Association between interpregnancy interval and pregnancy complications in multiparas / 中华围产医学杂志

Objective:To explore the influence of interpregnancy interval (IPI) on pregnancy complications in multiparas.Methods:This was a retrospective cohort study involving 7 669 singleton parturients who delivered at ≥28 gestational weeks in the Affiliated Hospital of Southwest Medical University between December 2015 and December 2020 and had given birth in the third trimester before. Clinical data were collected, including the baseline characteristics, pregnancy complications, gestational weeks at delivery, and neonatal birth weight. According to the IPI, these women were divided into five groups: <12 months ( n=350), 12-<24 months ( n=945), 24-<60 months ( n=2 544), 60-<120 months ( n=2 478), and ≥120 months ( n=1 352). Based on the recommendation of the World Health Organization, pregnant women with an IPI of 24-<60 months were the control group. A multivariate logistic model was used to adjust for confounders and calculate the risks of pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). The influences of maternal age and previous delivery mode on the associations between IPI and maternal complications were analyzed. Analysis of variance (ANOVA), Chi-square test, and Cochran-Mantel-Haenszel Chi-square test were used for statistical analysis. Results:Compared with the control group, the incidence of GDM and HDP increased in the 60-<120 months group ( OR=1.23, 95% CI: 1.01-1.48 and OR=1.47, 95% CI: 1.13-1.92) and ≥120 months group ( OR=1.37, 95% CI:1.07-1.78 and OR=1.92, 95% CI: 1.39-2.64); the risks of uterine rupture/postpartum hemorrhage and placental abruption increased in the <12 months group ( OR=1.54, 95% CI: 1.01-2.34) and 12-<24 months group ( OR=2.38 95% CI: 1.13-5.02), respectively. In the 60-<120 months group, the risk of GDM increased only in non-elderly women (adjusted OR=1.71, 95% CI: 1.36-2.14), so did the risks of GDM and HDP in the ≥120 months group (adjusted OR=3.11, 95% CI: 2.10-4.62 and adjusted OR=1.81, 95% CI: 1.12-2.91). Among women who had undergone a previous cesarean section, the risk of GDM increased in the ≥120 months group (adjusted OR=1.35, 95% CI: 1.00-1.81). In the 60-<120 months group and ≥120 months group, the risk of HDP increased in postpartum women (adjusted OR=1.79, 95% CI: 1.08-2.95 and adjusted OR=3.32, 95% CI: 1.91-5.77). Conclusion:IPI≥60 months is a risk factor for GDM and HDP, and the associations between IPI and maternal complications are influenced by maternal age.

Effect of birth interval on maternal and infant outcomes in patients with gestational diabetes mellitus / 中华围产医学杂志

Objective:To investigate the effects of birth intervals on maternal and infant outcomes in pregnant women with gestational diabetes mellitus (GDM).Methods:This retrospective study recruited 445 pregnant women with GDM who received prenatal examinations and delivered in Peking University First Hospital-Ningxia Women Children's Hospital from January 2020 to December 2021. Based on the birth interval classification standard recommended by WHO and the American College of Obstetricians and Gynecologists, these subjects were divided into three groups: shorter group (<18 months, n=69), normal group (18-59 months, n=213) and longer group (≥60 months, n=163). Analysis of variance, Chi-square test, and multivariate logistic regression model were used for statistical analysis. Results:There were statistically significant differences in the maternal age at this and previous pregnancy [(30.6±4.1), (30.8±3.8) vs (32.7±3.7) years; (22.7±2.4), (26.3±2.9) vs (29.9±4.1) years] and the incidence of oligohydramnios [10.1% (7/69), 1.9% (4/213) vs 3.1% (5/163)] and preterm birth [14.5% (10/69), 5.2% (11/213) vs 1.8% (3/163)] between the shorter, normal, and longer groups (all P<0.05). After adjusting for confounding factors in the present pregnancy, the risks of oligohydramnios, preterm birth, and low birth weight increased in the shorter group [ OR (95% CI): 4.73 (1.75-12.85), 5.54 (1.37-22.42) and 9.54 (3.05-29.82), all P<0.05] and so did the risk of postpartum hemorrhage in the longer group [ OR (95% CI): 4.45 (1.72-11.49), P<0.05]. Conclusions:Both longer and shorter birth intervals can affect maternal and infant outcomes of GDM patients. Postpartum healthcare should be strengthened for GDM patients who desire more children to help them maintain an appropriate birth interval, thus promoting maternal and infant health.

