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Pregnancies Risky When Too Close Together

Study finds complications likelier without a respite

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THURSDAY, 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."

More information

For more on pregnancy and childbirth, visit or do a search at the American College of Obstetricians and Gynecologists.

SOURCES: Gordon Smith, M.D., professor, obstetrics and gynecology, Cambridge University, Cambridge, U.K.; Maureen Malee, M.D., Ph.D., director, Maternal Fetal Medicine, University of Miami School of Medicine; Jonathan Muraskas, M.D., professor and director, neonatal perinatal medicine, Loyola University Medical Center, Chicago; Ralph Dauterive, M.D., chief, obstetrics and gynecology, Ochsner Clinic Foundation, New Orleans; Aug. 9, 2003, British Medical Journal
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