PDF(Pubmed)
Abstract：
The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing.
We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random-effects model, and the dose-response relationships were evaluated using generalized least squares trend estimation.
A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18-23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08-1.56; p < 0.05). The dose-response analyses further confirmed these J-shaped relationships (pnon-linear < 0.001-0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon-linear < 0.005 and pnon-linear < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon-linear < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04-2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose-response analyses (pnon-linear = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76-1.21; p > 0.05).
Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18-23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months.
We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random-effects model, and the dose-response relationships were evaluated using generalized least squares trend estimation.
A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18-23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08-1.56; p < 0.05). The dose-response analyses further confirmed these J-shaped relationships (pnon-linear < 0.001-0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon-linear < 0.005 and pnon-linear < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon-linear < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04-2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose-response analyses (pnon-linear = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76-1.21; p > 0.05).
Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18-23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months.
摘要：
背景：极端出生间隔和不良结局之间的关联是有争议的，现有证据分为不同的出生间隔分类。
方法：我们对观察性研究进行了系统回顾，以评估出生间隔之间的关联（即，妊娠间期和结局间期)和不良结局(即妊娠并发症,不良分娩结局)。使用随机效应模型计算具有95%置信区间(CI)的集合优势比(OR)，并使用广义最小二乘趋势估计评估剂量-反应关系。
结果：共纳入129项研究，涉及46874843例妊娠。在一般人群中,与18-23个月的妊娠间隔相比，极端间隔（<6个月和≥60个月）与不良结局风险增加相关，包括早产,小于胎龄，低出生体重,胎儿死亡,出生缺陷,新生儿早期死亡，和胎膜早破（合并OR范围：1.08-1.56；p<0.05）。剂量反应分析进一步证实了这些J形关系(pnon-linear<0.001-0.009)。妊娠间隔时间长仅与先兆子痫和妊娠糖尿病的风险增加相关(分别为pnon-linear<0.005和pnon-linear<0.001)。在结果间期与低出生体重和早产风险之间观察到类似的关联(pnon-linear<0.001)。此外，结局间期≥60个月与剖宫产风险增加相关(汇总OR1.72,95%CI1.04~2.83).对于早产后的怀孕，妊娠间隔9个月与早产风险增加无关,根据剂量反应分析（pnon-linear=0.008）。基于有限的证据,我们没有观察到妊娠间期或妊娠丢失后的结局间期与小于胎龄的风险之间的显著关联,胎儿死亡,流产,或先兆子痫（合并OR范围：0.76-1.21；p>0.05）。
结论：极端出生间隔对母婴健康有广泛的不利影响。在一般人群中,妊娠间期为18-23个月可能对母亲和婴儿都有潜在益处.对于先前早产的女性，最佳生育间隔可能是9个月。
方法：我们对观察性研究进行了系统回顾，以评估出生间隔之间的关联（即，妊娠间期和结局间期)和不良结局(即妊娠并发症,不良分娩结局)。使用随机效应模型计算具有95%置信区间(CI)的集合优势比(OR)，并使用广义最小二乘趋势估计评估剂量-反应关系。
结果：共纳入129项研究，涉及46874843例妊娠。在一般人群中,与18-23个月的妊娠间隔相比，极端间隔（<6个月和≥60个月）与不良结局风险增加相关，包括早产,小于胎龄，低出生体重,胎儿死亡,出生缺陷,新生儿早期死亡，和胎膜早破（合并OR范围：1.08-1.56；p<0.05）。剂量反应分析进一步证实了这些J形关系(pnon-linear<0.001-0.009)。妊娠间隔时间长仅与先兆子痫和妊娠糖尿病的风险增加相关(分别为pnon-linear<0.005和pnon-linear<0.001)。在结果间期与低出生体重和早产风险之间观察到类似的关联(pnon-linear<0.001)。此外，结局间期≥60个月与剖宫产风险增加相关(汇总OR1.72,95%CI1.04~2.83).对于早产后的怀孕，妊娠间隔9个月与早产风险增加无关,根据剂量反应分析（pnon-linear=0.008）。基于有限的证据,我们没有观察到妊娠间期或妊娠丢失后的结局间期与小于胎龄的风险之间的显著关联,胎儿死亡,流产,或先兆子痫（合并OR范围：0.76-1.21；p>0.05）。
结论：极端出生间隔对母婴健康有广泛的不利影响。在一般人群中,妊娠间期为18-23个月可能对母亲和婴儿都有潜在益处.对于先前早产的女性，最佳生育间隔可能是9个月。
