Pregnancy interval and delivery outcome among HIV-seropositive and HIV-seronegative women in Kisumu, Kenya.
OBJECTIVE
A short pregnancy interval (PI) has been associated with increased child mortality, but mechanisms are unclear. We studied factors associated with PI and the effect of PI on birthweight and haemoglobin.


METHODS
Information was analysed from 2218 multigravidae who were recruited at the prenatal clinic (1758) or in the labour ward (460) of the Provincial Hospital in Kisumu between June 1996 and July 2000 for a study to assess the interaction between placental malaria and vertical HIV transmission.


RESULTS
The HIV prevalence was 28.9%. HIV seropositivity, older age, being unmarried, and <8 years of education were associated with a prolonged PI; among all women, a stillbirth, abortion, or death of a liveborn child as outcome of the previous pregnancy, and death of a child other than the last born among HIV-seronegative women, were associated with a shortened PI. No significant effect of short PI (an interval <24 months) on low birth weight (LBW), prematurity, small-for-gestational-age infants or maternal anaemia was evident. An abortion, stillbirth, or death of a liveborn child as outcome of the previous pregnancy was associated at the present delivery with LBW among HIV-seronegative women [adjusted odds ratio (AOR) 3.33, 95% confidence interval (CI) 1.63-6.81], and a low haemoglobin (<11 g/dl) among HIV-seropositive women (AOR 2.01, 95% CI 1.05-4.03 in the third trimester).


CONCLUSIONS
Public health efforts to ensure 'adequate' birth spacing may run contrary to family planning decisions to replace a deceased child and may be spent on prenatal issues like prevention of anaemia, and vertical HIV transmission.
van Eijk
Anna M
AM
Kenya Medical Research Institute, Kisumu, Kenya. avaneijk@kisian.mimcom.net
De Cock
Kevin M
KM
Ayisi
John G
JG
Rosen
Daniel H
DH
Otieno
Juliana A
JA
Nahlen
Bernard L
BL
Steketee
Richard W
RW
D000022:Abortion, Spontaneous / Q000150:complications; D000293:Adolescent; D000328:Adult; D001721:Birth Intervals; D001724:Birth Weight; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007630:Kenya / Q000453:epidemiology; D008423:Maternal Age; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D015995:Prevalence; D012959:Socioeconomic Factors; D013997:Time Factors