Interpregnancy interval and adverse pregnancy outcomes among pregnancies following miscarriages or induced abortions in Norway (2008–2016): A cohort study

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dc.contributor.authorTessema, G.A.
dc.contributor.authorHåberg, S.E.
dc.contributor.authorPereira, G.
dc.contributor.authorRegan, A.K.
dc.contributor.authorDunne, J.
dc.contributor.authorMagnus, M.C.
dc.contributor.editorSmith, G.C.
dc.date.issued2022
dc.descriptionPublished: November 22, 2022
dc.description.abstractBackground: The World Health Organization recommends to wait at least 6 months after miscarriage and induced abortion before becoming pregnant again to avoid complications in the next pregnancy, although the evidence-based underlying this recommendation is scarce. We aimed to investigate the risk of adverse pregnancy outcomes—preterm birth (PTB), spontaneous PTB, small for gestational age (SGA) birth, large for gestational age (LGA) birth, preeclampsia, and gestational diabetes mellitus (GDM)—by interpregnancy interval (IPI) for births following a previous miscarriage or induced abortion. Methods and findings: We conducted a cohort study using a total of 49,058 births following a previous miscarriage and 23,707 births following a previous induced abortion in Norway between 2008 and 2016. We modeled the relationship between IPI and 6 adverse pregnancy outcomes separately for births after miscarriages and births after induced abortions. We used log-binomial regression to estimate unadjusted and adjusted relative risk (aRR) and 95% confidence intervals (CIs). In the adjusted model, we included maternal age, gravidity, and year of birth measured at the time of the index (after interval) births. In a sensitivity analysis, we further adjusted for smoking during pregnancy and prepregnancy body mass index. Compared to births with an IPI of 6 to 11 months after miscarriages (10.1%), there were lower risks of SGA births among births with an IPI of <3 months (8.6%) (aRR 0.85, 95% CI: 0.79, 0.92, p < 0.01) and 3 to 5 months (9.0%) (aRR 0.90, 95% CI: 0.83, 0.97, p = 0.01). An IPI of <3 months after a miscarriage (3.3%) was also associated with lower risk of GDM (aRR 0.84, 95% CI: 0.75, 0.96, p = 0.01) as compared to an IPI of 6 to 11 months (4.5%). For births following an induced abortion, an IPI <3 months (11.5%) was associated with a nonsignificant but increased risk of SGA (aRR 1.16, 95% CI: 0.99, 1.36, p = 0.07) as compared to an IPI of 6 to 11 months (10.0%), while the risk of LGA was lower among those with an IPI 3 to 5 months (8.0%) (aRR 0.84, 95% CI: 0.72, 0.98, p = 0.03) compared to an IPI of 6 to 11 months (9.4%). There was no observed association between adverse pregnancy outcomes with an IPI >12 months after either a miscarriage or induced abortion (p > 0.05), with the exception of an increased risk of GDM among women with an IPI of 12 to 17 months (5.8%) (aRR 1.20, 95% CI: 1.02, 1.40, p = 0.02), 18 to 23 months (6.2%) (aRR 1.24, 95% CI: 1.02, 1.50, p = 0.03), and ≥24 months (6.4%) (aRR 1.14, 95% CI: 0.97, 1.34, p = 0.10) compared to an IPI of 6 to 11 months (4.5%) after a miscarriage. Inherent to retrospective registry-based studies, we did not have information on potential confounders such as pregnancy intention and health-seeking bahaviour. Furthermore, we only had information on miscarriages that resulted in contact with the healthcare system. Conclusions: Our study suggests that conceiving within 3 months after a miscarriage or an induced abortion is not associated with increased risks of adverse pregnancy outcomes. In combination with previous research, these results suggest that women could attempt pregnancy soon after a previous miscarriage or induced abortion without increasing perinatal health risks.
dc.description.statementofresponsibilityGizachew A. Tessema, Siri E. Håberg, Gavin Pereir, Annette K. Regan, Jennifer Dunne, Maria C. Magnus
dc.identifier.citationPLoS Medicine, 2022; 19(11):e1004129-1-e1004129-19
dc.identifier.doi10.1371/journal.pmed.1004129
dc.identifier.issn1549-1277
dc.identifier.issn1549-1676
dc.identifier.orcidTessema, G.A. [0000-0002-4784-8151]
dc.identifier.urihttps://hdl.handle.net/2440/137081
dc.language.isoen
dc.publisherPublic Library of Science (PLoS)
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1195716
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1099655
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1173991
dc.rightsCopyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
dc.source.urihttps://doi.org/10.1371/journal.pmed.1004129
dc.subjectHumans
dc.subjectAbortion, Spontaneous
dc.subjectDiabetes, Gestational
dc.subjectFetal Growth Retardation
dc.subjectPremature Birth
dc.subjectInfant, Newborn, Diseases
dc.subjectPregnancy Outcome
dc.subjectAbortion, Induced
dc.subjectRetrospective Studies
dc.subjectCohort Studies
dc.subjectPregnancy
dc.subjectBirth Intervals
dc.subjectInfant, Newborn
dc.subjectFemale
dc.subject.meshHumans
dc.subject.meshAbortion, Spontaneous
dc.subject.meshDiabetes, Gestational
dc.subject.meshFetal Growth Retardation
dc.subject.meshPremature Birth
dc.subject.meshInfant, Newborn, Diseases
dc.subject.meshPregnancy Outcome
dc.subject.meshAbortion, Induced
dc.subject.meshRetrospective Studies
dc.subject.meshCohort Studies
dc.subject.meshPregnancy
dc.subject.meshBirth Intervals
dc.subject.meshInfant, Newborn
dc.subject.meshFemale
dc.titleInterpregnancy interval and adverse pregnancy outcomes among pregnancies following miscarriages or induced abortions in Norway (2008–2016): A cohort study
dc.typeJournal article
pubs.publication-statusPublished

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