Impact of Inter-Pregnancy Interval on Maternal Serum Ferritin, Haematocrit Level and Fetal Outcome in University of Ilorin Teaching Hospital Ilorin, Nigeria

Abstract

Background: Short inter-pregnancy interval (SIPI) has been linked with low maternal haematological indices and adverse fetal outcome. The World Health Organization (WHO) recommended a minimum of 24 months inter-pregnancy interval to reduce the risk of adverse maternal and fetal outcomes. However, sub-optimal pregnancy spacing is common in many developing countries including Nigeria. Objectives: To determine the impact of inter-pregnancy interval on maternal serum ferritin, haematocrit level and fetal outcome among parturient in University of Ilorin Teaching Hospital, Ilorin, Nigeria. Study Design: A prospective cohort study of parturient less than 20weeks gestation. Those who did not satisfy the WHO recommended inter-pregnancy interval of at least 24months were categorized as group II while gestational age and social status matched parturient who satisfied the WHO recommendation were in group I. Methodology: A total of 316 parturient who satisfied the inclusion criteria were recruited for the study by systematic sampling. These were equal number of 158 participants each as subject and control. Subject and control were matched for gestational age and social status. The serum ferritin and haematocrit levels as well as fetal outcome were evaluated for each participant. The results were analysed using SPSS version 20.0 with appropriate tables and figures generated. Results: There was statistically significance difference in the mean levels of serum ferritin (P<0.001) and haematocrit (P<0.001) at booking for the two groups of participants. There was statistically significant difference in the gestational age at delivery (P<0.001) with higher rate of preterm delivery (22.1% vs. 1.9%; P<0.001) in group II compared to group I. In addition, there were higher percentages of group II babies with 1st (32.5% vs. 9.6%; P<0.001) and 5th minute (18.2% vs. 1.9%; P<0.001) APGAR scores < 7 compared to group I babies (P<0.001). The mean birth weight was lower in group II (2.70±0.35 vs. 3.10±0.31; P<0.001) with higher need for neonatal resuscitation (16.9% vs. 2.6%; P<0.001) and intensive care admission (18.2% vs. 1.3%; P<0.001) among neonates of women in group II. Neonatal anaemia (15.4% vs. 0.0%; P<0.001) occurred only in group II participants’ babies. Neonatal mortality was zero for group I and 18(11.7%) for group II babies. Conclusion: Inter-pregnancy interval below the WHO recommendation is associated with low maternal serum ferritin and haematocrit levels as well as adverse fetal outcome. Recommendations: Adequate child spacing should be emphasized during antenatal visits, postpartum counselling, postnatal clinic visits as well as other contacts with non-pregnant women of reproductive age.