Birth spacing, pregnancy spacing, or inter-pregnancy interval refers to how soon after a prior pregnancy a woman becomes pregnant or gives birth again. There are health risks associated both with pregnancies placed closely together and those placed far apart, but the majority of health risks are associated with births that occur too close together. The March of Dimes recommends a minimum of 18 months before becoming pregnant again following an uncomplicated vaginal delivery of a full term infant; the WHO recommends 24 months. A shorter interval may be appropriate if the pregnancy ended in abortion or miscarriage, typically 6 months. If the mother has had a prior C-section, it is advisable to wait before giving birth again due to the risk of uterine rupture in the mother during childbirth, with recommendations of a minimum inter-delivery interval ranging from a year to three years. Pregnancy intervals longer than 5 years are associated with an increased risk of pre-eclampsia. The global public heath burden of short inter-pregnancy intervals is substantial. Family planning can help increase inter-pregnancy interval.
Factors influencing birth spacing
Family planning, such as the use of contraceptives can increase inter-pregnancy interval. Breastfeeding and extended breastfeeding can also increase birth spacing due to lactational amenorrhea.
Cultural and religious attitudes towards both sex and the use of contraceptives, price and availability of health care, and poverty are all factors which can decrease inter-pregnancy intervals.
Short inter-pregnancy interval
Short inter-pregnancy interval is associated with an increase in maternal mortality, stillbirth, and child mortality. Inter-pregnancy interval of lower than 18 months is associated with an increased risk of pre-term birth.
Short inter-pregnancy interval after a prior C-section can be a contraindication for having a vaginal birth after a prior C-section (VBAC). In one study inter-pregnancy intervals shorter than 6 months were associated with 2-3 times increased risk of uterine rupture, major morbidity, and blood transfusion during vaginal delivery in mothers with at least one prior C-section.
Complications of a short inter-pregnancy interval are lower after an abortion or miscarriage compared to a full-term pregnancy.
Long inter-pregnancy interval
The global public heath burden of short inter-pregnancy intervals is substantial. In developing countries, children born two years or early after an older sibling were at a 60% increased risk of death in infancy, while those born between two and three years had a 10% increase, compared with those born after intervals of four to five years. Various organisations, including the World Health Organization and the Bill and Melinda Gates Foundation have identified birth spacing as an important area of public health intervention.
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