title: Effect of pregnancy-lactation overlap on the current pregnancy outcome in women with substandard nutrition: a prospective cohort study.
abstract: BACKGROUND
  Pregnancy during lactation is common in Egypt and is often unplanned. Overlap between pregnancy and lactation could be associated with an increased risk for the pregnant mother, her fetus as well as her nursing child.
  
  
  OBJECTIVE
  The current study aims to compare the maternal and perinatal outcome of pregnancies occurred during lactation with those occurred after weaning in women with substandard nutrition.
  
  
  METHODS
  A prospective-cohort study was carried out in six Maternal and Child Health Centers in Assiut-Egypt. Estimated sample size was 540 women divided equally into two groups; the first included women who got pregnant during breastfeeding (PDBF), while the second included women who got pregnant after weaning (PAW). Tools were consisted of structured interview questionnaire including personal history, obstetrical data, breastfeeding, family planning histories and dietary intake during pregnancy. Pregnant women had been followed up to delivery to assess different maternal and fetal outcomes.
  
  
  RESULTS
  Miscarriage rate was not statistically significant between both groups (2.2% in PDBF and 0.4% in PAW, p = 0.284). Women in PDBF group had higher prevalence of maternal anemia (54.1% versus 30.7%), intrauterine growth restriction (16.7% versus 4.8%), cesarean delivery (43.7% versus 31.5%), prolonged labor (13.3% versus 11.1%) and low birth weight infants (15.7% versus 8.8%) compared to women in PAW group.
  
  
  CONCLUSIONS
  Pregnancy during breastfeeding is associated with an increase in the overall complications of pregnancy as compared to PAW. Although it does not increase the miscarriage rate, it increases the prevalence of maternal anemia, delayed fetal growth, prolonged labor, cesarean section delivery and the prevalence of low birth weight infants.
authors.affiliation: Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut Governorate, Egypt.
authors.forename: O M
authors.initials: OM
authors.lastname: Shaaban
authors.affiliation: Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut Governorate, Egypt.
authors.forename: A M
authors.initials: AM
authors.lastname: Abbas
authors.affiliation: Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut Governorate, Egypt.
authors.forename: H A
authors.initials: HA
authors.lastname: Abdel Hafiz
authors.affiliation: Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut Governorate, Egypt.
authors.forename: A S
authors.initials: AS
authors.lastname: Abdelrahman
authors.affiliation: Department of food science and technology, Faculty of Agriculture, Assiut University, Assiut Governorate, Egypt.
authors.forename: M
authors.initials: M
authors.lastname: Rashwan
authors.affiliation: Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut Governorate, Egypt.
authors.forename: E R
authors.initials: ER
authors.lastname: Othman
keywords: Breastfeeding; LAM; maternal anemia; miscarriage; nutrition during pregnancy; obstetrics; perinatal outcome; pregnancy-lactation overlap