title: Do short birth intervals have long-term implications for parental health? Results from analyses of complete cohort Norwegian register data.
abstract: BACKGROUND
  Short and very long interbirth intervals are associated with worse perinatal, infant and immediate maternal outcomes. Accumulated physiological, mental, social and economic stresses arising from raising children close in age may also mean that interbirth intervals have longer term implications for the health of mothers and fathers, but few previous studies have investigated this.
  
  
  METHODS
  Discrete-time hazards models were estimated to analyse associations between interbirth intervals and mortality risks for the period 1980-2008 in complete cohorts of Norwegian men and women born during 1935-1968 who had had two to four children. Associations between interbirth intervals and use of medication during 2004-2008 were also analysed using ordinary least-squares regression. Covariates included age, year, education, age at first birth, parity and change in coparent since the previous birth.
  
  
  RESULTS
  Mothers and fathers of two to three children with intervals between singleton births of less than 18 months, and mothers of twins, had raised mortality risks in midlife and early old age relative to parents with interbirth intervals of 30-41 months. For parents with three or four children, longer average interbirth intervals were associated with lower mortality. Short intervals between first and second births were also positively associated with medication use. Very long intervals were not associated with raised mortality or medication use when change of coparent since the previous birth was controlled.
  
  
  CONCLUSIONS
  Closely spaced and multiple births may have adverse long-term implications for parental health. Delayed entry to parenthood and increased use of fertility treatments mean that both are increasing, making this a public health issue which needs further investigation.
authors.affiliation: Department of Social Policy, London School of Economics, London, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Grundy
authors.affiliation: Department of Economics, University of Oslo, Oslo, Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Kravdal
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001721:Birth Intervals / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004522:Educational Status; D005220:Fathers / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D061213:Mortality, Premature; D009035:Mothers / Q000706:statistics & numerical data*; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D055553:Prescription Drugs / Q000627:therapeutic use*; D012042:Registries; D017678:Sex Distribution; D013997:Time Factors; D055815:Young Adult
chemical_list: D055553:Prescription Drugs
keywords: DEMOGRAPHY; EPIDEMIOLOGY; FERTILITY; Life course epidemiology; MORTALITY