A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objectives: Interpregnancy interval (IPI), the time period between the end of one pregnancy and the conception of the next, can have a significant impact on maternal and infant outcomes. This study examines the relationship between interpregnancy interval and neonatal outcomes of low birth weight, preterm birth, and specific neonatal morbidities. Study Design: Retrospective cohort study comparing neonatal outcomes across 6 categories of IPI using data on 202,600 cases identified from Arizona birth certificates and the Newborn Intensive Care Program data. Comparisons between groups were made using odds ratios and 95% confidence intervals, and multivariable logisitic regression analysis. Results: Interpregnancy intervals of < 12 months and ≥ 60 months were associated with low birth weight, preterm birth, and small for gestational age births. The shortest and longest IPI categories were also associated with specific neonatal morbidities, including periventricular leukomalacia, bronchopulmonary dysplasia, intraventricular hemorrhage, apnea bradycardia, respiratory distress syndrome, transient tachypnea of the newborn, and suspected sepsis. Relationships between interpregnancy interval and specific neonatal morbidities did not remain significant when adjusted for birth weight and gestational age. Conclusions: Significant differences in neonatal outcomes (preterm birth, low birth weight, and small for gestational age) were observed between IPI categories. Consistent with previous research, interpregnancy intervals < 12 months and ≥ 60 months appear to be associated with increased risk of poor neonatal outcomes. Any difference in specific neonatal morbidities between IPI groups appears to be mediated through increased risk of low birth weight and preterm birth by IPI.

Low birth weight (LBW) is a major public health concern globally. Despite its negative social and economic impact on the family and community at large, it has remained relatively unexplored at population level in Zimbabwe. The purpose of the study was to establish determinants of LBW using data from the 2015 Zimbabwe Demographic and Health Survey. The socioecological model was the conceptual framework for the study. A secondary analysis was conducted on 4,227 mother-infant dyads. Independent variables were duration of pregnancy, number of births within the past 5-year period, exposure to mass media, type of fuel used for cooking in the household, and intimate partner violence. Covariates were maternal age at delivery, place of residence, anemia, marital status, education, wealth index, ever terminated pregnancy, infant sex, and alcohol consumption. For parsimony, statistical significance was set at p < 0.05 at the 95% confidence interval (CI). Multivariable logistic regression analysis showed that mild maternal anemia (adjusted odds ratio [aOR] 1.83 CI 1.17-2.87 p = 0.01), moderate to severe anemia (aOR 1.80 CI 1.01-3.19 p = 0.05), and being a female neonate (aOR 1.48 CI 1.17-2.87 p = 0.008) had higher odds for LBW. Pregnancy duration of 8 months (aOR 0.01 CI 0.003-0.039 p < 0.001) and of 9 months (aOR 0.12 CI 0.04-0.33 p = 0.001) had lower odds for LBW. Birth of 2 infants within a 5-year period (aOR 2.40 CI 1.24-4.66 p = 0.01) was associated with LBW. Implications for positive social change include coming up with a health policy on the management of anemia during pregnancy and health promotion messages to promote optimal birth spacing, including strategies that reduce chances for preterm deliveries.

Background: Rapid repeat pregnancy (RRP), a pregnancy occurring less than 24 months from a prior birth, and unintended pregnancy-related induced abortions can be prevented with family planning. However, few studies have adequately addressed the role of male partners in reproductive decision-making. Objectives: The goal of this research is to understand the interrelationships between couple pregnancy intention, intimate partner violence (IPV), reproductive health and behaviors. Specifically, this project aims to: (1) examine the extent to which couple pregnancy intentions are associated with RRP and (2) induced abortions among women in the U.S., and (3) examine the extent to which IPV around the time of pregnancy is associated with postpartum birth control use by race/ethnicity and receipt of prenatal contraceptive counseling among U.S. women with live births. Methods: This project uses data from the 2006-2010 National Survey on Family Growth (NSFG), and the 2004-2008 national Pregnancy Risk Assessment Monitoring System (PRAMS). RRP and induced abortion of first pregnancy were self-reported in the NSFG. Couple pregnancy intentions were categorized as: both intended (M+P+), both unintended (M-P-), maternal intended and paternal unintended (M+P-), maternal unintended and paternal intended (M-P+). Multiple logistic regression analysis was used to assess the relationships between couple pregnancy intentions and RRP and induced abortion. Data on IPV and postpartum contraceptive use came from PRAMS. Stratified analyses were conducted to assess differences in the association by race/ethnicity and receipt of prenatal contraceptive counseling. Results: Compared to couples where pregnancy was intended by both, those with discordant pregnancy intentions and both unintended pregnancy had greater odds of induced abortion. The odds of RRP was higher for M-P+ couples and lower for M+P- couples. Abused women were significantly less likely to report postpartum contraceptive use. This was particularly true for Hispanic women who reported no prenatal birth control counseling and all other racial/ethnic groups who received birth control counseling. Conclusion: Health providers may need to consider the interpersonal dynamics of couple-based decision-making and behaviors to prevent RRP and induced abortions due to unintended pregnancy. Providers should discuss contraceptive options that are not partner-dependent within the context of abusive relationships.