Does Maternal Age Modify the Risk Associated with Short Interpregnancy Interval?
BACKGROUND AND PURPOSE:
Schummers et al. ( JAMA Internal Medicine, 2018) sought to determine whether maternal age modifies the association between short interpregnancy (delivery to conception) interval and adverse pregnancy outcomes
Population-based cohort study
≥2 singleton pregnancies
Risks of each outcome for 3- to 24-month interpregnancy intervals were estimated, according to maternal age at index birth
Maternal mortality or severe morbidity: Mechanical ventilation, blood transfusion >3 U, intensive care unit admission, organ failure, death)
SGA: <10th percentile BW for gestational age and sex
Fetal and infant composite outcome: Stillbirth, infant death, <3rd BW percentile for gestational age and sex, delivery <28 weeks
Spontaneous and indicated preterm delivery
148,544 pregnancies subsequent to a live birth
Risk curves were U- or L-shaped
Nadirs for the various outcomes were approximately 18 months
Low risks were seen for most outcomes between 12- to 24-month intervals
Increased 6-month vs 18-month interpregnancy intervals for women aged 35 years or older
0.62% at 6 months vs 0.26% at 18 months
Adjusted risk ratio (RR) 2.39 (95% CI, 2.03-2.80)
No increase in 6-month vs 18-month interpregnancy intervals for women aged 20 to 34 years
0.23% at 6 months vs 0.25% at 18 months
aRR 0.92 (95% CI, 0.83-1.02)
Risk ratio for adverse fetal and infant outcomes comparing 6 vs 18 months were greater for women aged 20 to 34 years than women ≥35 years
20 to 34 years: 2.0% at 6 months vs 1.4% at 18 months (aRR 1.42; 95% CI, 1.36-1.47)
≥35 years: 2.1% at 6 months vs 1.8% at 18 months (aRR 1.15; 95% CI, 1.01-1.31)
Risk ratio for spontaneous preterm delivery comparing 6 months to 18 months was greater for women 20 to 34 years
20 to 34 years: 5.3% at 6 months vs 3.2% at 18 months (aRR 1.65; 95% CI, 1.62-1.68)
≥35 years: 5.0% at 6 months vs 3.6% at 18 months (aRR 1.40; 95% CI, 1.31-1.49)
Short interpregnancy intervals that are less than <12 months are associated with increased risk for adverse pregnancy outcomes for all women across all ages
These risks persist after stratifying based on maternal age
The authors also state
Our findings indicate a shorter optimal interval than previously thought (12-24 months) for women of all ages. This finding may be reassuring particularly for older women who must weigh the competing risks of increasing maternal age with longer interpregnancy intervals
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