Effects of inter-pregnancy intervals on preterm birth, low birth weight and perinatal deaths in urban South Ethiopia: a prospective cohort study

BACKGROUND: Preterm birth, low birth weight and perinatal deaths are common adverse perinatal outcomes that are linked with each other, and a public health problems contributing to neonatal mortality, especially in developing countries. Although more than half of women in Ethiopia become pregnant within a short interval after the preceding childbirth, whether the short intervals increase the risk of adverse perinatal outcomes or not is understudied. We, therefore, aimed to assess the effects of inter-pregnancy intervals (IPIs) on the adverse perinatal outcomes. METHODS: A community-based prospective cohort study was conducted among 2578 pregnant women in urban South Ethiopia. Pregnant women with IPIs < 24 months (IPIs < 18 and 18-23 months) were exposed groups, and those with IPI 24-60 months were the unexposed group. A multilevel analysis (mixed-effects) was done to estimate the effect of IPIs on preterm birth and low birth weight, and a generalized linear model for a binary outcome (fixed-effect) was done for perinatal deaths, using a 95% confidence level. RESULTS: In this study, IPI < 18 months found to increase the risk of preterm birth (Adjusted Relative Risk (ARR) = 1.35, 95% CI: 1.02, 1.78), term low birth weight (ARR = 2.20, 95% CI: 1.35, 3.58) and perinatal deaths (ARR = 3.83, 95% CI: 1.90, 7.71) than 24-60 months. The results suggest that, about 9% of preterm birth, 21% of term low birth weight and 41% of perinatal deaths in the study population were attributed to IPI < 18 months. These could be prevented with the removal of the IPI < 18 months in the study population. IPI 18-23 months has shown no effect on the three adverse perinatal outcomes. CONCLUSION: This study has shown that, IPI under 18 months has a higher risk of adverse perinatal outcomes than IPI 24-60 months. Due attention should still be given for spacing pregnancies.