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Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study

BMJ 2000; 321 doi: (Published 18 November 2000) Cite this as: BMJ 2000;321:1255
  1. Agustin Conde-Agudelo (condeagu{at}, perinatal researcher,
  2. José M Belizán, director
  1. Latin American Centre for Perinatology and Human Development (CLAP), Division of Health Promotion and Protection, Pan American Health Organisation, World Health Organisation, Montevideo, Uruguay
  1. Correspondence to: A Conde-Agudelo
  • Accepted 11 September 2000


Objective: To study the impact of interpregnancy interval on maternal morbidity and mortality.

Design: Retrospective cross sectional study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Montevideo, Uruguay.

Setting: Latin America and the Caribbean, 1985-97.

Participants: 456 889 parous women delivering singleton infants.

Main outcome measures: Crude and adjusted odds ratios of the effects of short and long interpregnancy intervals on maternal death, pre-eclampsia, eclampsia, gestational diabetes mellitus, third trimester bleeding, premature rupture of membranes, postpartum haemorrhage, puerperal endometritis, and anaemia.

Results: Short (<6 months) and long (>59 months) interpregnancy intervals were observed for 2.8% and 19.5% of women, respectively. After adjustment for major confounding factors, compared with those conceiving at 18 to 23 months after a previous birth, women with interpregnancy intervals of 5 months or less had higher risks for maternal death (odds ratio 2.54; 95% confidence interval 1.22 to 5.38), third trimester bleeding (1.73; 1.42 to 2.24), premature rupture of membranes (1.72; 1.53 to 1.93), puerperal endometritis (1.33; 1.22 to 1.45), and anaemia (1.30; 1.18 to 1.43). Compared with women with interpregnancy intervals of 18 to 23 months, women with interpregnancy intervals longer than 59 months had significantly increased risks of pre-eclampsia (1.83; 1.72 to 1.94) and eclampsia (1.80; 1.38 to 2.32).

Conclusions: Interpregnancy intervals less than 6 months and longer than 59 months are associated with an increased risk of adverse maternal outcomes.


  • Funding Division of Health Promotion and Protection, Pan American Health Organisation.

  • Competing interests None declared.

  • Embedded Image This article is part of the BMJ's randomised controlled trial of open peer review. Documentation relating to the editorial decision making process is available on the BMJ's website

  • Accepted 11 September 2000
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