The associations of birth intervals with small-for-gestational-age, preterm, and newborn and infant mortality: a meta-analysis

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  • Kozuki, Naoko
    • Other Affiliation: Johns Hopkins Bloomberg School of Public Health
  • Lee, Anne CC
    • Other Affiliation: Johns Hopkins Bloomberg School of Public Health
  • Silveira, Mariangela F
    • Other Affiliation: Universidade Federal de Pelotas
  • Victora, Cesar G
    • Other Affiliation: Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
  • Adair, Linda
    • Affiliation: Gillings School of Global Public Health
  • Humphrey, Jean
    • Other Affiliation: Johns Hopkins Bloomberg School of Public Health
  • Ntozini, Robert
    • Other Affiliation: Zvitambo
  • Black, Robert E
    • Other Affiliation: Johns Hopkins Bloomberg School of Public Health
  • Katz, Joanne
    • Other Affiliation: Johns Hopkins Bloomberg School of Public Health
  • Child Health Epidemiology Reference Group Small-for-Gestational-Age-Preterm Birth Working Group
Abstract
  • Abstract Background Short and long birth intervals have previously been linked to adverse neonatal outcomes. However, much of the existing literature uses cross-sectional studies, from which deriving causal inference is complex. We examine the association between short/long birth intervals and adverse neonatal outcomes by calculating and meta-analyzing associations using original data from cohort studies conducted in low-and middle-income countries (LMIC). Methods We identified five cohort studies. Adjusted odds ratios (aOR) were calculated for each study, with birth interval as the exposure and small-for-gestational-age (SGA) and/or preterm birth, and neonatal and infant mortality as outcomes. The associations were controlled for potential confounders and meta-analyzed. Results Birth interval of shorter than 18 months had statistically significant increased odds of SGA (pooled aOR: 1.51, 95% CI: 1.31-1.75), preterm (pooled aOR: 1.58, 95% CI: 1.19-2.10) and infant mortality (pooled aOR: 1.83, 95% CI: 1.19-2.81) after controlling for potential confounding factors (reference 36-<60 months). It was also significantly associated with term-SGA, preterm-appropriate-for-gestational-age, and preterm-SGA. Birth interval over 60 months had increased risk of SGA (pooled aOR: 1.22, 95% CI: 1.07-1.39) and term-SGA (pooled aOR: 1.14, 95% CI: 1.03-1.27), but was not associated with other outcomes. Conclusions Birth intervals shorter than 18 months are significantly associated with SGA, preterm birth and death in the first year of life. Lack of access to family planning interventions thus contributes to the burden of adverse birth outcomes and infant mortality in LMICs. Programs and policies must assess ways to provide equitable access to reproductive health interventions to mothers before or soon after delivering a child, but also address underlying socioeconomic factors that may modify and worsen the effect of short intervals.
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  • Article
Rights statement
  • In Copyright
Rights holder
  • Naoko Kozuki et al.; licensee BioMed Central Ltd.
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Journal title
  • BMC Public Health
Journal volume
  • 13
Journal issue
  • 1
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
Bibliographic citation
  • BMC Public Health. 2013 Sep 17;13(Suppl 3):S3
Publisher
  • BioMed Central Ltd
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  • Open Access
Date uploaded
  • September 17, 2013

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