Effect of birth spacing on the pelvic floor type Ⅰ and type Ⅱ fiber muscle strength of postpartum women with parities of two in different delivery modes / 中华妇产科杂志

Objective:To speculate the effect of birth spacing on the pelvic floor type Ⅰ and Ⅱ fiber muscle strength of postpartum women with parities of two in different delivery modes.Methods:Totally 2 361 parturients who were investigated in Xuzhou Central Hospital from June 2016 to December 2020 were included in the questionnaire, clinical examination and pelvic floor surface electromyography assessment. According to the interval years between two parities and the pelvic floor typeⅠ and Ⅱ fiber muscle strength under different modes of delivery, curve fitting function equation was performed using curve regression method. The accuracy of the equation was verified by the receiver operating characteristic curve and the maximum area under the curve, and calculating the relative error rate.Results:A total of 2 357 parturients were included in the study and were divided into 4 groups based on delivery modes, women with both normal vaginal delivery were assigned to group A (589 cases); women with a first vaginal delivery and a second cesarean section were assigned to group B (480 cases); women with both cesarean deliveries were assigned to group C (1 273 cases); women with a first cesarean section and a second vaginal delivery were assigned to group D (15 cases). All of the curve fitting results were quadratic curves, and the appropriate interval years were selected when the muscle strength of type Ⅰ muscle fibers was>35 μV and that of type Ⅱ muscle fibers was>40 μV: 6-8 years in the group A, 5-10 years in the group B, and 1-11 years in the group C. The peak values of the quadratic curve were as follows: 7-8 years in the group A, 7-8 years in the group B, and 6 years in the group C. The maximum area under the curve of the function equations were all>0.6 (all P<0.05), the average relative error rate was 4.909%. Conclusions:The pelvic floor function of postpartum women with parities of two increases firstly and then decreases over time, showing a quadratic curve shape. In order to protect the pelvic floor function, the appropriate interval of birth spacing is 6-8 years.

Intervalo de nacimiento entre gemelos como determinante del resultado neonatal precoz / Inter-twin delivery interval as a determinant of early neonatal outcome

INTRODUCCIÓN Y OBJETIVOS: La mayoría de las sociedades científicas recomiendan el parto vaginal del segundo gemelo siempre que el primer gemelo esté en presentación cefálica. En estos casos existe controversia cuánto tiempo transcurrido entre el parto de ambos es determinante en el resultado adverso del segundo gemelo. El objetivo de este estudio es examinar cómo influye dicho intervalo en el resultado perinatal precoz en nuestro Centro y el coste de las estancias neonatales y maternas. MÉTODOS: Estudio de cohortes retrospectivo entre mayo de 2014 y diciembre de 2018. Se comparó el resultado neonatal adverso estableciendo puntos de corte de intervalo entre el nacimiento de 10 y 30 minutos. Así mismo, se examinó la relación de otras variables del parto con el desenlace neonatal y se calcularon los costes de las estancias neonatales y maternas. RESULTADOS: Se incluyeron 128 partos gemelares vaginales asistidos en el Hospital Universitario Nuestra Señora de la Candelaria. Se evidenció triple tasa de resultado neonatal adverso en el grupo de más de 10 minutos (p=0,026 y OR 2,4) y tres veces peor en el de más de 30 minutos (p=0,013 y OR 6,4). Se obtuvo una correlación lineal negativa significativa entre el intervalo intergemelar y el pH umbilical. La prematuridad y el bajo peso al nacer fueron predictores de un mal desenlace neonatal. CONCLUSIONES: No parece recomendable que el intervalo intergemelar se prolongue más allá de los 30 minutos. Es seguro recomendar el parto vía vaginal en gestaciones gemelares siempre que el primero esté en presentación cefálica.

INTRODUCTION AND OBJECTIVES: Most scientific societies recommend vaginal delivery of the second twin when the first twin is in cephalic presentation. In these cases, there is controversy over how much inter-twin interval is decisive in the adverse outcome of the second twin. The aim of this study is to examine whether inter-twin delivery interval affects immediate perinatal outcome and the cost of neonatal and maternal stays. METHODS: Retrospective cohort study including 128 twin vaginal births attended in the Hospital Universitario Nuestra Señora de la Candelaria between May 2014 and December 2018. We compared the presence of composite adverse neonatal outcome by establishing interval cut-off points between birth of 10 and 30 minutes. Likewise, the relationship of other delivery associated variables with neonatal outcome was examined. Health care costs were calculated. RESULTS: There was a higher rate of composite adverse neonatal outcome in the 10 minute-group (p = 0.026, OR 2.4) and three times higher in the 30 minute-group (p = 0.013, OR 6.4). A significant negative linear correlation was obtained between birth interval and umbilical artery pH. Prematurity and low birth weight were predictors of a poor neonatal outcome. CONCLUSION: Our data suggests that inter-twin delivery interval shouldn't be prolonged beyond 30 minutes. Vaginal delivery is a safe option in twin gestations providing the first twin is in a cephalic presentation, regardless of the second twin presentation.

