.01), non-use of modern contraceptive (AOR = 2.51; 95% CI: 1.23-3.71), duration of breastfeeding for less than 12 months (AOR = 2.62; 95% CI: 1.32-5.23), parity above four (AOR = 0.31; 95% CI: 0.05-0.81), and unintended pregnancy (AOR = 5.42; 95% CI: 3.34-9.22) were independently associated factors with short inter-pregnancy interval. CONCLUSION: Despite the public health interventions being tried in the country, the prevalence of short inter-pregnancy interval in this study is high. Therefore, it implies that increasing contraceptive use and encouraging optimal breastfeeding might help in the efforts made to avert the problem.


Assuntos
Intervalo entre Nascimentos/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Gestantes/psicologia , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Gravidez , Prevalência , Adulto Jovem
9.
BMC Pregnancy Childbirth ; 21(1): 552, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34384389

RESUMO

BACKGROUND: Euglycaemic diabetic ketoacidosis (DKA) during pregnancy is a life-threatening obstetric emergency. It requires early identification and prompt action. Obstetricians' knowledge about symptoms, diagnostic pitfalls and management during pregnancy and delivery need to be improved. We report a case of a young diabetic woman developing severe euglycaemic DKA in two consecutive pregnancies; the first pregnancy resulted in the most deviating outcome (i.e., intrauterine death), while the second pregnancy resulted in the delivery of a healthy newborn. Thus, the novelty of the case presented here is the possibility to demonstrate how the management of DKA in pregnancy can dramatically change outcomes. CASE PRESENTATION: We report a case of a young diabetic woman in whom DKA was concealed by hyperemesis and oesophageal reflux. This woman presented to our delivery unit with severe euglycaemic DKA during her first pregnancy. While the mother's condition could be successfully stabilized, the foetus died shortly after admission. Two years later, the same woman presented with similar problems. Repeated episodes of mild euglycaemic DKA could be successfully managed with consequent interdisciplinary treatment and close observation, leading to a good pregnancy outcome, i.e., the birth of a healthy child. CONCLUSION: Awareness of euglycaemic DKA needs to be increased to reduce the risk of severe complications during pregnancies in diabetic women. This case report demonstrates that increased awareness of DKA with immediate recognition and a successful multidisciplinary approach are mandatory for an positive pregnancy outcomes.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/fisiopatologia , Cetoacidose Diabética/terapia , Resultado da Gravidez , Gravidez em Diabéticas , Intervalo entre Nascimentos , Feminino , Humanos , Recém-Nascido , Nascido Vivo , Equipe de Assistência ao Paciente , Gravidez , Natimorto , Adulto Jovem
10.
BMC Public Health ; 21(1): 1577, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34418993

RESUMO

BACKGROUND: India has achieved impressive gains in child survival over the last two decades; however, it was not successful in attaining MDG 2015 goals. The study's objective is to inquire how the survival status of the preceding child affects the survival of the next born child. METHODS: This is a retrospective analysis of data from the National Family Health Survey, 2015-16. Analysis was restricted to women with second or higher-order births because women with first-order births do not have a preceding child. Proportional hazards regression, also called the Cox regression model, has been used to carry out the analysis. Kaplan-Meier (K-M) survival curves were also generated, with a focus on preceding birth intervals. RESULTS: Results found that female children were more likely to experience infant mortality than their male counterparts. Children born after birth intervals of 36+ months were least likely to experience infant mortality. Mother's education and household wealth are two strong predictors of child survival, while the place of residence and caste did not show any effect in the Cox proportional model. Infant and child deaths are highly clustered among those mothers whose earlier child is dead. CONCLUSION: Maternal childbearing age is still low in India, and it poses a high risk of infant and child death. Education is a way out, and there is a need to focus on girl's education. The government shall also focus on raising awareness of the importance of spacing between two successive births. There is also a need to create a better health infrastructure catering to the needs of rich and poor people alike.


Assuntos
Intervalo entre Nascimentos , Mortalidade da Criança , Criança , Feminino , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Lactente , Mortalidade Infantil , Masculino , Estudos Retrospectivos , Fatores Socioeconômicos
11.
BMJ Open ; 11(8): e047892, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408041

RESUMO

OBJECTIVE: To assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia. DESIGN: A nationally representative cross-sectional survey. SETTING: This study used data from the Ethiopia Demographic and Health Survey 2016. PARTICIPANTS: A total of 8448 women who had at least two live births during the 5 years preceding the survey were included in the analysis. OUTCOME MEASURES: Neonatal mortality (death of the child within 28 days of birth), infant mortality (death between birth and 11 months) and under-five mortality (death between birth and 59 months) were the outcome variables. METHODS: Weighted logistic regression analysis based on inverse probability of treatment weights was used to estimate exposure effects adjusted for potential confounders. RESULTS: The adjusted ORs (AORs) of neonatal mortality were about 85% higher among women with SBI (AOR=1.85, 95% CI=1.19 to 2.89) than those without. The odds of infant mortality were twofold higher (AOR=2.16, 95% CI=1.49 to 3.11) among women with SBI. The odds of under-five child mortality were also about two times (AOR=2.26, 95% CI=1.60 to 3.17) higher among women with SBI. CONCLUSION: SBI has a significant effect on neonatal, infant and under-five mortality in Ethiopia. Interventions targeting SBI are warranted to reduce neonatal, infant and under-five mortality.


