Beyond birth outcomes: Interpregnancy interval and injury-related infant mortality
- PMID: 31512273
- PMCID: PMC6913028
- DOI: 10.1111/ppe.12575
Beyond birth outcomes: Interpregnancy interval and injury-related infant mortality
Abstract
Background: Several studies have examined the association between IPI and birth outcomes, but few have explored the association between interpregnancy interval (IPI) and postnatal outcomes.
Objective: We examined the association between IPI and injury-related infant mortality, a leading cause of postneonatal mortality.
Methods: We used 2011-2015 US period-linked birth-infant death vital statistics data to generate a multiyear birth cohort of non-first-born singleton births (N = 9 782 029). IPI was defined as the number of months between a live birth and the start of the pregnancy leading to the next live birth. Causes of death in the first year of life were identified using ICD-10 codes. Hazard ratios (HR) for IPI categories were estimated using Cox proportional hazards models adjusted for birth order, county poverty level, and maternal characteristics (marital status, race/ethnicity, education, age at previous birth).
Results: After adjustment, overall infant mortality (48.1 per 10 000 births) was higher for short and long IPIs compared with IPI 18-23 months (reference): <6, aHR 1.61, 95% CI 1.54, 1.68; 6-11, aHR 1.22, 95% CI 1.17, 1.26; and 60+ months, aHR 1.12, 95% CI 1.08, 1.16. In comparison, the risk of injury-related infant mortality (4.4 per 10 000 births) decreased with longer IPIs: <6, aHR 1.77, 95% CI 1.55, 2.01; 6-11, aHR 1.41, 95% CI 1.25, 1.59; 12-17, aHR 1.25, 95% CI 1.10, 1.41; 24-59, aHR 0.78, 95% CI 0.69, 0.87; and 60+ months, aHR 0.55, 95% CI 0.48, 0.62.
Conclusion: Unlike overall infant mortality, injury-related infant mortality decreased with IPI length. While injury-related deaths are rare, these patterns suggest that the timing between births may be a marker of risk for fatal infant injuries. The first year postpartum may be an ideal time for the delivery of evidence-based injury prevention programmes as well as family planning services.
Keywords: birth spacing; infant mortality; injury; interpregnancy interval; parity.
© 2019 John Wiley & Sons Ltd.
Conflict of interest statement
CONFLICT OF INTEREST
All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Figures
![FIGURE 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6913028/bin/nihms-1061464-f0001.gif)
![FIGURE 2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/6913028/bin/nihms-1061464-f0002.gif)
Comment in
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Interpregnancy interval and outcomes beyond the neonatal period: More complicated than it seems.Paediatr Perinat Epidemiol. 2019 Sep;33(5):371-373. doi: 10.1111/ppe.12579. Epub 2019 Sep 12. Paediatr Perinat Epidemiol. 2019. PMID: 31513282 No abstract available.
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