Adane AA, Ayele TA, Ararsa LG, Bitew BD, Zeleke BM. Adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia. BMC Pregnancy Childbirth. 2014; 14:(1)

Addisu D, Biru S, Mekie M Predictors of adverse pregnancy outcome at hospitals in South Gondar Zone, north-central Ethiopia: a multicenter facility-based unmatched case-control study. Heliyon. 2021; 7:(2)

Ahrens KA, Hutcheon JA, Ananth CV Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: methodological quality of existing studies and future directions for research. Paediatr Perinat Epidemiol. 2019; 33:(1)O5-O14

Al-Balushi M, Ahmed M, Islam M, Khan M. Determinants of contraceptive use in Oman. Far East J Theoret Stat. 2015; 50:51-64

Al-Barwani TA, Albeely TS. The Omani family: strengths and challenges. Marriage Fam Rev. 2007; 41:(1-2)119-142

Al Kindi RM, Al Sumri HH. Prevalence and sociodemographic determinants of contraceptive use among women in Oman. East Mediterr Health J. 2019; 25:(7)495-502

Al-Yaqoobi HS, Waly MI, Ali A, Al-Habsi NA, Al-Farsi YM. The impact of daily iron supplementation on hemoglobin levels of pregnant Omani women. Clin Nutr. 2015; 3:(1)15-31

ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol. 2008; 112:(1)201-207

Arabin B, Baschat AA. Pregnancy: an underutilized window of opportunity to improve long-term maternal and infant health—an appeal for continuous family care and interdisciplinary communication. Front Pediatr. 2017; 5

Ajayi AI, Somefun OD. Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries. Medicine. 2020; 99:(19)

Ball SJ, Pereira G, Jacoby P, de Klerk N, Stanley FJ. Re-evaluation of link between interpregnancy interval and adverse birth outcomes: retrospective cohort study matching two intervals per mother. BMJ. 2014; 349

Bassey G, Nyengidiki T, Dambo N. Determinants of interpregnancy interval among parturient in Port Harcourt, Nigeria. Sahel Medical J. 2016; 19:(4)

Bauserman M, Nowak K, Nolen TL The relationship between birth intervals and adverse maternal and neonatal outcomes in six low and lower-middle income countries. Reprod Health. 2020; 17:(S2)

Begna Z, Assegid S, Kassahun W, Gerbaba M. Determinants of inter birth interval among married women living in rural pastoral communities of southern Ethiopia: a case control study. BMC Pregnancy Childbirth. 2013; 13:(1)

Belaid L, Atim P, Ochola E Community views on short birth interval in Northern Uganda: a participatory grounded theory. Reprod Health. 2021; 18:(1)

Bener A, Saleh NM, Salameh KMK The impact of the interpregnancy interval on birth weight and other pregnancy outcomes. Rev Bras Saúde Mater Infant. 2012; 12:(3)233-241

Brhane M, Hagos B, Abrha MW, Weldearegay HG. Does short inter-pregnancy interval predicts the risk of preterm birth in Northern Ethiopia?. BMC Res Notes. 2019; 12:(1)

Brunner Huber LR, Smith K, Sha W, Vick T. Interbirth interval and pregnancy complications and outcomes: findings from the pregnancy risk assessment monitoring system. J Midwifery Womens Health. 2018; 63:(4)436-445

Cheslack-Postava K, Liu K, Bearman PS. Closely spaced pregnancies are associated with increased odds of autism in California sibling births. Pediatr. 2011; 127:(2)246-253

Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012; 380:(9837)149-156

Conde-Agudelo A, Rosas-Bermudez A, Castaño F, Norton MH. Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. Stud Fam Plann. 2012; 43:(2)93-114

Coo H, Brownell MD, Ruth C, Flavin M, Au W, Day AG. Interpregnancy interval and adverse perinatal outcomes: a record-linkage study using the Manitoba Population Research Data Repository. J Obstet Gynaecol Can. 2017; 39:(6)420-433

Davis EM, Zyzanski SJ, Olson CM, Stange KC, Horwitz RI. Racial, ethnic, and socioeconomic differences in the incidence of obesity related to childbirth. Am J Public Health. 2009; 99:(2)294-299

de Jonge HCC, Azad K, Seward N Determinants and consequences of short birth interval in rural Bangladesh: a cross-sectional study. BMC Pregnancy Childbirth. 2014; 14:(1)

Ejigu AG, Yismaw AE, Limenih MA. The effect of sex of last child on short birth interval practice: the case of northern Ethiopian pregnant women. BMC Res Notes. 2019; 12:(1)

