Interpregnancy Interval Effect on Perinatal Outcome- A Prospective Observational Study

Introduction: Spacing of birth is an important parameter affecting maternal and foetal health. Optimal birth spacing provides multiple benefits for both mother and her child. Both short and long Inter-Pregnancy Intervals (IPI) is associated with multiple adverse perinatal outcomes. Therefore, IPI is viewed as a potential modifiable risk factor for adverse foetal-maternal outcome.

Aim: To study the association of IPIs with adverse maternal and foetal outcomes.

Materials and Methods: This prospective observational study was conducted in R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India for a period of 18 months from January 2019 to June 2020. All multigravida women with atleast three antenatal check-ups were included in the study. The subjects were divided in two groups: group A consisted of 86 subjects, who had <2 year IPI and group B consisted of 87 subjects, who had ≥2 year IPI. These were compared on the basis of following socio-demographic characteristics: maternal age, Body Mass Index (BMI), contraceptive use, socio-economic status. Foetal outcome was assessed by gestational age at delivery, birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, need for Neonatal Intensive Care Unit/Sick Neonatal Care Unit (NICU/SNCU) admission and perinatal morbidity and mortality. Data were collected and statistically analysed using Statistical Package for Social Science (SPSS) version 19.0 (SPSS Inc, Chicago, IL, USA). Chi-square test was used for categorical data and students t-test was used for continuous data. Statistical significance in all evaluations was defined as p-value <0.05.

Results: Contraception use were significantly less in women with short IPI (p=0.001). The incidence of anaemia (p=0.026), scar dehiscence in postcaesarean pregnancies (p=0.031) and Post Partum Haemorrhage (PPH) (p=0.041) were also higher in mothers with short IPI. In this group incidence of low-birth-weight baby (p=0.039), preterm birth (p=0.041) and need for care of babies in NICU (p=0.043) were also higher and was statistically significant.

Conclusion: Lack of contraceptive use significantly increases the risk of short IPI which increases the risk of preterm delivery, maternal anaemia PPH and scar rupture in post-CS pregnancy and therefore, has a serious impact on maternal morbidity. Low birth weight and NICU/SNCU admission being more in group A was a drain on the health expenditure.