The effects of birth spacing after cesarean delivery on pregnancy
outcomes: a retrospective cohort study
Abstract
Objective: To examine the relationship between interpregnancy interval
(IPI) after previous cesarean section (CS) and perinatal outcomes.
Design: Retrospective cohort study. Setting: West China Second
University Hospital, Sichuan University, China. Population: A total of
1854 women with a history of CS who delivered from January 2016 to
December 2016. Methods: With an IPI of 24-59 months as the reference,
the associations between various IPIs (<24, 60-119, and ≥120
months) and perinatal outcomes were examined by multivariate logistic
regression analysis with multiple models. Main outcome measures: Adverse
maternal and fetal outcomes of different IPIs after CS. Results: IPI
<24 months significantly increased the risk of anemia in late
pregnancy (aOR 2.09, 95% CI 1.21-2.62, p = 0.008). IPI <24
months was associated with a higher risk for incomplete uterine rupture
(OR 1.30, 95% CI 1.05-1.61), IPI ≥60 months was related to a lower risk
for incomplete uterine rupture (IPI = 60-119 months: OR 0.77, 95% CI
0.62-0.95; IPI ≥120 months, OR 0.59, 95% CI 0.38-1.08), and women with
IPI ≥120 months were more likely to develop gestational hypertension
(GHP) (p = 0.036) and gestational diabetes mellitus (GDM) (p = 0.001).
These effects became nonsignificant after adjusting possible
confounders. Conclusion: IPI <24 months is associated with a
higher risk for anemia in late pregnancy. IPI may combine with other
factors to affect GHP, GDM, and uterine rupture in the subsequent
pregnancy after previous CS. Funding: National Natural Science
Foundation of China (No. 81571465). Keywords: Adverse pregnancy
outcomes, Birth spacing, Cesarean delivery.