Maternal and perinatal outcomes among women with short inter–pregnancy interval delivered at Muhimbili National Hospital, Tanzania

Abstract

Background: Pregnancy exposes a woman to physiological changes and increased demand to ensure adequate nutritional and oxygen supply to the growing fetus. Women should have an optimal time to recover from physiological stress of the preceding pregnancy and lactation before they conceive again. With regard to birth spacing, the Tanzanian standard antenatal clinic card (RCH4) indicates only an IPI of more than 10 years as a high risk pregnancy and does not consider short IPI as a high risk pregnancy despite having adverse pregnancy outcomes. Categorizing women with non-optimal IPI as high risk group is an important step to improve awareness of adherence to standard birth spacing. Objective: To compare maternal and perinatal outcomes of short inter-pregnancy interval and normal inter pregnancy interval among women delivered at Muhimbili National Hospital (MNH) Tanzania. Methods: This was a hospital based prospective cohort study conducted at MNH from July to December 2016. Parturient women aged 20 to 34 years with singleton pregnancy at ≥28 weeks of gestation and immediate preceding live birth, admitted in MNH labour ward were included in the study whereby 420 women and their newborns completed seven days postpartum follow up. Exposed group were 140 women and un-exposed group were 280 women. Non probability convenience sampling method was used to recruit study participants whereby each exposed woman who met the inclusion criteria was matched for age with two eligible unexposed women from the study population who met the inclusion criteria during study duration and delivered next to the exposed candidate. Structured questionnaire was used to collect information. Data analysis was done using SPSS software (IBM SPSS Statistics version 20.0) Results were summarized in form of proportions for categorical variables and in forms of mean and standard deviation for continuous variables. Chi square test was used to compare significance of association for categorical variables with a cut-off P value of less than 0.05; Binary logistic regression models were used to estimate the relative risk (RR) at 95% confidence interval for maternal and perinatal adverse outcomes across the two matched groups. Results: Compared with normal IPI, women with short IPI were at higher risk of having PPROM (RR 3; 95% CI 1.90-4.718), PROM (RR 2.58; CI 95% 1.578-4.229), preterm labour (RR 1.44; 95% CI 1.055-1.983) and HDP (RR 2.44; 95% CI 1.356-4.405). Newborns from women with short IPI were at increased risk of low birth weight (RR 2.74; 95% CI 1.986-3.778), prematurity (RR 2.82; 95% CI 1.974-4.029), low APGAR score at 5th minute (RR 1.78; 95% CI 1.280, 2.478) and perinatal deaths (RR 2.54; 95% CI 1.187-5.460). Conclusion: The findings suggest that, IPI less than 18 months was associated with poor maternal and perinatal outcomes compared with IPI 18 to 35 months.