Ekin A, Gezer C, Taner CE, Ozeren M, Mat E, Solmaz U. Impact of interpregnancy interval on the subsequent risk of adverse perinatal outcomes. J Obstet Gynaecol Res. 2015; 41:(11)1744-1751

Gebremedhin AT, Regan AK, Malacova E Effects of interpregnancy interval on pregnancy complications: protocol for systematic review and meta-analysis. BMJ Open. 2018; 8:(8)

Getahun D, Strickland D, Ananth CV Recurrence of preterm premature rupture of membranes in relation to interval between pregnancies. Am J Obstet Gynecol. 2010; 202:(6)570.e1-570.e6

Gilmore LA, Klempel-Donchenko M, Redman LM. Pregnancy as a window to future health: excessive gestational weight gain and obesity. Semin Perinatol. 2015; 39:(4)296-303

Grundy E, Kravdal Ø. Do short birth intervals have long-term implications for parental health? Results from analyses of complete cohort Norwegian register data. J Epidemiol Community Health. 2014; 68:(10)958-964

Gwin KM, Schrader R, Peters K, Moreno A, Thiel KW, Leslie KK. An exploratory study of the variables impacting preterm birth rates in New Mexico. BMC Pregnancy Childbirth. 2012; 12:(1)

Hanley GE, Hutcheon JA, Kinniburgh BA, Lee L. Interpregnancy interval and adverse pregnancy outcomes. Obstet Gynecol. 2017; 129:(3)408-415

Ikamari L, Izugbara C, Ochako R. Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya. BMC Pregnancy Childbirth. 2013; 13:(1)

Islam MM. Rapid fertility decline in Oman: understanding the role of proximate determinants. Middle East Fertil Soc J. 2017; 22:(4)275-284

Kannaujiya AK, Kumar K, Upadhyay AK, McDougal L, Raj A, Singh A. Short interpregnancy interval and low birth weight births in India: evidence from National Family Health Survey 2015-16. SSM Popul Health. 2020; 12

Khan MN, Harris ML, Loxton D. Assessing the effect of pregnancy intention at conception on the continuum of care in maternal healthcare services use in Bangladesh: evidence from a nationally representative cross-sectional survey. PLoS One. 2020; 15:(11)

Lilungulu A, Matovelo D, Kihunrwa A, Gumodoka B. Spectrum of maternal and perinatal outcomes among parturient women with preceding short inter-pregnancy interval at Bugando Medical Centre, Tanzania. Matern Health Neonatol Perinatol. 2015; 1:(1)1-7

Mahfouz E, El-Sherbiny N, Hamed W, Hamed NS. Effect of inter-pregnancy interval on pregnancy outcome: a prospective study at Fayoum, Egypt. Int J Med Dev Countries. 2018; 2:(2)38-44

Mamo H, Dagnaw A, Sharew NT, Brhane K, Kotiso KS. Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia. PLoS One. 2021; 16:(8)

Marinovich ML, Regan AK, Gissler M Developing evidence-based recommendations for optimal interpregnancy intervals in high-income countries: protocol for an international cohort study. BMJ Open. 2019; 9:(1)

Ministry of Health. Birth spacing standard operating procedures. 2012. (accessed 9 May 2023)

Murad M, Arbab M, Khan MB Study of factors affecting and causing preterm birth. J Entomol Zool Stud. 2017; 5:(2)406-409

Read S, Grundy E, Wolf DA. Fertility history, health, and health changes in later life: a panel study of British women and men born 1923–49. Population Stud. 2011; 65:(2)201-215

Trends in birth spacing: DHS comparative reports 28. 2011. (accessed 22 May 2023)

Saral N, Cambaz Ulaş S. The effect of short pregnancy interval on perinatal outcomes in Turkey: a retrospective study. Pak J Med Sci. 2019; 35:(5)1243-1247

Shachar BZ, Lyell DJ. Interpregnancy interval and obstetrical complications. Obstet Gynecol Surv. 2012; 67:(9)584-596

Shimels Hailemeskel H, Assebe T, Alemayehu T Determinants of short birth interval among ever married reproductive age women: a community based unmatched case control study at Dessie city administration, Northern Ethiopia. PLoS One. 2020; 15:(12)

Shree R, Caughey AB, Chandrasekaran S. Short interpregnancy interval increases the risk of preterm premature rupture of membranes and early delivery. J Matern Fetal Neonatal Med. 2018; 31:(22)3014-3020

Shrestha P, Mahato V, Karmacharya S. Effect of inter-pregnancy interval on maternal and fetal outcome. Nepal J Obstet Gynaecol. 2020; 15:(1)58-61

Singh SN, Singh SN, Narendra RK. Demographic and socio-economic determinants of birth interval dynamics in Manipur: a survival analysis. Online J Health Allied Sci. 2011; 9:(4)

