Interpregnancy and interbirth intervals and all-cause, cardiovascular-related and cancer-related maternal mortality: findings from a large population-based cohort study. Issue 11 (12th July 2020)

• Record Type: Journal Article
• Authors: Weisband, Yiska Loewenberg; Manor, Orly; Friedlander, Yechiel; Hochner, Hagit; Paltiel, Ora; Calderon-Margalit, Ronit
• Is Part Of: Journal of epidemiology and community health. Volume 74:Issue 11(2020)
• Page Start: 957
• Page End: 963
• Publication Date: 2020-07-12
• Subjects: MATERNAL HEALTH -- SOCIAL INEQUALITIES -- EPIDEMIOLOGY -- MIDWIFERY -- Lifecourse/ Childhood Circumstances; Public health -- Periodicals; Epidemiology -- Periodicals; 614.4
• DOI: 10.1136/jech-2020-214242
• Languages: English
• ISSNs: 0143-005X

Abstract

Abstract : Introduction: Scarce research is available regarding the association between interbirth intervals (IBI) and long-term maternal health outcomes, particularly cardiovascular disease (CVD) mortality. We aimed to assess whether IBIs were associated with all-cause, CVD-related and cancer-related mortality. Methods: We conducted a cohort study in the setting of the Jerusalem Perinatal Study. Women with at least two consecutive singleton live births in 1964–1976 (N=18 294) were followed through 2016. IBIs were calculated as the interval between women's first and second cohort birth. We estimated associations between IBIs and mortality using Cox's proportional hazards models, adjusting for age, parity, maternal education, maternal origin and paternal socioeconomic status. Date of last menstrual period was available for a subset of women. We assessed the interpregnancy interval (IPI) for these women and compared the models using IPI and IBI. Results: During 868 079 years of follow up (median follow-up: 49.0 years), 3337 women died. Women with IBIs <15 months had higher all-cause mortality rates (HR 1.18; 95% CI 1.05 to 1.33) compared to women with 33-month to 68-month IBIs (reference category). IBI and CVD mortality appeared to have a J-shaped association; IBIs of <15, 15–20, 21–2626–2632, 33–68 and ≥69 months had HRs of 1.44, 1.40, 1.33, 1.14, 1.00 and 1.30, respectively. No substantial association was found with cancer mortality. Models using IPIs and those using IBI were similar. Conclusion: Our results support the WHO recommendations for IPIs of ≥24 months and add additional evidence regarding long-term CVD mortality.