Nutritional stress of reproduction, A cohort study over two consecutive pregnancies

Khan, Khalid S.; Chien, Patrick; Khan, Neelofur Babar

doi:10.1034/j.1600-0412.1998.770407.x

Cited by 17 publications

(10 citation statements)

References 20 publications

(35 reference statements)

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“…12 One hypothesis is that maternal nutritional depletion through close succession of pregnancies and lactations arising because of insufficient time for replenishment may increase the risk of adverse offspring outcomes. 19 For example, the lack of replenishment of the physiological depletion of folate that occurs in pregnancy and lactation may lead future pregnancies to be conceived under a state of folate deficiency, thereby increasing the risks of neural tube defects, fetal growth restriction, and preterm birth. 20…”

Section: Discussionmentioning

confidence: 99%

Interpregnancy interval and perinatal outcomes across Latin America from 1990 to 2009: a large multi‐country study

Mignini

Carroli

Betrán

et al. 2015

BJOG

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ObjectiveTo determine the relationship of interpregnancy interval with maternal and offspring outcomes.DesignRetrospective study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Uruguay.SettingLatin America, 1990–2009.PopulationA cohort of 894 476 women delivering singleton infants.MethodsDuring 1990–2009 the Perinatal Information System database of the Latin American Centre for Perinatology identified 894 476 women with defined interpregnancy intervals: i.e. the time elapsed between the date of the previous delivery and the first day of the last normal menstrual period for the index pregnancy. Using the interval 12–23 months as the reference category, multiple logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) of the association between various interval lengths and maternal and offspring outcomes.Main outcome measuresMaternal death, pre‐eclampsia, eclampsia, puerperal infection, fetal death, neonatal death, preterm birth, and low birthweight.ResultsIn the reference interval there was 0.05% maternal death, 1.00% postpartum haemorrhage, 2.80% pre‐eclampsia, 0.15% eclampsia, 0.28% puerperal infection, 3.45% fetal death, 0.68% neonatal death, 12.33% preterm birth, and 9.73% low birthweight. Longer intervals had increased odds of pre‐eclampsia (>72 months), fetal death (>108–119 months), and low birthweight (96–107 months). Short intervals of <12 months had increased odds of pre‐eclampsia (aOR 0.80; 95% CI 0.76–0.85), neonatal death (aOR 1.18; 95% CI 1.08–1.28), and preterm birth (aOR 1.16; 95% CI 1.11–1.21). Statistically, the interval had no relationship with maternal death, eclampsia, and puerperal infection.ConclusionsA short interpregnancy interval of <12 months is associated with pre‐eclampsia, neonatal mortality, and preterm birth, but not with other maternal or offspring outcomes. Longer intervals of >72 months are associated with pre‐eclampsia, fetal death, and low birthweight, but not with other maternal or offspring outcomes.Tweetable abstractA short interpregnancy interval of <12 months is associated with neonatal mortality and preterm birth.

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Section: Discussionmentioning

confidence: 99%

Interpregnancy interval and perinatal outcomes across Latin America from 1990 to 2009: a large multi‐country study

Mignini

Carroli

Betrán

et al. 2015

BJOG

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“…Nine studies examined the association between birth spacing and maternal anthropometric outcomes (Greene et al 1988;Miller and Huss-Ashmore 1989;Merchant, Martorell, andHaas 1990a and1990b;Farahati, Bozorgi, and Luke 1993;Pebley and DaVanzo 1993;Winkvist et al 1994;Herman and Yu 1997;Khan, Chien, and Khan 1998). Three used interpregnancy interval, two used birth interval, three used recuperative interval, and one used both interpregnancy and recuperative interval as measures of birth spacing.…”

Section: Maternal Nutritional Depletionmentioning

confidence: 99%

“…Greene and colleagues (1988) and Merchant, Martorell, and Haas (1990a) found that long interpregnancy or recuperative intervals were associated with greater weight gain between pregnancies or with greater maternal anthropometric measures. Merchant, Martorell, and Haas (1990b) and Khan, Chien, and Khan (1998) reported that short recuperative or birth intervals were significantly associated with reduced maternal fat stores or with a negative change in postpartum maternal weight and body mass index.…”