Sundtoft I, Sommer S, Uldbjerg N. Cervical collagen concentration within 15 months after delivery. Am J Obstet Gynecol. 2011; 205:(1)59.e1-59.e3

Tessema GA, Marinovich ML, Håberg SE Interpregnancy intervals and adverse birth outcomes in high-income countries: an international cohort study. PLoS One. 2021; 16:(7)

Tsakiridis I, Mamopoulos A, Chalkia-Prapa EM, Athanasiadis A, Dagklis T. Preterm premature rupture of membranes: a review of 3 national guidelines. Obstet Gynecol Surv. 2018; 73:(6)368-375

Ugwu EO, Onwuka CC, Obi SN Effects of short inter-pregnancy interval on maternal and perinatal outcomes: a cohort study of pregnant women in a low-income country. Niger J Clin Pract. 2020; 23:(7)928-933

Uthman SG, Garba MA, Danazumi AG, Mandara MU. How birth interval and antenatal care affects postpartum haemorrhage prevention in Maiduguri, Nigeria. J Applied Pharmaceutical Sci. 2013; 3:(3)36-39

Winkvist A, Rasmussen KM, Habicht JP. A new definition of maternal depletion syndrome. Am J Public Health. 1992; 82:(5)691-694

World Health Organization. Report of a WHO technical consultation on birth spacing. 2005. (accessed 22 May 2023)

World Health Organization. Programming strategies for postpartum family planning. 2013. (accessed 22 May 2023)

World Health Organization. Global nutrition targets 2025: low birth weight policy brief. 2014. (accessed 22 May 2023)

World Health Organization. Preterm birth. 2018. (accessed 9 May 2023)

Wormer KC, Jamil RT, Bryant SB. Acute postpartum hemorrhage.Treasure Island (FL): StatPearls Publishing; 2022

Zhang Q, Dang S, Bai R, Mi B, Wang L, Yan H. Association between maternal interpregnancy interval after live birth or pregnancy termination and birth weight: a quantile regression analysis. Sci Rep. 2018a; 8:(1)

Zhang L, Shen S, He J Effect of interpregnancy interval on adverse perinatal outcomes in Southern China: a retrospective cohort study, 2000–2015. Paediatr Perinat Epidemiol. 2018b; 32:(2)131-140

Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. 2016; 16:(1)

Short interpregnancy interval and adverse pregnancy outcomes among women in a Middle Eastern country

02 June 2023
Volume 31 · Issue 6



A short interpregnancy interval is associated with several maternal and neonatal complications. In Oman, the incidence of short interpregnancy interval is well documented in the annual health report, but evidence is lacking on its impact on adverse pregnancy outcomes. This study examined short interpregnancy interval, its risk factors and its association with the prevalence of adverse pregnancy outcomes among Omani pregnant women.


A retrospective matched case–control design was adopted. Data were collected from medical records between January and December 2020. A total of 597 pregnant women from two tertiary care hospitals in Oman were included.


There was a significant relationship between interpregnancy interval and the prevalence of adverse maternal and perinatal outcomes, including postpartum haemorrhage, iron deficiency anemia, preterm birth and low birth weight. Significant risk factors for a short interpregnancy interval were advanced maternal age, young age at first birth, low parity and previous perinatal loss.


Encouraging acceptance of birth spacing through the use of contraception would signify a notable change in cultural values that can act as a barrier to birth spacing. This would therefore improve pregnancy outcomes.

Inter pregnancy interval is defined as ‘the time between the end of a pregnancy and the start of another pregnancy’ (World Health Organization (WHO), 2005). A short interpregnancy interval has been defined by the WHO (2013) as ‘a period of less than 24 months from last delivery to the current pregnancy’ while a long interval is defined as ‘an interval of longer than 59 months’. The recommended optimal interpregnancy interval according to many international agencies is to leave at least 2 years after a live birth or 6 months after spontaneous miscarriage or induced abortion before conceiving another pregnancy (Marinovich et al, 2019).

Although birth spacing is becoming a prominent health promotion intervention for women and children's health, the prevalence of short interpregnancy intervals is rising. In low-income countries such as Nigeria, the prevalence of short interpregnancy interval ranges from 19.4–65.9% (Bassey et al, 2016). Pregnancies conceived after a short interpregnancy interval place both mother and fetus in danger, while the optimal interpregnancy interval is a crucial driver of maternal health and favours perinatal outcomes (Arabin and Baschat, 2017). Therefore, maintaining an optimal interval between pregnancies is necessary to avoid high-risk pregnancies (Gilmore et al, 2015).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month