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Aug. 7, 2003 (HealthDayNews)
Women who have their babies too close together
have an increased risk for complications, including premature
birth, low birth weight and even death of the baby.
This increased risk seems to exist independently of other risk
factors, such as a complicated first birth, young age and socioeconomic
status, report researchers in the Aug. 9 issue of the British
Medical Journal.
"It represents a true biological effect," says study author
Dr. Gordon Smith, a professor of obstetrics and gynecology
at Cambridge University in England.
Although the study does expand on certain aspects of the phenomenon,
most of the news is not new. "It's long been known that
short pregnancy intervals don't give the mother time to recover
her own nutritional status," says Dr. Maureen Malee, director
of maternal fetal medicine at the University of Miami School
of Medicine.
A woman's body needs time to recover in other ways as well,
even from a normal pregnancy. Many women are anemic after birth
because they lose blood, and few mothers are getting the requisite
eights hours of sleep a night plus three square meals a day. "Pregnancy
and delivery are a huge phenomenon, never mind the phenomenon
of trying to tackle the care of a newborn," Malee says.
Although recouping the mother's health is critical, other issues
also play a part.
Social factors are also involved. In general, women whose interval
between pregnancies was less than six months were more likely
to be less than 20 years old, to smoke and to live in a poor
area. "Most moms that are single, smoke and have a low
socioeconomic status are not going to get prenatal care," says
Dr. Jonathan Muraskas, director of neonatal perinatal medicine
at Loyola University Medical Center in Chicago.
Smith and his colleagues wanted to try to sift these independent
factors out, something previous studies had not done.
The research team excluded women who had had a complicated
first birth, concentrating only on those who had had a normal
first birth. They used data from the health records of 89,143
women in Scotland who had given birth a second time between
1992 and 1998. All of the women had conceived the second child
within five years of the first.
Women who had conceived within six months of the first, normal
birth were more than two times as likely to give birth to an
extremely premature baby (24 to 32 weeks), 60 percent more
likely to give birth to a "moderately preterm" birth
(33 to 36 weeks), and the baby was more than three and a half
times more likely to die at birth.
And these risk factors existed independent of age, socioeconomic
status and whether or not the mother smoked. In other words,
married nonsmokers over the age of 25 who had conceived within
six months of a prior birth also had an increased risk over
women in the same group who had had a longer time interval
between pregnancies.
The findings do seem to make an argument for birth control.
"Everybody will start ovulating at a different time
[after birth]," Malee
says. "I certainly don't want to put you in the precarious
position of being reproductively vulnerable when you have yet
to recover the consequences of you most recent delivery."
And the study may persuade some to review long-standing practices. "We
do counsel people on birth control from a social perspective
but we haven't brought in the biological aspect because there
hasn't been any data," says Dr. Ralph Dauterive, chief
of obstetrics and gynecology at the Ochsner Clinic Foundation
in New Orleans. "This may change the way we bring that
up."
© 2003 The Atlanta Journal-Constitution
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Childbirth