Interpregnancy Interval After Healthy Live Birth and Subsequent Spontaneous Abortion

Author:

Hu Xuan123,Yang Ying134,Wang Long5,Zhao Chuanyu134,Lyu Xinyi134,Liu Meiya13,Wu Hanbin13,Lei Jueming13,Li Jiaxin134,Yao Mengxin2,Ding Yaling2,Zhang Hongguang13,He Yuan134,Wang Yuanyuan134,Peng Zuoqi13,Shen Haiping6,Wang Qiaomei6,Zhang Yiping6,Yan Donghai6,Yin Jieyun278,Ma Xu134

Affiliation:

1. National Research Institute for Family Planning, Beijing, China

2. Department of Epidemiology and Health Statistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China

3. National Human Genetic Resources Center, Beijing, China

4. Graduate School of Peking Union Medical College, Beijing, China

5. Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China

6. Department of Maternal and Child Health, National Health Commission of the People’s Republic of China, Beijing, China

7. Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases, Soochow University, Jiangsu, China

8. MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China

Abstract

ImportanceMany studies have reported that the interpregnancy interval (IPI) is a potential modifiable risk factor for adverse perinatal outcomes. However, the association between IPI after live birth and subsequent spontaneous abortion (SA) is unclear.ObjectiveTo investigate the association of IPI after a healthy live birth and subsequent SA.Design, Setting, and ParticipantsThis prospective cohort study used data from 180 921 women aged 20 to 49 years who had a single healthy live birth and planned for another pregnancy and who participated in the Chinese National Free Prepregnancy Checkups Project from January 1, 2010, to December 31, 2020. Statistical analysis was conducted from June 20 to October 5, 2023.ExposureInterpregnancy interval, defined as the interval between the delivery date and conception of the subsequent pregnancy, was categorized as follows: less than 18 months, 18 to 23 months, 24 to 35 months, 36 to 59 months, and 60 months or longer.Main Outcomes and MeasuresThe main outcome was SA. Multivariable-adjusted odds ratios (ORs) were calculated by logistic regression models to examine the association between IPI and the risk of SA. Dose-response associations were evaluated by restricted cubic splines.ResultsThe analyses included 180 921 multiparous women (mean [SD] age at current pregnancy, 26.3 [2.8] years); 4380 SA events (2.4% of all participants) were recorded. A J-shaped association between IPI levels and SA was identified. In the fully adjusted model, compared with IPIs of 18 to 23 months, both short (<18 months) and long (≥36 months) IPIs showed an increased risk of SA (IPIs of <18 months: OR, 1.15 [95% CI, 1.04-1.27]; IPIs of 36-59 months: OR, 1.28 [95% CI, 1.15-1.43]; IPIs of ≥60 months: OR, 2.13 [95% CI, 1.78-2.56]). Results of the subgroup analysis by mode of previous delivery were consistent with the main analysis.Conclusions and RelevanceThis cohort study of multiparous women suggests that an IPI of shorter than 18 months or an IPI of 36 months or longer after a healthy live birth was associated with an increased risk of subsequent SA. The findings are valuable to make a rational prepregnancy plan and may facilitate the prevention of SA and improvement in neonatal outcomes.

Publisher

American Medical Association (AMA)

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