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Paediatr Perinat Epidemiol. 2018 Oct 9. doi: 10.1111/ppe.12504. [Epub ahead of print]

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.

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Office of Population Affairs, Office of the Assistant Secretary for Health, Rockville, Maryland.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York.
Department of Obstetrics and Gynecology, Royal Victoria Hospital, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville, Maryland.
Department of Community and Family Health, University of South Florida College of Public Health, Tampa, Florida.
Center for Perinatal Research, Departments of Pediatrics and Obstetrics and Gynecology and Division of Epidemiology, The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Guttmacher Institute, New York, New York.
Division of Intramural Population Health Research, Epidemiology Branch, National Institute of Child Health and Human Development, Bethesda, Maryland.
Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
Department of Obstetrics and Gynecology, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Family Science, University of Maryland, College Park, Maryland.



The World Health Organization (WHO) recommends that women wait at least 24 months after a livebirth before attempting a subsequent pregnancy to reduce the risk of adverse maternal, perinatal, and infant health outcomes. However, the applicability of the WHO recommendations for women in the United States is unclear, as breast feeding, nutrition, maternal age at first birth, and total fertility rate differs substantially between the United States and the low- and middle-resource countries upon which most of the evidence is based.


To inform guideline development for birth spacing specific to women in the United States, the Office of Population Affairs (OPA) convened an expert work group meeting in Washington, DC, on 14-15 September 2017 among reproductive, perinatal, paediatric, social, and public health epidemiologists; obstetrician-gynaecologists; biostatisticians; and experts in evidence synthesis related to women's health.


Presentations and discussion topics included the methodological quality of existing studies, evaluation of the evidence for causal effects of short interpregnancy intervals on adverse perinatal and maternal health outcomes, good practices for future research, and identification of research gaps and priorities for future work.


This report provides an overview of the presentations, discussions, and conclusions from the expert work group meeting.


birth spacing; confounding; contraception; interpregnancy interval; maternal health; neonatal health; preterm birth; study design


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