Assuntos
Intervalo entre Nascimentos , Mortalidade da Criança , Criança , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Probabilidade
12.
Autism Res ; 14(11): 2432-2443, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34423916

RESUMO

It is biologically plausible that risk of autism spectrum disorder (ASD) is elevated by both short and long interpregnancy intervals (IPI). We conducted a retrospective cohort study of singleton, non-nulliparous live births, 1998-2007 in Denmark, Finland, and Sweden (N = 925,523 births). Optimal IPI was defined as the IPI at which minimum risk was observed. Generalized additive models were used to estimate relative risks (RR) of ASD and 95% Confidence Intervals (CI). Population impact fractions (PIF) for ASD were estimated under scenarios for shifts in the IPI distribution. We observed that the association between ASD (N = 9302) and IPI was U-shaped for all countries. ASD risk was lowest (optimal IPI) at 35 months for all countries combined, and at 30, 33, and 39 months in Denmark, Finland, and Sweden, respectively. Fully adjusted RRs at IPIs of 6, 12, and 60 months were 1.41 (95% CI: 1.08, 1.85), 1.26 (95% CI: 1.02, 1.56), and 1.24 (95% CI: 0.98, 1.58) compared to an IPI of 35 months. Under the most conservative scenario PIFs ranged from 5% (95% CI: 1%-8%) in Denmark to 9% (95% CI: 6%-12%) in Sweden. The minimum ASD risk followed IPIs of 30-39 months across three countries. These results reflect both direct IPI effects and other, closely related social and biological pathways. If our results reflect biologically causal effects, increasing optimal IPIs and reducing their indications, such as unintended pregnancy and delayed age at first pregnancy has the potential to prevent a salient proportion of ASD cases. LAY SUMMARY: Waiting 35 months to conceive again after giving birth resulted in the least risk of autism. Shorter and longer intervals resulted in risks that were up to 50% and 85% higher, respectively. About 5% to 9% of autism cases might be avoided by optimizing birth spacing.


Assuntos
Transtorno do Espectro Autista , Intervalo entre Nascimentos , Transtorno do Espectro Autista/epidemiologia , Feminino , Finlândia/epidemiologia , Humanos , Gravidez , Estudos Retrospectivos , Fatores de Risco
13.
Eur J Obstet Gynecol Reprod Biol ; 264: 299-305, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34358877

RESUMO

OBJECTIVE: To evaluate maternal and neonatal outcomes associated with recurrent short interpregnancy interval (IPI) in women in their third delivery. METHODS: A retrospective computerized database study of all women who delivered their first three consecutive deliveries in a single tertiary medical center over 20 years (1999-2019). Maternal and neonatal outcomes of women with recurrent short IPI (<6 months between the 1st and 2nd pregnancy and the 2nd and 3rd pregnancy) were compared to women with recurrent optimal IPI (18-48 months), and to women with a single short IPI (<6 months between the 1st and 2nd pregnancy followed by an optimal IPI of 18-48 months between the 2nd and 3rd pregnancy). Additionally, in the recurrent short IPI groups, outcomes of the 2nd and 3rd pregnancies were compared in order to achieve an ideal adjustment to background characteristics. Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS: During the study period 10,569 women had three consecutive deliveries at our medical center, of those 338 (3.2%) women had recurrent short IPIs, and 1,021 (9.7%) had recurrent optimal IPIs. Recurrent short IPI was associated with a significantly higher risk of maternal anemia (Hb < 10gr%) on admission to labor (aOR 3.4 [95% CI 1.09-10.65], p = 0.04) and higher risk of small for gestational age neonates (aOR 10.4 [95% CI 2.32-46.93], p < 0.01), as compared with women with recurrent optimal IPI and significantly higher rates of low neonatal birth weights (2500 gr) and anemia (Hb < 10gr%) alongside lower rates of operative vaginal deliveries as compared with women with single short IPI followed by an optimal IPI. In the recurrent short IPI groups, the 3rd deliveries had significantly higher rates of in-labor cesarean and anemia (Hb < 10gr%) on admission as compared to their 2nd deliveries. CONCLUSION: Recurrent short IPI is associated with maternal anemia and small for gestational age neonates. Guiding patients towards prolongation of the IPI should include explanatory comments on these outcomes.


