Interpregnancy interval and risk of perinatal death: a systematic review and meta-analysis

BJOG. 2020 Nov;127(12):1470-1479. doi: 10.1111/1471-0528.16303. Epub 2020 Jun 16.


Background: Interpregnancy interval (IPI) <6 months is a potentially modifiable risk factor for adverse perinatal health outcomes.

Objective: This systematic review evaluated the international literature on the risk of perinatal death associated with IPI.

Search strategy: Two independent reviewers screened titles and abstracts identified in MEDLINE, EMBASE and Scopus from inception to 4 April 2019 (Prospero Registration #CRD42018092792).

Selection criteria: Studies were included if they provided a description of IPI measurement and perinatal death, including stillbirth and neonatal death.

Data collection and analysis: A narrative review was performed for all included studies. Random effects meta-analysis was used to compare unadjusted odds of perinatal death associated with IPI <6 months and IPI ≥6 months. Analyses were performed by outcome of the preceding pregnancy and study location.

Main results: Of the 624 unique articles identified, 26 met the inclusion criteria. The pooled unadjusted odds ratio of perinatal death for IPI <6 months was 1.34 (95% CI 1.17-1.53) following a previous live birth, 0.85 (95% CI 0.73-0.99) following a previous miscarriage and 1.07 (95% CI 0.84-1.36) following a previous stillbirth compared with IPI ≥6 months. However, few high-income country studies reported an association after adjustment. Fewer studies evaluated the impact of long IPI on perinatal death and what evidence was available showed mixed results.

Conclusions: Results suggest a possible association between short IPI and risk of perinatal death following a live birth, particularly in low- to middle-income countries.

Tweetable abstract: Short IPI <6 months after a live birth was associated with greater risk of perinatal death than IPI ≥6 months.

Keywords: Birth intervals; birth spacing; interpregnancy interval; perinatal death; stillbirth; systematic review.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Birth Intervals / statistics & numerical data*
  • Female
  • Humans
  • Infant, Newborn
  • Perinatal Death*
  • Pregnancy
  • Risk Assessment
  • Risk Factors