Interpregnancy interval and adverse pregnancy outcomes among pregnancies following miscarriages or induced abortions in Norway (2008–2016): A cohort study

Abstract

Background The World Health Organization recommends to wait at least 6 months after miscarriage and induced abortion before becoming pregnant again to avoid complications in the next pregnancy, although the evidence-based underlying this recommendation is scarce. We aimed to investigate the risk of adverse pregnancy outcomes—preterm birth (PTB), spontaneous PTB, small for gestational age (SGA) birth, large for gestational age (LGA) birth, preeclampsia, and gestational diabetes mellitus (GDM)—by interpregnancy interval (IPI) for births following a previous miscarriage or induced abortion. Methods and findings We conducted a cohort study using a total of 49,058 births following a previous miscarriage and 23,707 births following a previous induced abortion in Norway between 2008 and 2016. We modeled the relationship between IPI and 6 adverse pregnancy outcomes separately for births after miscarriages and births after induced abortions. We used log-binomial regression to estimate unadjusted and adjusted relative risk (aRR) and 95% confidence intervals (CIs). In the adjusted model, we included maternal age, gravidity, and year of birth measured at the time of the index (after interval) births. In a sensitivity analysis, we further adjusted for smoking during pregnancy and prepregnancy body mass index. Compared to births with an IPI of 6 to 11 months after miscarriages (10.1%), there were lower risks of SGA births among births with an IPI of 12 months after either a miscarriage or induced abortion (p > 0.05), with the exception of an increased risk of GDM among women with an IPI of 12 to 17 months (5.8%) (aRR 1.20, 95% CI: 1.02, 1.40, p = 0.02), 18 to 23 months (6.2%) (aRR 1.24, 95% CI: 1.02, 1.50, p = 0.03), and ≥24 months (6.4%) (aRR 1.14, 95% CI: 0.97, 1.34, p = 0.10) compared to an IPI of 6 to 11 months (4.5%) after a miscarriage. Inherent to retrospective registry-based studies, we did not have information on potential confounders such as pregnancy intention and health-seeking bahaviour. Furthermore, we only had information on miscarriages that resulted in contact with the healthcare system. Conclusions Our study suggests that conceiving within 3 months after a miscarriage or an induced abortion is not associated with increased risks of adverse pregnancy outcomes. In combination with previous research, these results suggest that women could attempt pregnancy soon after a previous miscarriage or induced abortion without increasing perinatal health risks. In a Norwegian cohort study, Dr Gizachew Tessema and colleagues investigate the association between interpregnancy interval and adverse pregnancy outcomes, among pregnancies following miscarriages or induced abortions. Author summary Why was this study done? The World Health Organization recommends to wait at least 6 months after miscarriage and induced abortion before becoming pregnant again to avoid complications in the next pregnancy, although the evidence-based underlying this recommendation is scarce. The differences in pregnancy outcomes according to interpregnancy interval (IPI) after miscarriage as opposed to induced abortions remains unclear. What did the researchers do and find? Using data linkage from registry data in Norway, we explored the risks of adverse pregnancy outcomes for births after a miscarriage and after an induced abortion separately. While 3 out of 5 women with previous miscarriages conceive within 6 months, 1 out of 5 women with previous induced abortions conceive within 6 months. Our study suggests that conceiving within 6 months after a miscarriage or an induced abortion is not associated with increased risks of adverse pregnancy outcomes. The results are consistent for IPI as short as 3 months. There was no evidence of higher risks of adverse pregnancy outcomes among women with an IPI of greater than 12 months after a miscarriages or induced abortions, with the exception of a modest increased risk of gestational diabetes mellitus. What do these findings mean? Our results do not support current international recommendations to wait at least 6 months after a miscarriage or an induced abortion. In combination with previous research, our results are reassuring for families who attempt pregnancy soon after a miscarriage or induced abortion. These findings motivate a review of current international guidelines for birth spacing after a miscarriage or an induced abortion.