{"id":16619,"date":"2023-01-21T13:56:28","date_gmt":"2023-01-21T19:56:28","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=16619"},"modified":"2024-10-30T10:44:37","modified_gmt":"2024-10-30T15:44:37","slug":"quel-est-lespacement-des-grossesses","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/fr\/how-far-apart-should-you-space-pregnancies\/","title":{"rendered":"\u00c0 quel intervalle faut-il espacer les grossesses ? De nouvelles recherches remettent en question la recommandation de l'OMS d'attendre au moins deux ans."},"content":{"rendered":"\n

If you use a fertility awareness method (FAM) <\/a>for family planning, you know you can use your body\u2019s fertility biomarkers to space pregnancies. Of course, some of the spacing may be taken out of your hands if, for example, breastfeeding causes a delay in your return of fertility for a full year or even longer, as some women experience. For other women, even while breastfeeding, their period returns like clockwork twelve or even fewer weeks postpartum (hence most methods\u2019 requirement that you start charting six weeks after birth). So, whether you\u2019re cycling regularly, cycling irregularly, or charting as you await the return of your fertility, you know you can <\/em>use FAMs to reliably avoid pregnancy<\/a>\u2014 but how long do you need<\/em> to? For the safety of both mom and baby, how long should you wait after giving birth before conceiving again? <\/p>\n\n\n\n

Where did the two year interpregnancy interval recommendation come from?<\/span><\/h2>\n\n\n\n

Many women have been counseled by their healthcare providers to space pregnancies two or more years apart. But where does that recommendation come from? And is it evidence-based? The recommendation seems to come from a 2005 report by the World Health Organization (WHO)<\/a> which specifically noted that an interpregnancy interval (IPI)\u2013the time between the birth of one child to the conception of the next child\u2013of less than 18 months was associated with increased infant mortality, low birth weight, and preterm delivery [1]. An IPI between 18-27 months may also have increased risk, but the document acknowledged that evidence for this was limited. The final recommendation of waiting at least two years was made with the consideration that saying \u201ctwo years\u201d is simpler than saying \u201c18 months\u201d or \u201c27 months\u201d when making recommendations [1]. <\/p>\n\n\n\n

However, the report also contained an important preamble emphasizing that family planning is a very personal decision with many factors to take into account:<\/p>\n\n\n\n

Individuals and couples should consider health risks and benefits along with other circumstances such as their age, fecundity, fertility aspirations, access to health services, child-rearing support, social and economic circumstances, and personal preferences in making choices for the timing of the next pregnancy [1].<\/p>\n\n\n\n

Issues with the WHO recommendation<\/span><\/h3>\n\n\n\n

The main issue with the WHO\u2019s recommendation of waiting two years between pregnancies seems to be that the data used to inform this recommendation comes largely from low to middle-income countries. Pregnant women with less access to adequate nutrition and health resources may indeed face a greater risk of experiencing, or their newborn experiencing, a medical complication during pregnancy or birth when having children relatively close together in age. However, adequate access to food and medical care is not a major obstacle for all women, especially in higher income countries, so this recommendation lacks universal application.<\/p>\n\n\n\n

Additionally, the WHO recommendation does not take maternal age into account. In addition to age being an important factor in fertility, experiencing pregnancy over the age of 35<\/a> is associated with greater risk of morbidity\u2013 particularly higher C-section rates. Couples for whom age is an important factor, such as couples who started having children later in life or couples hoping to have a large family may want to space pregnancies closer together to maximize their years of increased fertility\u2013what advice the WHO would give to such couples with these circumstances and desires is unclear. <\/p>\n\n\n\n

Recent research from Sweden doesn\u2019t back up the two year IPI recommendation<\/span><\/h2>\n\n\n\n

In the United States, the American College of Obstetricians and Gynecologists (ACOG) <\/a>also cautions that pregnancies less than 18 months apart are associated with an increase in adverse outcomes, but ACOG notes that recent studies call this timeframe into question. One such study released last year<\/a> and conducted in Sweden found that waiting more than 24 months between pregnancies was associated with an increase<\/em> in maternal and neonatal morbidity [2].<\/p>\n\n\n\n

Who and what did the Swedish researchers study?<\/span><\/h3>\n\n\n\n

The Swedish study analyzed birth data between 1997 and 2017 from multiple Swedish national registers, including the Swedish Medical Birth Register. The study excluded women who delivered their first baby via Cesarean section, women whose IPI was greater than five years, and cases with missing information. Nonetheless, the study still included over 300,000 mothers. <\/p>\n\n\n\n

Swedish researchers studied morbidity<\/span><\/h3>\n\n\n\n

Researchers assessed neonatal and maternal morbidity in relation to IPI, but what does that mean? \u201cMorbidity\u201d refers to developing some sort of medical condition during a specific timeframe; in this case, morbidity during pregnancy or immedi ately postpartum was studied. Mortality (maternal death) and severe maternal morbidities were measured in the study, including sepsis, eclampsia, surgery, unscheduled C-section, blood clots, and severe perineal tears (severe morbidities). Moderate maternal morbidities included postpartum hemorrhage, preeclampsia, gestational diabetes, infection, forceps use, vacuum extractor use, planned C-section, and episiotomy. Severe neonatal morbidities included stillbirth, need for ventilation, hypoglycemia, birth trauma, low birth weight and premature birth. Moderate neonatal morbidities included jaundice, macrosomia (large birth weight), and hematoma.  <\/p>\n\n\n\n

Lowest maternal and neonatal morbidity rate was found with IPI of 6-11 months<\/span><\/h3>\n\n\n\n

The researchers found that the risk of severe morbidity was lowest<\/em> for both mothers and infants with an IPI of 6-11 months and higher<\/em> when the IPI was 24-29 months or more.<\/p>\n\n\n\n