Assuntos
Intervalo entre Nascimentos , Recém-Nascido de Baixo Peso , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Estudos Retrospectivos , Fatores de Risco
14.
Reprod Health ; 18(1): 137, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193188

RESUMO

BACKGROUND: Despite six decades of official family planning programme, the use of modern contraceptive method remained low in India. The discontinuation of modern spacing method (DMSM) has also increased from 42.3% in 2005-06 to 43.6% during 2015-16. Discontinuation rate is higher for Injectable (51%), followed by condom (47%), pill (42%) and lowest in IUD (26%). METHODS: Data from NFHS-4 (2015-16) comprising of 601,509 households, 699,686 women and a sample of 119,548 episode of modern spacing method was used for the analysis. Multiple decrement life table has used to estimate 12-month discontinuation rate of modern spacing methods (DMSM). Moran's I statistics, Bivariate LISA cluster map has used to understand the spatial correlates and clustering the DMSM. OLS model and impact analysis has used to assess the significant associated covariates with discontinuation. RESULT: The 12-month DMSM in India is 43.5%; largely due to desire for becoming pregnant and method failure. The high discontinuation rate was observed in most of the southern (62%) and central (46%) regions of India. DMSM has significantly and spatially associated with neighbouring districts of India (Moran's I = 0.47, p-value = 0.00). The prevalence of modern spacing method is negatively associated with discontinuation in the neighbouring districts of India. The unmet need (ß = 0.84, 95% CI 0.55-1.14), desire of children (ß = 0.26, 95% CI - 0.05-0.57) and female sterilization (ß = 0.54, 95% CI 0.14-0.95) were three main contributing factor to DMSM. CONCLUSION: Districts of high DMSM need programmatic intervention. More attention for counselling to client, health worker outreach to user and better quality care services will stimulate non-user of contraception.


Assuntos
Intervalo entre Nascimentos , Anticoncepção , Serviços de Planejamento Familiar , Adulto , Comportamento Contraceptivo , Feminino , Humanos , Índia , Gravidez , Esterilização Reprodutiva
15.
PLoS One ; 16(7): e0255000, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34280228

RESUMO

BACKGROUND: Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women can address this issue. METHODS: We conducted an international longitudinal cohort study of 5,521,211 births to 3,849,193 women from Australia (1980-2016), Finland (1987-2017), Norway (1980-2016) and the United States (California) (1991-2012). IPI was calculated based on the time difference between two dates-the date of birth of the first pregnancy and the date of conception of the next (index) pregnancy. We estimated associations between IPI and preterm birth (PTB), spontaneous PTB, and small-for-gestational age births (SGA) using logistic regression (between-women analyses). We also used conditional logistic regression comparing IPIs and birth outcomes in the same women (within-women analyses). Random effects meta-analysis was used to calculate pooled adjusted odds ratios (aOR). RESULTS: Compared to an IPI of 18-23 months, there was insufficient evidence for an association between IPI <6 months and overall PTB (aOR 1.08, 95% CI 0.99-1.18) and SGA (aOR 0.99, 95% CI 0.81-1.19), but increased odds of spontaneous PTB (aOR 1.38, 95% CI 1.21-1.57) in the within-women analysis. We observed elevated odds of all birth outcomes associated with IPI ≥60 months. In comparison, between-women analyses showed elevated odds of adverse birth outcomes for <12 month and >24 month IPIs. CONCLUSIONS: We found consistently elevated odds of adverse birth outcomes following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of other adverse birth outcomes. Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries.


Assuntos
Intervalo entre Nascimentos , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Estudos de Coortes , Países Desenvolvidos , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Estudos Longitudinais , Idade Materna , Gravidez , Nascimento Prematuro/patologia , Adulto Jovem
18.
PLoS One ; 16(6): e0253736, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34191843

RESUMO

BACKGROUND: In low-income nations, high-risk fertility behavior is a prevalent public health concern that can be ascribed to unmet family planning needs, child marriage, and a weak health system. As a result, this study aimed to determine the factors that influence high-risk fertility behavior and its impact on child stunting and anemia. METHOD: This study relied on secondary data sources from recent demography and health surveys of nine east African countries. Relevant data were extracted from Kids Record (KR) files and appended for the final analysis; 31,873 mother-child pairs were included in the final analysis. The mixed-effect logistic regression model (fixed and random effects) was used to describe the determinants of high-risk fertility behavior (HRFB) and its correlation with child stunting and anemia. RESULT: According to the pooled study about 57.6% (95% CI: 57.7 to 58.2) of women had at least one high-risk fertility behavior, with major disparities found across countries and women's residences. Women who lived in rural areas, had healthcare access challenges, had a history of abortion, lived in better socio-economic conditions, and had antenatal care follow-up were more likely to engage in high-risk fertility practices. Consequently, Young maternal age at first birth (<18), narrow birth intervals, and high birth orders were HRFBs associated with an increased occurrences of child stunting and anemia. CONCLUSION: This study revealed that the magnitude of high-risk fertility behavior was higher in east Africa region. The finding of this study underscores that interventions focused on health education and behavioral change of women, and improvement of maternal healthcare access would be helpful to avert risky fertility behaviors. In brief, encouraging contraceptive utilization and creating awareness about birth spacing among reproductive-age women would be more helpful. Meanwhile, frequent nutritional screening and early intervention of children born from women who had high-risk fertility characteristics are mandatory to reduce the burden of chronic malnutrition.


