Paternal factors associated with short interpregnancy interval

1. Rapid repeat pregnancy, or a short interpregnancy interval, was more likely when the father desired pregnancy but the mother did not.

2. Older age and poor outcome at first pregnancy were associated with short interpregnancy interval.

Evidence Rating Level: 3 (Average)

Study Rundown: Approximately half of all pregnancies in the U.S. are unintended, and many of these include repeat pregnancies. Current literature suggests that an interval of 18 to 24 months is associated with the lowest risk of neonatal and maternal morbidity, though guidelines recommend a longer interval of 2-5 years to permit replenishment of maternal mineral and nutrient stores. Nearly a third of births in the U.S. violate these recommendations and complications associated with short interpregnancy interval include preterm birth and placental abruption. Women who are unmarried, younger, multiparous, and of lower socioeconomic status and education level are known to be at increased risk for shorter interpregnancy intervals. Rapid repeat pregnancy is often due to inconsistent or non-use of contraceptives. In the present work, the authors evaluated the relationship between rapid repeat pregnancy and maternal and paternal intentions for repeat pregnancy and assessed concordance of these intentions. They found that discordant intentions, specifically paternal intention for repeat pregnancy, were associated with increased likelihood of a short interpregnancy interval.

Strengths included a large national study and accounting for potential confounders in statistical models. Weaknesses included cross-sectional data, social desirability bias from in-person interviews and limited generalizability to unpartnered women or those with multiple partners. Prospective studies to further evaluate the impact of parental pregnancy intentions on interpregnancy interval in order to better inform preventative efforts are needed.

Click to read the study in AJOG

Relevant Reading: Short interpregnancy intervals in the United States

In-Depth [cross-sectional study]: This study evaluated the association between interpregnancy interval and agreement between maternal and paternal family planning intentions in 3463 multiparous women. The primary outcome of interest was rapid repeat pregnancy, defined as less than 24 months between delivery and repeat conception.

A total of 49.4% of surveyed participants experienced rapid repeat pregnancy, and over one-third experienced unintended repeat pregnancy. A total of 15.5% of couples had discordant maternal and paternal pregnancy intentions. Paternal intention and maternal non-intention was associated with increased odds of rapid repeat pregnancy (OR 2.51, CI 1.45-4.35). Age ≤19 years at second pregnancy (OR 3.75, CI 2.93-4.78) and poor first pregnancy outcome (OR 3.65, CI 3.29-4.04) were associated with increased odds of rapid repeat pregnancy.

Image: PD

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