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SCIENCE CHINA Life Sciences, Volume 63 , Issue 6 : 898-904(2020) https://doi.org/10.1007/S11427-018-9593-8

Long interpregnancy interval and adverse perinatal outcomes: a retrospective cohort study

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  • ReceivedApr 7, 2019
  • AcceptedJun 21, 2019
  • PublishedNov 5, 2019

Abstract


Funded by

the Major Program of National Natural Science Foundation of China(81490742)

the National Key Research and Development Program of China(2017YFC1001303,2018YFC1003200)

the National Natural Science Foundation of China(31471405,81771593,81671456)

the International Cooperation Project of China and Canada NSFC(81661128010)

the Interdisciplinary Key Program of Shanghai Jiao Tong University(YG2014ZD08)

and the Shen Kang Three-Year Action Plan(16CR3003A)


Acknowledgment

This work was supported by the Major Program of National Natural Science Foundation of China (81490742, 31471405, 81771593 and 81671456), the National Key Research and Development Program of China (2017YFC1001303 and 2018YFC1003200), the International Cooperation Project of China and Canada NSFC (81661128010), the Interdisciplinary Key Program of Shanghai Jiao Tong University (YG2014ZD08), and the Shen Kang Three-Year Action Plan (16CR3003A).


Interest statement

The author(s) declare that they have no conflict of interest. The study was approved by the Ethics Committee of the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University. Written informed consent was obtained from all participants.


References

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  • Figure 1

    Flow chart of the protocol used to select the study population.

  • Table 1   Table 1 Characteristics of the study population according to interpregnancy interval

    Interpregnancy interval (mon)a)

    P value

    Total

    <12

    12–23

    24–59

    60–119

    ≥120

    9552 (100)

    412 (4.3)

    1282 (13.4)

    3776 (39.5)

    3159 (33.1)

    923 (9.7)

    Maternal age at previous delivery (y)

    <0.001

    <25

    1731 (18.1)

    54 (13.1)

    127 (9.9)

    413 (10.9)

    631 (20.0)

    506 (54.8)

     

    25–29

    5597 (58.6)

    220 (53.4)

    712 (55.5)

    2235 (59.2)

    2036 (64.5)

    394 (42.7)

     

    30–34

    2077 (21.7)

    117 (28.4)

    399 (31.1)

    1054 (27.9)

    484 (15.3)

    23 (2.5)

     

    ≥35

    147 (1.5)

    21 (5.1)

    44 (3.4)

    74 (2.0)

    8 (0.3)

    0 (0.0)

     

    Maternal age at index delivery (y)

    <0.001

    <25

    70 (0.7)

    24 (5.8)

    22 (1.7)

    21 (0.6)

    3 (0.1)

    0 (0.0)

     

    25–29

    1454 (15.2)

    195 (47.3)

    445 (34.7)

    663 (17.6)

    148 (4.7)

    3 (0.3)

     

    30–34

    4730 (49.5)

    157 (38.1)

    689 (53.7)

    2336 (61.9)

    1404 (44.4)

    144 (15.6)

     

    ≥35

    3298 (34.5)

    36 (8.7)

    126 (9.8)

    756 (20.0)

    1604 (50.8)

    776 (84.1)

     

    Education (y)

    <0.001

    ≤12

    1040 (10.9)

    41 (10.0)

    106 (8.3)

    241 (6.4)

    372 (11.8)

    280 (30.3)

     

    13–16

    6570 (68.8)

    293 (71.1)

    917 (71.5)

    2668 (70.7)

    2155 (68.2)

    537 (58.2)

     

    ≥17

    1661 (17.4)

    64 (15.5)

    229 (17.9)

    772 (20.4)

    534 (16.9)

    62 (6.7)

     

    Missing

    281 (2.9)

    14 (3.4)

    30 (2.3)

    95 (2.5)

    98 (3.1)

    44 (4.8)

     

    Maternal height (cm)

    <0.001

    <160

    2522 (26.4)

    86 (20.9)

    302 (23.6)

    955 (25.3)

    907 (28.7)

    272 (29.5)

     

    160–<165

    3830 (40.1)

    148 (35.9)

    495 (38.6)

    1520 (40.3)

    1285 (40.7)

    382 (41.4)

     

    165–<170

    2130 (22.3)

    116 (28.2)

    331 (25.8)

    861 (22.8)

    644 (20.4)

    178 (19.3)

     

    ≥170

    707 (7.4)

    45 (10.9)

    117 (9.1)

    306 (8.1)

    196 (6.2)

    43 (4.7)

     

    Missing

    363 (3.8)

    17 (4.1)

    37 (2.9)

    134 (3.5)

    127 (4.0)

    48 (5.2)

     

    BMI at index delivery (kg m−2)

    <0.001

    <18.5

    940 (9.8)