The obstetric outcomes of multiparous pregnancies with advanced maternal age in different inter-pregnancy intervals / 中国医师杂志

Objective To investigate obstetric outcomes of multiparous pregnancies with advanced maternal age in different inter-pregnancy intervals.Methods A retrospective study was performed in 222 multiparous pregnancies with advanced maternal age from January 1 st 2016 to December 31 st 2016.According to the inter-pregnancy intervals,all cases were divided into four groups:Group A (1-3 years),group B (4-6 years) group C (7-9 years) and group D (≥10 years).The clinical characteristics,complications during pregnancy,maternal and fetal outcomes and duration of labor were compared and analyzed in the four groups.Results The average age of groups was significantly different (P ≤ 0.001).But there was no significant difference in the rate of oxytocin (P =0.465),incidence of gestational diabetes mellitus (P =0.698),pregnancy-induced hypertension (P =0.158),premature rupture of membrane (P =0.542)and postpartum hermorrhege (P =0.124) among the four groups.A total of 212 pregnancies underwent vaginal delivery.In group A,the first stage of labor last (239.16 ± 137.63) min,which was significantly shorted than that in group B [(296.36 ± 124.56) min],group C [(332.81 ± 181.01) min] and group D [(337.19 ±224.02)min,P =0.030].However,the interval of delivery did not prolong the second (P =0.137) and third stage of labor (P=0.079).The neonatal birth weight (P =0.276) and the neonatal sex (P =0.918),as well as admission of neonatal intensive care unit (NICU,P =0.103),were similar among three groups.The rate of neonatal asphyxia in group A and group D was higher than that in group B and group C (P =0.021).Conclusions Although the second and third stage were similar among multiparous pregnancies with advanced maternal age,the first stage of labor last longer in the longer inter-pregnancy interval.Furthermore,the risk of neonatal asphyxia was higher in women with inter-pregnancy interval ≤ 3 years or ≥ 10 years.

Periodo intergenésico: Revisión de la literature / Intergenesis period: Literature review

RESUMEN ANTECEDENTES: El período intergenésico es importante para la planificación de embarazos subsecuentes a partos, cesáreas y abortos. Actualmente existe falta de consenso en cuanto a las definiciones e importancia clínica de la duración del periodo intergenésico; por lo que se realiza esta revisión de la literatura para definir conceptos. MÉTODO: Se realizó una búsqueda bibliográfica en Pubmed y Medline, con periodo de búsqueda del 19992017, con el propósito de identificar publicaciones de relevancia relacionadas a periodo intergenésico. RESULTADOS: Entre los artículos seleccionados, se incluyeron de tipo revisión, originales y guías de práctica clínica. Se considera periodo intergenésico aquel que se encuentra entre la fecha del último evento obstétrico y el inicio del siguiente embarazo. Se sugiere como tiempo recomendado de espera para iniciar un siguiente embarazo mínimo 18 meses (Periodo intergenésico corto, PIC) y no más de 60 meses (Periodo intergenésico largo, PIL), para reducir el riesgo de eventos adversos maternos, perinatales y neonatales. Se debe enfatizar que aunque la dehiscencia de histerorrafia es una grave complicación del PIC menor a 6 meses posterior a una cesárea, no es su única complicación. De igual manera es importante tomar en cuenta el PIL durante la evaluación obstétrica, debido a su asociación con preeclampsia. CONCLUSIONES: Es relevante conocer la terminología adecuada en período intergenésico para evitar complicaciones asociadas a PIC como a PIL. Existe necesidad de estudios clínicos sobre período intergenésico que permitan conocer más consecuencias a corto y largo plazo en nuestra población y tomar medidas para mejorar el desenlace materno-fetal.

