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ForwardWMJ Vol 122 Issue 2: Incidence of Adverse Pregnancy Outcomes Based on the Degree of Short Interpregnancy Interval in Urban Milwaukee Population
ABSTRACT
Introduction: Short interpregnancy interval is defined as conception occurring within 18 months of a previous live birth. Studies show increased risks of preterm birth, low birth weight, and small for gestational age with short interpregnancy intervals; however, it is unclear if these risks are higher for all short interpregnancy intervals or only for those less than 6 months. The objective of this study was to evaluate prevalence of adverse pregnancy outcomes among people with short interpregnancy intervals, stratified by degree: less than 6 months, 6 to 11 months, and 12 to 17 months.
Methods: We conducted a retrospective cohort study of people with 2 singleton pregnancies between 2015 and 2018 at a single academic center. The following outcomes were compared between patients with interpregnancy intervals of less than 6 months, 6 to 11 months, 12 to 17 months, and 18 months or more; hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), preterm birth at less than 37 weeks, low birth weight (< 2500 g), congenital anomalies, and gestational diabetes. Bivariate and multivariate analyses were done to examine the independent role of the degree of short interpregnancy interval and each outcome.
Results: A total of 1,462 patients were included in the analysis, with 80 pregnancies occurring at interpregnancy intervals less than 6 months, 181 at 6 to 11 months, 223 at 12 to 17 months, and 978 at 18 months or more. In unadjusted analysis, patients with interpregnancy intervals less than 6 months had the highest rate of preterm birth at 15.0%. In addition, patients with interpregnancy intervals less than 6 months and 12 to 17 months had higher rates of congenital anomalies versus those with interpregnancy intervals of 18 months or more. In multivariate analysis, controlling for sociodemographic and clinical confounding factors, interpregnancy intervals less than 6 months were associated with 2.3 higher odds of preterm birth (95% CI, 1.13-4.68), and those 12 to 17 months were associated with 2.52 higher odds of congenital anomalies (95% CI, 1.22-5.20). The odds of gestational diabetes were lower with interpregnancy intervals of 6 to 11 months compared to those 18 months or more (aOR 0.26; 95% CI, 0.08-0.85).
Conclusions: In this single-site cohort, people with interpregnancy intervals less than 6 months had higher odds of preterm birth, while those with interpregnancy intervals 12 to 17 months had higher odds of congenital anomalies, compared with the control group with interpregnancy intervals greater than or equal to 18 months. Future research should focus on identifying modifiable risk factors for short interpregnancy intervals and interventions to reduce them.
Intended Audience
The intended audience for this journal-based activity is healthcare providers caring for the people and communities of Wisconsin and beyond.
Learning Objectives
As a result of this journal-based activity, learners, as members of the healthcare team, will be able to:
- Summarize findings from previous about publications about the risks of closely spaced pregnancies that were reviewed by the authors.
- Elaborate on the study findings regarding the rates of preterm birth, congenital anomalies, and gestational diabetes in different patients with different interpregnancy intervals.
- Generate ideas for team-based interventions to prevent short interpregnancy intervals.
FACULTY DISCLOSURE
It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE). In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.
For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.
| Name of Individual | Individual's Role in Activity | Financial Relationship Disclosure | Discussion of |
| Marianna Shershneva, MD, PhD | Accreditation Specialist | No relevant relationships with ineligible companies to disclose | No |
| Elizabeth Panther, BSN | Author | No relevant relationships with ineligible companies to disclose | No |
| Sarah Amherdt, MD | Author | No relevant relationships with ineligible companies to disclose | No |
| Margaret Macbeth, BSN | Author | No relevant relationships with ineligible companies to disclose | No |
| Brittany McNellis, MD | Author | No relevant relationships with ineligible companies to disclose | No |
| Amy Pan, PhD | Author | No relevant relationships with ineligible companies to disclose | No |
| Anna Palatnik, MD | Author | No relevant relationships with ineligible companies to disclose | No |
| Donald Weber, MD | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Kathleen M Antony, MD, MSCI | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Fahad Aziz, MD | Editor | No relevant relationships with ineligible companies to disclose | No |
| Cassie Meffert, PA | Reviewer | No relevant relationships with ineligible companies to disclose | No |
Caitlin Weitzel, APNP, ACNP, MSN | Reviewer | No relevant relationships with ineligible companies to disclose | No |
*Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients.
The ACCME does not consider providers of clinical services directly to patients to be ineligible companies.
Accreditation
Accreditation Statement
 | In support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal. The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. |
Credit Designation Statements
American Medical Association (AMA)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
American Nurses Credentialing Center (ANCC)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 ANCC contact hour.
AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS (AAPA)
 | The University of Wisconsin–Madison ICEP has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until 03/28/2025. PAs should only claim credit commensurate with the extent of their participation. |
Continuing Education Units
The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour.
Available Credit
- 1.00 AAPA Category 1 CME
- 1.00 AMA PRA Category 1 Credit™
- 1.00 ANCC Contact Hours
- 1.00 University of Wisconsin–Madison Continuing Education Hours
- 1.00 Approved for AMA PRA Category 1 Credit™
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