Advisory Committee Chair
Russell Kirby
Advisory Committee Members
John Owens
Hamisu Salihu
Shailender Swaminathan
Martha Wingate
Document Type
Dissertation
Date of Award
2007
Degree Name by School
Doctor of Public Health (DrPH) School of Public Health
Abstract
Introduction The main objective of the study was to examine reproductive health issues among women delaying initiation of childbearing until age 30 or older. Specifically, it examined pregnancy spacing patterns, relationship between pregnancy spacing and subsequent perinatal outcomes as well as racial differences in spacing and adverse perinatal outcomes. Methods A retrospective cohort study was conducted using the Missouri maternally linked live birth, fetal death and infant death files 1978-1997. The study sample was limited to mothers residing in Missouri during the study period, having first pregnancy at age 20-50 years, as well as a subsequent second pregnancy. Final study sample included 242,599 singleton sibling pairs. Interpregnancy interval was used as the measure for pregnancy spacing, and was determined as the interval between first and second pregnancy. Interval was categorized into 7 groups (0-5, 6-11, 12-17, 18-23, 24-59, 60-119, ≥120 months). Perinatal outcomes examined included fetal death, low birth weight, preterm and smallfor- gestational age. Bivariate and multivariable approaches were used for analysis, with the Chi-Square and Mantel-Haenszel statistics used to test for significant differences in iii proportions. Odds ratios and 95% confidence intervals were estimated for logistic regression analyses. Results The mean interpregnancy interval decreased significantly with increasing maternal age at initiation of childbearing (p <0.0001). Mothers delaying initiation of childbearing until age 35 or older had significantly higher rates of short interval <6 months compared to mothers 20-29 at initiation of childbearing (p <0.0001). Among women 35 or older at initiation of childbearing, the significant determinants for interpregnancy interval between first and second pregnancy included maternal educational status, body mass index, first pregnancy adverse outcome and year of delivery. Mothers 30-34 years at first pregnancy were less likely to have a second pregnancy with in 6 months, but mothers age 35 or older at initiation of childbearing were more likely to have a second pregnancy within less than 6 months of the first, as compared to mothers 20-29 at initiation of childbearing. Mothers 35 or older at first pregnancy had significantly higher rates of adverse perinatal outcomes in the second compared to mothers 20-29. Both advanced maternal age at first pregnancy and short interpregnancy interval (<6 months) were independent risk factors for poor perinatal outcome in subsequent pregnancy, particularly for mothers 35 or older. However, mothers with advanced maternal age at initiation of childbearing as well as short interval had no increased risk for poor perinatal outcome in subsequent pregnancy above that observed for each individual risk factor. iv Significantly fewer African Americans delayed initiation of childbearing; however, they had significantly higher rates of adverse perinatal outcomes for both first and second pregnancy compared to whites. No significant racial differences in interpregnancy interval were observed for mothers initiating childbearing at age 35 or older. African Americans had higher odds for adverse perinatal outcome in second pregnancy compared to Whites, however, African Americans delaying initiation of childbearing and having short interpregnancy interval had no increased risk for adverse perinatal outcomes, with the exception for small-for-gestational age births for mothers 30-34 at first pregnancy (OR= 1.91, 95% CI 1.08-3.37). Conclusion These study findings maybe of interest to health care providers and policy makers. In efforts to meet the Healthy People 2010 objectives, it is important to identify new areas for possible intervention. With the increasing number of women delaying initiation of childbearing, there is need to pay more close attention to their needs. The pregnancy spacing findings will aid in preconception counseling, and improving contraception use.
Recommended Citation
Nabukera, Sarah K., "Delayed Childbearing, Pregnancy Spacing And Impact On Subsequent Pregnancy Outcomes: Missouri Resident Mothers 1978-1997" (2007). All ETDs from UAB. 3770.
https://digitalcommons.library.uab.edu/etd-collection/3770