    59 (14.3)

    156 (12.2)

    403 (10.7)

    268 (8.5)

    54 (5.9)

     

    18.5–<25

    6834 (71.5)

    275 (66.7)

    840 (65.5)

    2690 (71.2)

    2328 (73.7)

    701 (75.9)

     

    ≥25

    809 (8.5)

    30 (7.3)

    107 (8.3)

    287 (7.6)

    302 (9.6)

    83 (9.0)

     

    Missing

    969 (10.1)

    48 (11.7)

    179 (14.0)

    396 (10.5)

    261 (8.3)

    85 (9.2)

     

    Birth place

    <0.001

    Shanghai

    7063 (73.9)

    279 (67.7)

    943 (73.6)

    2835 (75.1)

    2363 (74.8)

    643 (69.7)

     

    Outside of Shanghai

    2489 (26.1)

    133 (32.3)

    339 (26.4)

    941 (24.9)

    796 (25.2)

    280 (30.3)

     

    Conception method at index delivery

    <0.001

    SC

    9439 (98.8)

    408 (99.0)

    1277 (99.6)

    3738 (99.0)

    3125 (98.9)

    891 (96.5)

     

    ART

    113 (1.2)

    4 (1.0)

    5 (0.4)

    38 (1.0)

    34 (1.1)

    32 (3.5)

     

    Previous cesarean section

    <0.001

    Yes

    4416 (46.2)

    67 (16.3)

    448 (35.0)

    1849 (49.0)

    1637 (51.8)

    415 (45.0)

     

    No

    5096 (53.4)

    331 (80.3)

    821 (64.0)

    1920 (50.8)

    1518 (48.1)

    506 (54.8)

     

    Missing

    40 (0.4)

    14 (3.4)

    13 (1.0)

    7 (0.2)

    4 (0.1)

    2 (0.2)

     

    Previous abortion history

    <0.001

    Yes

    5080 (53.2)

    121 (29.4)

    452 (35.3)

    1738 (46.0)

    2020 (63.9)

    749 (81.1)

     

    No

    4472 (46.8)

    291 (70.6)

    830 (64.7)

    2038 (54.0)

    1139 (36.1)

    174 (18.9)

     

    Endocrine diseases

    0.431

    Yes

    480 (5.0)

    18 (4.4)

    63 (4.9)

    199 (5.3)

    145 (4.6)

    55 (6.0)

     

    No

    9072 (95.0)

    394 (95.6)

    1219 (95.1)

    3577 (94.7)

    3014 (95.4)

    868 (94.0)

     

    Data are shown as n (%). P values were analyzed with χ2 statistics. IPI, interpregnancy interval; BMI, body mass index; SC, spontaneous conception; ART, assisted reproductive techniques.

  • Table 2   Table 2 Rates of maternal and neonatal adverse outcomes by interpregnancy interval

    Total

    Interpregnancy interval (mon)a)

    P value

    <12

    12–23

    24–59

    60–119

    ≥120

    GDM

    1221 (12.8)

    28 (6.8)

    123 (9.6)

    430 (11.4)

    442 (14.0)

    198 (21.5)

    <0.001

    PROM

    1492 (15.6)

    53 (12.9)

    152 (11.9)

    528 (14.0)

    563 (17.8)

    196 (21.2)

    <0.001

    Gestational hypertension

    157 (1.6)

    4 (1.0)

    11 (0.9)

    50 (1.3)

    57 (1.8)

    35 (3.8)

    <0.001

    Preeclampsia

    146 (1.5)

    8 (1.9)

    13 (1.0)

    45 (1.2)

    56 (1.8)

    24 (2.6)

    0.008

    Placenta previa

    164 (1.7)

    6 (1.5)

    12 (0.9)

    58 (1.5)

    58 (1.8)

    30 (3.3)

    <0.001

    Postpartum hemorrhage

    143 (1.5)

    4 (1.0)

    10 (0.8)

    57 (1.5)

    54 (1.7)

    18 (2.0)

    0.112

    Preterm delivery

    546 (5.7)

    23 (5.6)

    59 (4.6)

    176 (4.7)

    212 (6.7)

    76 (8.2)

    <0.001

    LBW

    238 (2.5)

    11 (2.7)

    28 (2.2)

    75 (2.0)

    84 (2.7)

    40 (4.3)

    0.001

    Macrosomia

    629 (6.6)

    20 (4.9)

    85 (6.6)

    239 (6.3)

    219 (6.9)

    66 (7.2)

    0.476

    SGA

    185 (1.9)

    8 (1.9)

    18 (1.4)

    78 (2.1)

    66 (2.1)

    15 (1.6)

    0.540

    LGA

    1338 (14.0)

    44 (10.7)

    169 (13.2)

    542 (14.4)

    451 (14.3)

    132 (14.3)

