Does birth spacing affect maternal or child nutritional status? A systematic literature review

Abstract

This review addresses the question of whether a short birth interval is associated with adverse nutritional outcomes for the mother or the child. Indices of anthropometric status (maternal weight or body mass index; child growth) and micronutrient status (e.g. iron or vitamin A) were included as outcomes. A computerized search of all relevant papers published since 1966 was completed, and the 'snowball' method was used to identify additional relevant published or unpublished papers. In total, 57 papers were found to contain data regarding the relationship between birth spacing and nutritional outcomes (35 for child nutrition, 11 for maternal anthropometric status, and 11 for maternal anaemia or micronutrient status). Of these, 23 papers were excluded from further consideration because they did not include any multivariate analysis, leaving 34 papers that met the criteria for the review (22 for child nutrition, eight for maternal anthropometric status, and four for maternal anaemia or micronutrient status). The studies on child nutrition outcomes indicate that a longer birth interval is associated with a lower risk of malnutrition in some populations, but not all. In those countries in which the relationship was significant, the reduction in stunting associated with a previous birth interval >or=36 months ranged from approximately 10% to 50%. Some of this reduction may be due to residual confounding, i.e. to factors not included in the analysis (such as breastfeeding and maternal height). The studies on maternal anthropometric outcomes yielded mixed results. Because the nutritional burden on the mother between pregnancies depends on the extent of breastfeeding, the interpregnancy interval is not the best measure of whether the mother has had a chance to recover from the pregnancy, in terms of repleting her nutritional status. Therefore, some studies examined the 'recuperative interval' (duration of the non-pregnant, non-lactating interval) instead. Taken as a whole, the studies do not provide clear evidence of a link between interpregnancy or recuperative interval and maternal anthropometric status. This may be due, in part, to changes in the hormonal regulation of nutrient partitioning between the mother and the fetus when a mother is malnourished. Only four papers were identified that related to micronutrient status, three of which examined maternal anaemia. One study showed an increased risk for maternal anaemia when the interpregnancy interval was <6 months, but the analysis did not control for iron supplementation during pregnancy. The other two studies did not show a significant association between interpregnancy interval and maternal anaemia. One study of micronutrient status indicated no significant relationship between interpregnancy interval and maternal serum zinc, copper, magnesium, ferritin, folate or thyroid-stimulating hormone. Important methodological limitations were apparent in most of the studies. Thus, further research with more comprehensive control of potentially confounding variables is needed.

Determinants of reduced child stunting in Cambodia: analysis of pooled data from three Demographic and Health Surveys

“…A short interval between births can have an adverse effect on child nutrition by causing intrauterine growth retardation or undermining the quality of child care. 27 A reduction in the maternal use of tobacco also made a small contribution to the drop in stunting prevalence in Cambodia in the past decade. In our ‫الطفل.‬ ‫تغذية‬ ‫جمال‬ ‫يف‬ study, maternal smoking and tobacco chewing was significantly associated with child stunting at the individual level, as shown by previous studies in developing countries.…”

Anaemia among pregnant Palestinian women in the Occupied Palestinian Territory

“…It is now accepted that anaemia is not determined by the presence of a single risk factor but by interactions between groups of risk factors, such as poor Fe absorption due to inhibiting dietary substances such as tannins and phytates, high birth rates, short birth intervals, concurrent infections and genetic diseases (11) . There is still debate on the relationship between birth interval and anaemia (14,15) , although relevant correlations between anaemia and inter-pregnancy intervals shorter than 6 months (13,16) have been described. This is consistent with the findings of the present survey, where frequent pregnancy was correlated with increased anaemia prevalence.…”

Socioeconomic determinants of malnutrition among mothers in the Amoron’i Mania region of Madagascar: a cross-sectional study

“…Its involvement is linked to the ability and capacity of women with a better socio-economic status to eat well, create a healthy environment for the family and have better health [29]. Studies carried out in the world have identified other components of socioeconomic status that expose mothers to undernutrition such as a low level of education, early pregnancy, close pregnancy, high parity, and unmet specific needs in the event of breastfeeding [30][31][32][33]. The importance of each component may be different from one context to another and it must guide response interventions based on evidence.…”