Birth interval linked to stillbirth and infant death

Birth intervals of less than 18 months are associated with a high risk of stillbirth and infant deaths. A stillbirth is the death of a baby in the womb after the 20th week of pregnancy. Stillbirths may be due to maternal factors, fetal factors, or uterine factors. Injuries, illnesses (such as toxemia), infections, or catastrophic events (such as haemorrhage, or cardiac arrest) would affect both mother and child. Birth defects and growth abnormalities of the fetus can occur. Uterine factors (such as placental detachment, placental obstruction, or restricted uterine growth) can prove dangerous to the fetus. If one is pregnant, the usage of alcohol, drugs, and tobacco, can cause stillbirth, and infant death. Also, short birth intervals have been associated with adverse birth outcomes. To study the association between preceding interval and risk of stillbirth, researchers in India evaluated data collected as part of the government-sponsored Integrated Child Development Scheme in the province of Uttar Pradesh. Trained health workers recorded the detailed pregnancy outcomes of 33,111 married women during their home visits during the period between 1992 and 2002. During the study period, a total of 80,164 births and 78,186 live births were reported. After adjusting the data for potential and known risk factors, the incidence of stillbirth was significantly greater when birth intervals were less than 18 months; between 18 and 35 months and greater than 60 months with odds ratios of 3.44, 1.52 and 1.44, respectively. Additional risk factors were maternal age of 35 years or older, which increased the risk of still birth by 34 per cent and multiple births, which increased the stillbirth risk of more than four times. It was also found that infant deaths were significantly greater with birth intervals of less than 18 months and 18 to 35 months with odds ratios of 4.39 and 1.81, respectively. While the link between short birth intervals and infant deaths is well established, its link to stillbirths has not been clear. One factor could be that shorter birth intervals might be cyclic, that is, a stillbirth or child death leads to another pregnancy soon thereafter, which is at increased risk both because of short birth interval and other unmeasured factors. Thus, a birth-to-pregnancy interval of 24 months is optimal. Also, postpartum family planning should be promoted for all women and methods both for spacing and limiting birth should be widely accessible.