Providers, patients, and the interpregnancy interval: Knowledge, attitudes, and practices

Awarded 2014
Complex Family Planning Fellowship Research
Ashlee Bergin, MD
University of Illinois
$69,620

Background: The interpregnancy interval (IPI) is defined as the time between a live birth or stillbirth and the onset of a subsequent pregnancy. Short IPIs (60 months) have been associated with congenital anomalies, labor dystocia, and pre-eclampsia. While patients receive a great deal of counseling regarding contraception, it is unclear if they receive counseling about the IPI.
Purpose: To assess prenatal care providers’ knowledge of the recommended IPI, determine whether or not they provide counseling on the IPI, and if provided, what recommendations they make.
To assess if prenatal care patients are aware that short IPIs are associated with adverse obstetric outcomes.
Methods: Of patients greater than 24 weeks gestation seeking prenatal care at the UIC Center for Women’s Health between November 2014 and March 2015, 330 patients were approached and 281 completed the survey. Descriptive statistics, chi-square analysis and multivariable logistic regression were used for data analysis.
Secondly, 6,685 prenatal care providers were randomly selected to receive a survey between January and April 2015 with 344 responses collected. Descriptive statistics were performed.
Findings: Patient Survey: Women who did not pursue education beyond high school had a decreased likelihood of being familiar with the IPI and of being aware that a short IPI can adversely affect neonatal outcomes. Those women receiving prenatal care from certified nurse-midwives were less likely to be aware that a short IPI can affect maternal health as compared to those women receiving prenatal care from obstetricians and maternal fetal medicine specialists. Non-Hispanic Black and Hispanic race/ethnicity were associated with a decreased likelihood of being familiar with the IPI, as compared to Non-Hispanic White women. In addition, Non-Hispanic Black race/ethnicity was associated with a decreased likelihood of being aware that a short IPI can adversely affect maternal health, as compared to Non-Hispanic White women.
Provider Survey: The majority of prenatal care providers were aware that short IPIs can be associated with adverse maternal and perinatal outcomes, but far fewer were aware that long IPIs can be similarly associated with adverse outcomes. A higher proportion of certified nurse-midwives, as compared to family medicine physicians and obstetrician/gynecologists, counsel all or most of their patients on the optimal IPI.
Conclusions: There is a gap in communication between patients and providers about the IPI. Increases in patient and provider awareness about the importance of discussing ideal birth spacing may improve reproductive life planning.

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