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A large body of research has found an association between short birth intervals and the risk of infant mortality in developing countries, but recent work on other perinatal outcomes from highly developed countries has called these claims into question, arguing that previous studies have failed to adequately control for unobserved heterogeneity. Our study addresses this issue by estimating within-family models on a sample of 4.5 million births from 77 countries at various levels of development. We show that after unobserved maternal heterogeneity is controlled for, intervals shorter than 36 months substantially increase the probability of infant death. However, the importance of birth intervals as a determinant of infant mortality varies inversely with maternal education and the strength of the relationship varies regionally. Finally, we demonstrate that the mortality-reducing effects of longer birth intervals are strong at low levels of development but decline steadily toward zero at higher levels of development. These findings offer a clear way to reconcile previous research showing that birth intervals are important for perinatal outcomes in lowincome countries but are much less consequential in high-income settings.

Short inter-pregnancy interval is an interval of <24 months between the dates of birth of the preceding child and the conception date of the current pregnancy. Despite its direct effects on the perinatal and maternal outcomes, there is a paucity of evidence on its prevalence and determinant factors, particularly in Ethiopia. Therefore, this study assessed the prevalence and associated factors of short inter-pregnancy interval among pregnant women in Debre Berhan town, Northern Ethiopia. A community based cross-sectional study was conducted among a randomly selected 496 pregnant women in Debre Berhan town from February 9 to March 9, 2020. The data were collected by using an interviewer-administered questionnaire and analyzed using STATA (14.2) statistical software. To identify the predictors of short inter-pregnancy interval, multivariable binary logistic regression was fitted and findings are presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). The overall prevalence of short inter-pregnancy interval (<24 months) among pregnant women was 205 (40.9%). Being over 30 years of age at first birth (AOR = 3.50; 95% CI: 2.12-6.01), non-use of modern contraceptive (AOR = 2.51; 95% CI: 1.23-3.71), duration of breastfeeding for less than 12 months (AOR = 2.62; 95% CI: 1.32-5.23), parity above four (AOR = 0.31; 95% CI: 0.05-0.81), and unintended pregnancy (AOR = 5.42; 95% CI: 3.34-9.22) were independently associated factors with short inter-pregnancy interval. Despite the public health interventions being tried in the country, the prevalence of short inter-pregnancy interval in this study is high. Therefore, it implies that increasing contraceptive use and encouraging optimal breastfeeding might help in the efforts made to avert the problem.

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. In this systematic review and meta‐analysis of 129 studies, extreme short or long birth spacing was associated with increased odds of adverse pregnancy and birth outcomes. In the general population, interpregnancy interval of 18 to 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.

Background Research has shown a relationship between interpregnancy intervals (IPIs) and preterm birth, but a comprehensive understanding remains elusive. The aim of this systematic review and meta-analysis was to examine the effect of different IPIs on the risk of preterm birth Methods Systematic searches were conducted in PubMed, Cochrane, Web of Science, and Embase up to June 2, 2023. Studies included in the review provided data on IPIs and preterm birth outcomes, assessed via the NOS quality scale. A Bayesian network meta-analysis was performed to evaluate the association between IPIs and preterm birth. Results From 34 studies and 8,646,679 individuals, the optimal IPIs were found to be 24-29 months, showing significantly lower risks of preterm birth at less than 32 weeks of gestation [OR=0.55 (95%CI: 0.50 - 0.62)]and at less than 37 weeks of gestation[OR=0.61 (95%CI: 0.59 - 0.63)]compared to IPIs less than 5 months. Conclusions IPIs of 24-29 months significantly reduce the risk of preterm birth, suggesting a potential target range for family planning and clinical recommendations. Trial registration Not applicable.