Section: Maternal Nutritional Depletionmentioning

confidence: 99%

“…Seven studies evaluated the relationship between interpregnancy or birth intervals and maternal anemia, hemoglobin concentration, or iron deficiency (Khan, Chien, and Khan 1998;Singh, Fong, and Arulkumaran 1998;Conde-Agudelo and Belizan 2000;Dairo and Lawoyin 2004;Pathak et al 2004;Razzaque et al 2005;Uche-Nwachi et al 2010). One study controlled for prophylactic iron supplementation during pregnancy (Singh, Fong, and Arulkumaran 1998).…”

Section: Maternal Nutritional Depletionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Birth Spacing on Maternal, Perinatal, Infant, and Child Health: A Systematic Review of Causal Mechanisms

Conde-Agudelo

Rosas-Bermúdez

Castaño³

et al. 2012

Studies in Family Planning

428

441

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This systematic review of 58 observational studies identified hypothetical causal mechanisms explaining the effects of short and long intervals between pregnancies on maternal, perinatal, infant, and child health, and critically examined the scientific evidence for each causal mechanism hypothesized. The following hypothetical causal mechanisms for explaining the association between short intervals and adverse outcomes were identified: maternal nutritional depletion, folate depletion, cervical insufficiency, vertical transmission of infections, suboptimal lactation related to breastfeeding-pregnancy overlap, sibling competition, transmission of infectious diseases among siblings, incomplete healing of uterine scar from previous cesarean delivery, and abnormal remodeling of endometrial blood vessels. Women's physiological regression is the only hypothetical causal mechanism that has been proposed to explain the association between long intervals and adverse outcomes. We found growing evidence supporting most of these hypotheses.

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“…The mechanism of the adverse effects of short pregnancy intervals has not been established, but the leading theory involves the incomplete restoration of the mother's physiologically critical nutrient reserves that are depleted during the course of pregnancy (Khan et al 1998). …”

Section: Discussionmentioning

confidence: 99%

Inter-pregnancy folate and iron status of women in an inner-city population

Doyle

Srivastava²,

Crawford

et al. 2001

Br J Nutr

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The purpose of the present study was to evaluate whether micronutrient supplementation improved the nutritional status of women with poor diets during the inter-pregnancy interval. Fifty-five women who had given birth to a low birth weight baby (,2´5 kg), and who planned to have a further pregnancy, were recruited to a prospective randomised study in East London, UK. Of the fifty-five mothers recruited, forty-four (78 %) met fewer than four of sixteen dietary reference values according to the information provided in a 7 d diet diary, and were categorised as having an`inadequate' diet. Half of the mothers in the`inadequate'-diet group were randomly assigned to receive a micronutrient and a single cell oil supplement containing docosahexaenoic acid. All participants received dietary advice based on analysis of their diet diaries, and general lifestyle advice on preparing for pregnancy. Mothers had a blood sample taken at 3 and 9 months post-partum to measure their folate, Fe stores and fatty acid status. Mean serum and erythrocyte folate levels increased significantly between 3 and 9 months post-partum in both the adequate-diet group and the supplemented group. At 9 months post-partum, over half of the unsupplemented, inadequate-diet group remained severely deficient in folate (serum folate ,230 nmol/l) and had low serum ferritin levels (,15 mg/l). The high prevalence of inadequate diets in this inner-city population and the low motivation of women to participate in a nutrition programme suggests that consideration should be given to the provision of free folate and Fe supplements to all women in this and similar populations, or at least to women who have delivered a low birth weight baby, who plan further pregnancies.

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Nutritional stress of reproduction, A cohort study over two consecutive pregnancies

Cited by 17 publications

References 20 publications

Interpregnancy interval and perinatal outcomes across Latin America from 1990 to 2009: a large multi‐country study

Interpregnancy interval and perinatal outcomes across Latin America from 1990 to 2009: a large multi‐country study

Effects of Birth Spacing on Maternal, Perinatal, Infant, and Child Health: A Systematic Review of Causal Mechanisms

Inter-pregnancy folate and iron status of women in an inner-city population

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