ABSTRACT BACKGROUND: Interpregnancy interval is a topic of importance when planning new pregnancies after previous vaginal delivery, cesarean section or abortion. There is currently a lack of consensus in terms of definitions and the clinical importance of interpregnancy interval length, which is the reason to perform a literature review to clarify concepts. METHODS: Published papers from 1999 to 2017 from PubMed/MEDLINE were searched with the purpose of identifying those related to interpregnancy interval. Review articles, original papers, and clinical guidelines in relation to short and long interpregnancy interval were considered. RESULTS: Interpregnancy interval is defined as the period between the last obstetric event and the beginning of the next pregnancy (last menstrual period). Recommended time to initiate the next pregnancy must be at least 18 months (short interpregnancy interval, SII) and no more than 60 months (long interpregnancy interval, LII) to reduce the risk of adverse maternal, perinatal and neonatal outcomes. It is important to emphasize that even though uterine scar dehiscence is a serious complication of SII less than 6 months after a cesarean section, it is not the only complication. It is important to consider LII during obstetric evaluation, due to its association with preeclampsia. CONCLUSION: It is clinically relevant to know the correct definitions of SII and LII to avoid their complications. There is also a need for clinical trials about interpregnancy interval within our population in order to better understand the consequences of SII and LII, thus taking the necessary measures to improve maternal and fetal outcomes.

Estudio de factores obstétricos, nutricionales y hormonales y su influencia en el desarrollo de cáncer de mama / Association between obstetric factors, hormone levels and nutritional status with the development of breast cancer

Background: Recent studies suggest that the age at first pregnancy, number of children and the lapse between births may protect against breast cancer. Furthermore, serum levels of estrogen, prolactin and progesterone appear to contribute to the development of this tumors in obese women. Aim: To verify whether the variables age at first pregnancy, number of children, birth interval, hormone levels and nutritional status are associated with the age at diagnosis of breast cancer. Material and Methods: Retrospective analysis of medical records of550female patients, diagnosed and treated for breast cancer at a hospital in Spain between 2009 and 2012. Results: We found a significant and positive association between age at diagnosis of cancer and the variables age at first pregnancy, parity and interval between pregnancies. There was also a significant correlation (p < 0.000) between serum levels of estrogen, prolactin and progesterone and nutritional status of patients. Conclusions: In this sample, age at first pregnancy or number of children, hormone levels and nutritional status are related to the age of onset of cancer.

Contracepção no puerpério: [revisão] / Postpartum contraception: [review]

Uma adequada contracepção no puerpério é recomendada para prevenir morbidades maternas e infantis. Os benefícios materno-fetais da lactação são indiscutíveis e a amamentação exclusiva em pacientes amenorréicas é um método contraceptivo eficaz. No entanto, o reinício da fertilidade é variável entre as mulheres e deve-se considerar que o acesso ao serviço de saúde em muitas regiões não é garantido, comprometendo a prescrição de um método eficaz, quando ocorre o retorno dos ciclos ovulatórios. Foram pesquisados no Medline (PubMed) os artigos relacionados ao tema publicados entre 1971 e abril de 2008 e selecionados os artigos relevantes na literatura sobre contracepção no puerpério. Curtos intervalos intergestacionais aumentam complicações maternas e fetais, portanto uma contracepção eficaz no puerpério é imperiosa. O ideal é que o método prescrito seja eficaz e seguro (não interfira na lactação e nem altere o sistema hemostático). Apesar do método contraceptivo da lactação-amenorréia representar um método eficaz de prevenção de gestação, o retorno à fertilidade é impreciso. Em populações de risco para intervalo intergestacional curto e/ou acesso difícil ao serviço de saúde, outros métodos deverão ser associados após seis semanas, como os não hormonais ou os de progestagênios isolados, podendo ser utilizados antes em situações especiais.

Adequate postpartum contraception is recommended in order to prevent mother and infant morbidity. The mother-infant benefits of lactation are well recognized, and exclusive, regular and frequent breastfeeding is an effective contraceptive method for amenorrheic patients. However, the resumption of fertility varies among women and access to health services is not guaranteed in many regions of the world. We searched the articles in Medline (PubMed) related to the subject published between 1971 to April 2008 and selected the most relevant articles in the literature about postpartum contraception. Short interpregnancy intervals increase maternal and fetal complications and therefore effective postpartum contraception is imperative. The ideal method prescribed should be effective and safe, id est, should not interfere with lactation or alter the hemostatic system. During the postpartum period, ideally non-hormonal methods should be used because they do not alter lactation or hemostasis. However, in populations with difficult access to health or with an early start of calorie supplementation to the newborn, the option should be for progestogens-only contraceptives, ideally initiated after six weeks or earlier in special situations.