Introduction Short inter-birth intervals negatively impact maternal and child health; however, data on their prevalence and associated factors in Tanzania are limited. This study investigates the prevalence of short inter-birth intervals and the associated factors among women of reproductive age in Tanzania. Methods This was a cross-sectional study utilizing the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey dataset. The study population included women aged 15–49 years with at least two births within five years preceding the survey. A short inter-birth interval was defined as a birth occurring < 33 months after the preceding birth. A generalized linear model with Poisson as a link and robust standard errors was used to examine factors associated with short inter-birth intervals. A p -value < 0.05 was considered statistically significant. Results A total of 8,350 births from 6,034 women were included in this analysis. The mean (± SD) age of the women was 31.6 ± 6.8 years. The overall prevalence of short inter-birth intervals was 42.6%. Younger age (aPR 3.12, 95% CI 2.88–3.52 for age 15–24 years, and aPR 1.74, 95% CI 1.62–1.1.86 for age 25–34 years), being married (aPR 1.27, 95% CI 1.03–1.57), late age at first childbirth (aPR 1.24, 95% CI 1.17–1.32) for a 20–24 years and aPR 1.55, 95% CI 1.39–1.73 for ≥ 25 years), and higher birth order (aPR 1.02, 95% CI 1.03–1.19; aPR 1.24, 95% CI 1.14–1.34; aPR 1.72, 95% CI 1.58–1.86 for 3rd, 4th, and 5th or more birth orders, respectively, compared to 2nd birth order) were independently associated with short inter-birth intervals. Additionally, there was significant variation in the prevalence of short inter-birth intervals across different zones and levels of household wealth. Women from richer (aPR 0.87, 95% CI: 0.80–0.95) and richest (aPR 0.84, 95% CI: 0.74–0.94) households exhibited a lower prevalence of short inter-birth intervals. Conclusion This study highlights the significant prevalence of short inter-birth intervals among women of reproductive age in Tanzania. The associated factors include younger age, marital status, delayed first childbirth, higher birth order, geographical disparities, and lower household wealth. These findings highlight the need for targeted interventions to promote birth spacing and improve maternal and child health outcomes.

Background Both interpregnancy intervals (IPI) and environmental factors might contribute to low birth weight (LBW). However, the extent to which air pollution influences the effect of IPIs on LBW remains unclear. We aimed to investigate whether IPI and air pollution jointly affect LBW. Methods A retrospective cohort study was designed in this study. The data of birth records was collected from the Jiangsu Maternal Child Information System, covering January 2020 to June 2021 in Nantong city, China. IPI was defined as the duration between the delivery date for last live birth and date of LMP for the subsequent birth. The maternal exposure to ambient air pollutants during pregnancy—including particulate matter (PM) with an aerodynamic diameter of ≤ 2.5 μm (PM 2.5 ), PM 10 , ozone (O 3 ), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ) and carbon monoxide (CO)—was estimated using a hybrid kriging-LUR-RF model. A novel air pollution score was proposed, assessing combined exposure to five pollutants (excluding CO) by summing their concentrations, weighted by LBW regression coefficients. Multivariate logistic regression models were used to estimate the effects of IPI, air pollution and their interactions on LBW. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP) and synergy index (S) were utilized to assess the additive interaction. Results Among 10, 512 singleton live births, the LBW rate was 3.7%. The IPI-LBW risk curve exhibited an L-shaped pattern. The odds ratios (ORs) for LBW for each interquartile range increase in PM 2.5 , PM 10 , O 3 and the air pollution score were 1.16 (95% CI: 1.01–1.32), 1.30 (1.06–1.59), 1.22 (1.06–1.41), and 1.32 (1.10–1.60) during the entire pregnancy, respectively. An additive interaction between IPI and PM 2.5 was noted during the first trimester. Compared to records with normal IPI and low PM 2.5 exposure, those with short IPI and high PM 2.5 exposure had the highest risk of LBW (relative risk = 3.53, 95% CI: 1.85–6.49, first trimester). Conclusion The study demonstrates a synergistic effect of interpregnancy interval and air pollution on LBW, indicating that rational birth spacing and air pollution control can jointly improve LBW outcomes.

A growing body of research has argued that the traditional categories of stopping and spacing are insufficient to understand why individuals want to control fertility. In a series of articles, Timæus, Moultrie, and colleagues defined a third type of fertility motivation—postponement—that reflects a desire to avoid childbearing in the short term without clear goals for long-term fertility. Although postponement is fundamentally a description of fertility desires, existing quantitative research has primarily studied fertility behavior in an effort to find evidence for the model. In this study, we use longitudinal survey data to consider whether postponement can be identified in standard measures of fertility desires among reproductive-age women in rural Mozambique. Findings show strong evidence for a postponement mindset in this population, but postponement coexists with stopping and spacing goals. We reflect on the difference between birth spacing and postponement and consider whether and how postponement is a distinctive sub-Saharan phenomenon.

