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Developing evidence-based recommendations for optimal interpregnancy intervals in high-income countries: protocol for an international cohort study
  1. M Luke Marinovich1,
  2. Annette K Regan2,
  3. Mika Gissler3,4,
  4. Maria C Magnus5,6,7,
  5. Siri Eldevik Håberg7,
  6. Amy M Padula8,
  7. Jonathan A Mayo9,
  8. Gary M Shaw9,
  9. Stephen Ball10,
  10. Eva Malacova1,
  11. Amanuel T Gebremedhin1,
  12. Natasha Nassar11,
  13. Cicely Marston12,
  14. Nick de Klerk13,
  15. Ana Pilar Betran14,
  16. Gavin F Pereira1
  1. 1 School of Public Health, Curtin University, Bentley, Western Australia, Australia
  2. 2 School of Public Health, Texas A and M University, College Station, Texas, USA
  3. 3 Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
  4. 4 Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
  5. 5 MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  6. 6 Population Health Sciences, Bristol Medical School, Bristol, UK
  7. 7 Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
  8. 8 Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
  9. 9 Department of Pediatrics, Stanford University, Stanford, California, USA
  10. 10 School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
  11. 11 Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  12. 12 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  13. 13 Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
  14. 14 UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr M Luke Marinovich; luke.marinovich{at}


Introduction Short interpregnancy interval (IPI) has been linked to adverse pregnancy outcomes. WHO recommends waiting at least 2 years after a live birth and 6 months after miscarriage or induced termination before conception of another pregnancy. The evidence underpinning these recommendations largely relies on data from low/middle-income countries. Furthermore, recent epidemiological investigations have suggested that these studies may overestimate the effects of IPI due to residual confounding. Future investigations of IPI effects in high-income countries drawing from large, population-based data sources are needed to inform IPI recommendations. We aim to assess the impact of IPIs on maternal and child health outcomes in high-income countries.

Methods and analysis This international longitudinal retrospective cohort study will include more than 18 million pregnancies, making it the largest study to investigate IPI in high-income countries. Population-based data from Australia, Finland, Norway and USA will be used. Birth records in each country will be used to identify consecutive pregnancies. Exact dates of birth and clinical best estimates of gestational length will be used to estimate IPI. Administrative birth and health data sources with >99% coverage in each country will be used to identify maternal sociodemographics, pregnancy complications, details of labour and delivery, birth and child health information. We will use matched and unmatched regression models to investigate the impact of IPI on maternal and infant outcomes, and conduct meta-analysis to pool results across countries.

Ethics and dissemination Ethics boards at participating sites approved this research (approval was not required in Finland). Findings will be published in peer-reviewed journals and presented at international conferences, and will inform recommendations for optimal IPI in high-income countries. Findings will provide important information for women and families planning future pregnancies and for clinicians providing prenatal care and giving guidance on family planning.

  • pregnancy
  • birth intervals
  • family planning
  • siblings
  • preterm birth
  • fetal growth restriction

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  • Patient consent for publication Not required.

  • Contributors GFP, SB, AKR and MLM conceived the idea, planned and designed the study protocol. GFP, SB, AKR, MLM, MG, MCM, SEH, AMP, JAM, GMS, EM, ATG, NN, CM, NdK and APB contributed to the development of the protocol, study design and methods. MLM and AKR wrote the first draft. MG, MCM, SEH, AMP, JAM, GMS, SB, EM, ATG, NN, CM, NdK, AMP and GFP critically revised the draft for important intellectual content. All authors have approved the final written manuscript.

  • Funding This work was supported by funding from the National Health and Medical Research Council, including an Early Career Fellowship [#GNT1138425 to AR], Senior Research Fellowship [# 1117105 to HL], Career Development Fellowship [#APP1067066 to NN] and project grants [#1099655 to GP, NN, SJB; #APP1141510 to AR, GP]. MCM works at the MRC Integrative Epidemiology Unit at the University of Bristol which receives infrastructure funding from UK Medical Research Council (MC/UU/12013/5), and she is also supported by the following fellowship from the UK Medical Research Council (MR/M009351/1). This work was partly supported by the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Department of Health Western Australia Human Research Ethics Committee; Curtin University Human Research Ethics Committee; NSW Population and Health Services Research Ethics Committee; Stanford University Institutional Review Board; and the Norwegian Regional Committees for Medical and Health Research Ethics. Each committee provided a waiver of consent for participants.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

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