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Spacing Births Appropriately May Reduce Risk of Adverse Outcomes

Women should space their pregnancies between 18 months and five years in order to minimize risk of premature birth and low birth weight, says a new study in the Journal of the American Medical Association (JAMA).

The study analyzed the findings of 67 previous studies that addressed birth spacing and adverse perinatal outcomes (preterm birth, low birth weight, perinatal death).1 The analysis, which involved over 11 million pregnancies, found that infants born to women with pregnancy intervals shorter than 6 months had a 40% higher risk for prematurity and a 60% higher risk for low birth weight (LBW) compared to infants born to women with pregnancy intervals of 18-23 months. Further, risk for premature birth increased 1.9 percent for each month under the recommended 18 month interval. 1 Women with birth intervals longer than 59 months also faced an increase in adverse perinatal outcomes including preterm birth and LBW. 1

Pregnancy and the subsequent lactation period weaken women's nutritional status. Short intervals between pregnancies do not allow women to build up their depleted nutrient stores.

For example, women's folate levels naturally decrease during the fifth month of pregnancy and remain low after delivery. Folate is a B-vitamin that reduces risk of birth defects: Short intervals between pregnancies prevent women from restoring adequate amounts of folate, increasing the risk for birth defects, preterm birth, and low birth weight in subsequent pregnancies.

Costs to Employers

Adverse health outcomes from premature birth have a major financial impact on businesses. According to the March of Dimes, 11% of babies covered by private insurance are born prematurely. 2 On average, the direct health expenditures for a premature baby cost employers $41,610 compared to the $2,830 for a healthy, full-term baby.2

Costs of Prematurity: Impact on Businesses


March of Dimes. Costs of Prematurity: Impact on Businesses. Available online at: http://www.marchofdimes.com/prematurity/15341_15349.asp
Accessed on April 21, 2006.

Indirect expenditures (lost productivity) related to premature births cost employers an average of $2,766 per year. In the six months following delivery, mothers of premature babies spend an average of 29.1 days on short term disability compared to the 18.9 days spent by mothers of full-term babies. In 2002, approximately $7.4 billion in hospital charges for premature infants were billed to employers and other private insurers.3

What Can Employers Do?

Employers can play a significant role in reducing the number of premature births and the costs associated with prematurity by improving maternal health.

Employers should:
  • Provide coverage for all FDA-approved contraceptives so that women are able to appropriately space their pregnancies.

  • Provide adequate healthcare coverage to ensure that all women have access to preconception, prenatal, and post-partum care. Examples include:
    • Assessment/risk-appraisal (e.g., clinician review of pregnancy history; use of medications that could affect the fetus; and tobacco, alcohol, and or drug use)
    • Immunizations (e.g., rubella, tetanus, influenza)
    • Pharmacy services (e.g., prenatal vitamins, folic acid supplements)
    • Preventive counseling services (e.g., counseling to prevent alcohol misuse, counseling to promote breastfeeding)
    • Screening services (e.g., to detect Rh (D) incompatibility, pre-eclampsia, Down syndrome and other fetal anomalies)
    • Treatment of preexisting medical conditions


  • Offer access to, and encourage the use of, employee assistance and health promotion programs that address pregnancy (nutrition, prenatal care, alcohol-use, smoking, etc
    • Integrate preconception education into other health promotion campaigns (i.e. smoking, obesity)
    • Offer incentives for participation in EAP and health promotion programs that address preconception care.


  • Provide employees with free educational materials relating to pregnancy, childbirth, and infant care.
    • Develop and distribute health education materials on preconception risks (biological, behavioral, social)
    • Develop reproductive planning tools for women and men, taking age, health literacy, and cultural competency into consideration
    • Educate employees on the importance of preventive services (screenings, immunizations)
References:
  1. Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Birth Spacing and Risk of Adverse Perinatal Outcomes: A Meta-analysis. JAMA 2006;295(15):1809-1823.

  2. March of Dimes Costs of Prematurity: Impact on Business. March of Dimes, White Plains, NY Accessed at http://www.marchofdimes.com/prematurity/15341_15349.asp

  3. Agency for Healthcare Research and Quality, 2002 Nationwide Inpatient Sample, prepared by March of Dimes Perinatal Data Center, 2004.

  4. Centers for Disease Control and Prevention. Recommendations to Improve Preconception Health and Health Care - United States. MMWR 2006; 55(RR6): 001.

  5. Centers for Disease Control and Prevention. CDC Releases National Recommendations to Improve Health of Babies and Moms. Press Release. April 20, 2006. Availble at: http://www.cdc.gov/od/oc/media/pressrel/r060420b.htm



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