Short birth interval (SBI), defined as < 33 months between two consecutive live births, remains a pressing public health concern in Nigeria, with potential adverse consequences for both mothers and children. Understanding the factors associated with SBI is crucial for developing effective interventions to improve maternal and child health outcomes. This study investigates the sociodemographic and regional disparities influencing SBI among women of reproductive age in Nigeria, utilizing data from the 2018 Nigeria Demographic and Health Survey (NDHS). This study analysed data from 25,280 women of reproductive age who had given birth within five years preceding the NDHS survey. Bivariate and multivariable logistic regression analyses were conducted to assess the relationship between SBI and associated factors. Prevalence rates were analysed and presented using map and chart to highlight regional disparities. The overall prevalence of SBI in Nigeria was 51.6%. Older age was associated with a higher likelihood of optimal birth interval (AOR = 3.23, 95% confidence interval [CI]: 2.32–4.50, p  < 0.001). Women in the South East (55.3%) and North West (52.2%) regions had the highest prevalence of SBI, while the South West had the lowest (38.4%). South East had lower odds of optimal BI (AOR = 0.67, 95% CI: 0.59–0.75, p  < 0.001) compared to the North Central region. Higher education (AOR = 0.85, 95% CI: 0.74–0.99, p  = 0.03) was associated with reduced odds of SBI, but wealth index did not show significant associations in the adjusted analysis. This study highlights significant regional disparities in short birth interval SBI in Nigeria. Interventions addressing regional and educational disparities, particularly in underserved regions, are essential for promoting optimal birth intervals and improving maternal and child health outcomes.

Background We aimed to comprehensively analyze the impact of both maternal age and birth spacing on adverse maternal and neonatal outcomes. Methods A total of 151,301 pregnancies in China from January 1, 2010, to December 31, 2021 were included, and 8,222 subjects matched their primary and second pregnancy information. Join point regression was used to analyze the temporal trends of adverse outcomes with maternal age and birth spacing. Results The mean maternal age at delivery rose from 27.1 years to 28.5 between 2010 and 2021, and the average annual percentage change in advanced maternal age (≥ 35 years) was 1.2%. The optimal childbearing age (with the fewest adverse outcomes) appears to be 27 years. Compared with women aged 27 years, both those aged < 27 years and those aged > 27 years exhibited a significantly higher risk of anemia, low birth weight (LBW), preeclampsia, and preterm birth. In addition, we found that the optimal primiparous childbearing age was 26 years old and birth spacing was 3 years, < 3 years increased the risk of FGR, oligohydramnios, placenta previa, preeclampsia, LBW, preterm birth and premature rupture of membranes (PROM). While birth spacing > 3 years significantly increased the risks of anemia, gestational diabetes mellitus (GDM), placenta previa, preeclampsia, thyroid dysfunction (TD), preterm birth and PROM. The subgroup analysis revealed that the common adverse outcomes increased with longer birth spacing in pregnant women < 26 years, while these adverse outcomes showed lowest prevalence rates at 3-year birth spacing in pregnant women > 26 years. Conclusions The age of childbearing continues to be delayed, and we are in favor of having children at relatively optimal ages and spacing.

Background Short birth interval, defined as a birth-to-birth interval less than 33 months, is associated with adverse maternal and child outcomes. Evidence regarding the association of maternal socioeconomic status and short birth interval is inconclusive. Factors contributing to the socioeconomic inequality of short birth interval have also not been investigated. The current study assessed socioeconomic inequality in short birth interval and its contributing factors in Ethiopia. Methods Data from 8448 women collected in the 2016 Ethiopia Demographic and Health survey were included in the study. Socioeconomic inequality in short birth interval was the outcome variable. Erreygers normalized concentration index (ECI) and concentration curves were used to measure and illustrate socioeconomic-related inequality in short birth interval, respectively. Decomposition analysis was performed to identify factors explaining the socioeconomic-related inequality in short birth interval. Results The Erreygers normalized concentration index for short birth interval was − 0.0478 (SE = 0.0062) and differed significantly from zero ( P  < 0.0001); indicating that short birth interval was more concentrated among the poor. Decomposition analysis indicated that wealth quintiles (74.2%), administrative regions (26.4%), and not listening to the radio (5.6%) were the major contributors to the pro-poor socioeconomic inequalities in short birth interval. Conclusion There was a pro-poor inequality of short birth interval in Ethiopia. Strengthening the implementation of poverty alleviation programs may improve the population’s socioeconomic status and reduce the associated inequality in short birth interval.