    0.273

    5-min Apgar score

    0.255

    8–10

    9450 (98.9)

    408 (99.1)

    1274 (99.4)

    3739 (99.0)

    3123 (98.9)

    906 (98.2)

     

    4–7

    90 (1.0)

    3 (0.7)

    7 (0.5)

    33 (0.9)

    18 (1.0)

    14 (1.5)

     

    0–3

    12 (0.1)

    1 (0.2)

    1 (0.1)

    4 (0.1)

    3 (0.1)

    3 (0.3)

     

    Data are shown as n (%). P values were analyzed with χ2 statistics. GDM, gestational diabetes mellitus; PROM, premature rupture of membrane; LWB, low birth weight; SGA, small for gestation age; LGA, large for gestation age.

  • Table 3   Table 3 Crude and adjusted odds ratios for adverse perinatal outcomes by interpregnancy interval

    Unadjusted OR (95% CI)

    Adjusted OR (95% CI)a)

    GDM

     

    IPI<12 mon

    0.69 (0.45–1.05)

    0.80 (0.52–1.24)

    IPI 12–23 mon

    1

    1

    IPI 24–59 mon

    1.21 (0.98–1.50)

    1.08 (0.87–1.35)

    IPI 60–119 mon

    1.53 (1.24–1.89)***

    1.17 (0.92–1.47)

    IPI≥120 mon

    2.57 (2.02–3.28)***

    1.76 (1.32–2.35)***

    PROM

     

    IPI<12 mon

    1.10 (0.79–1.53)

    0.93 (0.66–1.33)

    IPI 12–23 mon

    1

    1

    IPI 24–59 mon

    1.21 (1.00–1.47)

    1.32 (1.08–1.62)**

    IPI 60–119 mon

    1.61 (1.33–1.95)***

    1.77 (1.43–2.20)***

    IPI≥120 mon

    2.00 (1.59–2.53)***

    2.03 (1.53–2.67)***

    Gestational hypertension

     

    IPI<12 mon

    1.13 (0.36–3.58)

    1.18 (0.32–4.29)

    IPI 12–23 mon

    1

    1

    IPI 24–59 mon

    1.55 (0.81–2.99)

    1.30 (0.67–2.54)

    IPI 60–119 mon

    2.12 (1.11–4.06)*

    1.43 (0.72–2.83)

    IPI≥120 mon

    4.55 (2.30–9.02)***

    2.54 (1.17–5.51)*

    Preeclampsia

    IPI<12 mon

    1.93 (0.80–4.70)

    2.55 (1.02–6.37)*

    IPI 12–23 mon

    1

    1

    IPI 24–59 mon

    1.18 (0.63–2.19)

    1.09 (0.57–2.11)

    IPI 60–119 mon

    1.76 (0.96–3.23)

    1.30 (0.66–2.56)

    IPI≥120 mon

    2.61 (1.32–5.15)**

    1.18 (0.52–2.70)

    Placenta previa

     

    IPI<12 mon

    1.56 (0.58–4.19)

    1.88 (0.69–5.13)

    IPI 12–23 mon

    1

    1

    IPI 24–59 mon

    1.65 (0.88–3.08)

    1.26 (0.66–2.38)

    IPI 60–119 mon

    1.98 (1.06–3.70)*

    1.33 (0.68–2.60)

    IPI≥120 mon

    3.56 (1.81–6.98)***

    1.68 (0.75–3.76)

    Preterm delivery

     

    IPI<12 mon

    1.23 (0.75–2.01)

    1.35 (0.81–2.24)

    IPI 12–23 mon

    1

    1

    IPI 24–59 mon

    1.01 (0.75–1.37)

    0.97 (0.70–1.33)

    IPI 60–119 mon

    1.49 (1.11–2.01)**

    1.30 (0.93–1.81)

    IPI≥120 mon

    1.86 (1.31–2.64)***

    1.32 (0.86–2.02)

    LBW

    IPI<12 mon

    1.23 (0.61–2.49)

    1.26 (0.61–2.61)

    IPI 12–23 mon

    1

    1

    IPI 24–59 mon

    0.91 (0.59–1.41)

    0.92 (0.58–1.47)

    IPI 60–119 mo

    1.22 (0.79–1.89)

    1.15 (0.70–1.89)

    IPI≥120 mon

    2.03 (1.24–3.31)**

    1.43 (0.77–2.67)

    Boldface indicates statistical significance (*, P<0.05, **, P<0.01, ***, P<0.001). IPI, interpregnancy interval; OR, odds ratios; CI, confidence interval; GDM, gestational diabetes mellitus; PROM, premature rupture of membrane; LWB, low birth weight. Adjusted for maternal age at index delivery, BMI at index delivery, conception method, education, birthplace, previouscesarean section, and previous abortion history.

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