{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:22:04Z","timestamp":1792790524273,"version":"4.5.0"},"reference-count":170,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81602853"],"award-info":[{"award-number":["81602853"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95%\u202fconfidence intervals (CI) were calculated using a random\u2010effects model, and the dose\u2013response relationships were evaluated using generalized least squares trend estimation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 129 studies involving 46\u2009874\u2009843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18\u201323\u2009months, extreme intervals (&lt;6\u2009months and \u2265\u200960\u2009months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08\u20131.56; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). The dose\u2013response analyses further confirmed these J\u2010shaped relationships (<jats:italic>p<\/jats:italic><jats:sub>non\u2010linear<\/jats:sub>\u2009&lt;\u20090.001\u20130.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (<jats:italic>p<\/jats:italic><jats:sub>non\u2010linear<\/jats:sub>\u2009&lt;\u20090.005 and <jats:italic>p<\/jats:italic><jats:sub>non\u2010linear<\/jats:sub>\u2009&lt;\u20090.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (<jats:italic>p<\/jats:italic><jats:sub>non\u2010linear<\/jats:sub>\u2009&lt;\u20090.001). Moreover, interoutcome interval of \u226560\u2009months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95%\u202fCI 1.04\u20132.83). For pregnancies following preterm births, an interpregnancy interval of 9\u2009months was not associated with an increased risk of preterm birth, according to dose\u2013response analyses (<jats:italic>p<\/jats:italic><jats:sub>non\u2010linear<\/jats:sub>\u2009=\u20090.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76\u20131.21; <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18\u201323\u2009months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9\u2009months.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14648","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T10:37:22Z","timestamp":1694083042000},"page":"1618-1633","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Birth spacing and risk of adverse pregnancy and birth outcomes: A systematic review and dose\u2013response meta\u2010analysis"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6384-3190","authenticated-orcid":false,"given":"Wanze","family":"Ni","sequence":"first","affiliation":[{"name":"Department of Public Health and Preventive Medicine, School of Medicine Jinan University  Guangzhou Guangdong 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