Assuntos
Anemia/epidemiologia , Transtornos do Crescimento/epidemiologia , Comportamento Reprodutivo/estatística & dados numéricos , Assunção de Riscos , Adolescente , Adulto , África Oriental/epidemiologia , Fatores Etários , Intervalo entre Nascimentos/psicologia , Intervalo entre Nascimentos/estatística & dados numéricos , Ordem de Nascimento , Feminino , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Idade Materna , Pessoa de Meia-Idade , Estado Nutricional , Gravidez , Comportamento Reprodutivo/psicologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
19.
Paediatr Perinat Epidemiol ; 35(4): 415-424, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34131934

RESUMO

BACKGROUND: Short and long interpregnancy intervals (IPI) are associated with increased risk of hypertensive disorders of pregnancy, yet whether this association is modified by maternal age remains unclear. OBJECTIVES: To examine if the association between IPI and hypertensive disorders of pregnancy varies by maternal age at birth prior to IPI. METHODS: We conducted a population-based cohort study of all mothers who had their first two (n = 169 896) consecutive births in Western Australia (WA) between 1980 and 2015. We estimated the risk of preeclampsia and gestational hypertension for 6 to 60 months of IPI according to maternal age at birth prior to IPI (<20 years, 20-24, 25-29, 30-34 and ≥35 years). We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 6, 12, 24, 36, 48 and 60 months, with 18 months as reference. RESULTS: The risk of preeclampsia was increased at longer IPIs (60 months) compared to 18 months for mothers 35 years or older (RR 2.19, 95% confidence interval (CI) 1.14, 4.18) and to a lesser extent for mothers 30- to 34 years old (RR 1.43, 95% CI 1.10, 1.84). Compared to 18 months, the risk of preeclampsia was lower at 12 months of IPI for mothers younger than 20 years (RR 0.74, 95% CI 0.57, 0.96), but not for mothers 35 years or older (RR 0.62, 95% CI 0.36, 1.07). There was insufficient evidence for increased risk of hypertensive disorders of pregnancy at shorter IPIs of <18 months for mothers of all ages. CONCLUSIONS: Our findings challenge the "one size fits all" recommendation for an optimal IPI, and a more tailored approach to family planning counselling may be required to improve health.


Assuntos
Hipertensão Induzida pela Gravidez , Adulto , Intervalo entre Nascimentos , Estudos de Coortes , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Idade Materna , Gravidez , Estudos Retrospectivos , Fatores de Risco
20.
Womens Health Issues ; 31(5): 503-509, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34088600

RESUMO

INTRODUCTION: Maternal mortality and morbidity rates have risen significantly, yet little research has focused on how severe maternal morbidity (SMM) is associated with future reproductive health, such as birth spacing or the likelihood of subsequent SMM. This study focuses on the risk of SMM recurrence and the association of interpregnancy intervals with SMM. METHODS: This population-based, retrospective cohort study used Iowa hospital discharge data longitudinally linked to birth certificate data between 2009 and 2014. To examine recurrence of SMM, crude and adjusted multivariable logistic regression models were generated. The associations between varying interpregnancy intervals and subsequent SMM were examined. Crude, stratified, and adjusted risk ratios and their associated 95% confidence intervals were estimated. RESULTS: A total of 36,190 women were included in this study. Women with SMM in the index delivery had significantly higher odds of SMM in the subsequent delivery (adjusted odds ratio, 8.16; 95% confidence interval, 5.45-12.24) compared with women without SMM. Women with an interpregnancy interval of less than 6 months compared with 18 months or longer were more likely to experience SMM during their subsequent delivery, although the difference was not statistically significant (adjusted odds ratio, 1.41; 95% confidence interval, 0.99, 2.03). CONCLUSIONS: This study demonstrates that women who experience SMM are at markedly increased risk of subsequent SMM. Further investigation is necessary to inform optimal interpregnancy interval recommendations based on prior maternal health outcomes.


Assuntos
Intervalo entre Nascimentos , Complicações na Gravidez , Feminino , Humanos , Iowa/epidemiologia , Idade Materna , Mortalidade Materna , Gravidez , Estudos Retrospectivos , Fatores de Risco
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