Interbirth Interval and Pregnancy Complications and Outcomes: Findings from the Pregnancy Risk Assessment Monitoring System

Exploring Captive Giant Panda Reproduction: Maternal and Offspring Factor Correlations from 324 Breeding Events

This study analyzes 324 captive giant panda breeding events (1998-2023) to unravel maternal and gestational drivers of cub survival and health-the largest dataset of its kind to date. Key variables included gestational duration, maternal age, interbirth interval, number of cubs per breeding event, cub birth weight, and neonatal mortality. Maternal age (5-7 years, ≥20 years) and interbirth intervals ≤1 year were linked to increased neonatal mortality, whereas intermediate gestational durations (110-127 days) and longer interbirth intervals (≥4 years) correlated with higher cub survival ratios. Although no direct relationship was found between gestational duration and birth weight, singleton cubs exhibited significantly higher weights than twins. By quantifying these relationships, we propose actionable strategies to enhance reproductive efficiency in managed populations, such as adjusting breeding schedules and maternal health monitoring.

Lonely, stressed-out moms: Does the postindustrial social experience put women at risk for perinatal mood disorders?

Perinatal mood and anxiety disorders (PMADs) are estimated to affect as many as 17.7% of mothers in agricultural and postindustrial societies. Various lines of research converge to suggest that PMADs may be 'diseases of modernity', arising from a mismatch between the environments in which humans evolved over hundreds of thousands of years and contemporary postindustrial lifestyles. Here we highlight the social context of childrearing by focusing on three sources of mismatch associated with PMADs: closer interbirth spacing, lack of allomaternal support and lack of prior childcare experience. The transitions to agriculture and industrialization disrupted traditional maternal support networks, allowing closer birth spacing without compromising infant survival but increasing maternal isolation. Caring for closely spaced offspring is associated with high levels of parenting stress, and poses a particular challenge in the context of social isolation. The mother's kin and community play a critical role in allomothering (childcare participation) in all contemporary hunter-gatherer societies, facilitating a system of simultaneous care for children of a range of ages with unique age-specific needs. The absence of social support and assistance from allomothers in postindustrial societies leaves mothers at increased risk for PMADs due to elevated caregiving burdens. Furthermore, the traditional system of allomothering that typified human evolutionary history afforded girls and women experience and training before motherhood, which likely increased their self-efficacy. We argue that the typical postindustrial motherhood social experience is an evolutionary anomaly, leading to higher rates of PMADs.

Birth spacing and risk of adverse pregnancy and birth outcomes: A systematic review and dose-response meta-analysis

INTRODUCTION

The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing.

MATERIAL AND METHODS

We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random-effects model, and the dose-response relationships were evaluated using generalized least squares trend estimation.

RESULTS

A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18-23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08-1.56; p < 0.05). The dose-response analyses further confirmed these J-shaped relationships (pnon-linear  < 0.001-0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon-linear  < 0.005 and pnon-linear  < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon-linear  < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04-2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose-response analyses (pnon-linear  = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76-1.21; p > 0.05).

CONCLUSIONS

Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18-23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months.

Fertility Planning Is More Critical Now Than Ever

Comprehensive fertility care has been reduced in many parts of the United States following the U.S. Supreme Court decision in June 2022 in the Dobbs v. Jackson Women's Health Organization case, which eliminated the constitutional right to abortion. Because of this change, there is an increasing need and desire among many for fertility planning as women want to understand their health, including their reproductive health. This commentary outlines the importance of fertility planning, how fertility planning affects fetal and maternal outcomes, and what people need to know about fertility planning. Guidance is offered on the role of nurses in supporting and advocating for individuals in their desire for fertility planning.

Postpartum contraception method type and risk of a short interpregnancy interval in a state Medicaid population

OBJECTIVE

To evaluate the likelihood of a short interpregnancy interval (IPI) resulting in a birth among women covered by Medicaid, as a function of postpartum contraceptive method type.

STUDY DESIGN

We used Medicaid claims and eligibility data to identify women (aged 15-44) who had a Medicaid-financed birth in Delaware in the years 2012-2014 (n = 10,328). Claims were analyzed to determine postpartum contraceptive type within 60 days of the index birth, and linked birth certificates were used to determine the incidence and timing of a subsequent birth through 2018 (regardless of payer). We used logistic regression to analyze the likelihood of having a short IPI following the index birth as a function of postpartum contraceptive type, controlling for preterm births, parity, having a postpartum checkup, and maternal characteristics including age, race, education, and marital status.

RESULTS

Compared to patients receiving postpartum long-acting reversible contraceptive methods (LARC), patients with no contraceptive claims had nearly 5 times higher odds (odds ratio [OR] = 4.98, confidence interval [CI] = 3.05-8.13) and those with claims for moderately effective methods (injectable, pill, patch, or ring) had 3.5 times higher odds (OR = 3.51, CI = 2.13-5.77) of a subsequent birth following a short IPI.

CONCLUSIONS

In a state population of Medicaid-enrolled women, women with claims for postpartum LARC had substantially lower risk of a short IPI resulting in a birth.

IMPLICATIONS

Women who received LARC within 60 days postpartum are less likely to experience a short interpregnancy interval resulting in a birth. The evidence suggests that recent state policy changes that make postpartum LARC more accessible to those that desire it will be an effective strategy in helping patients obtain desired birth intervals.

Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers

BACKGROUND

Reliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives.

METHODS

A convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data.

RESULTS

Women reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods.

CONCLUSION

Women's contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women's choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.

Determinants of premature rupture of membrane in Southern Ethiopia, 2017: case control study design

OBJECTIVE

To identify the determinants of term premature rupture of membrane in Southern Ethiopia public hospitals, 2017.

RESULTS

Seventy-five cases and 223 controls women were enrolled for the study. Two hundred eighty-four (95.3%) participants were admitted at the gestational age of above 40, and the rest, 14 (4.7%), were admitted at 37-40 weeks of gestation. The current study identified wealth index and inter-birth interval as preventive predictors, but smoking and hypertension during pregnancy were identified as positive determinants of premature rupture of membrane. This finding is supported by multiple logistic regression analysis result of wealth index (AOR: 0.102, 95% CI [0.033, 0.315]), inter-birth interval (AOR: 0.251, 95% CI [0.129, 0 0.488]), smoking (AOR: 17.053, 95% CI [2.145, 135.6]), and hypertension (AOR: 8.92, 95% CI (1.91, 41.605]). The association between PROM and its determinants indicated that evidence-based interventions should be needed and designed to have very high wealth index, and optimal interbirth interval, and prevent smoking and hypertension during pregnancy to decrease PROM occurrence in the study settings. Hence, we recommended that integration of prevention mechanism of modifiable determinants to the obstetrics health care system will reduce premature ruptures of a membrane.