Both short and long interconceptional periods (ICP) have been associated with adverse pregnancy outcomes. Several investigators have argued that the apparent association between short ICP and obstetrical complications may simply reflect the prevalence of short ICPs among women predisposed to adverse outcomes based on confounding factors like maternal age, socioeconomic status, lifestyle, long working hours and the outcome of the previous pregnancy. [1 – 3]

The interconceptional period, defined as the time interval between a previous delivery and the conception of the subsequent pregnancy, plays a crucial role in determining maternal and neonatal health outcomes. [4, 5] A short interconceptional period, commonly defined as less than 18 months, has been associated with increased risks of adverse perinatal outcomes, particularly in women with a history of lower segment caesarean section (LSCS). [6, 7] In such cases, insufficient healing time of the uterine scar may predispose to complications such as uterine rupture, placental abnormalities, and impaired fetal growth. Neonatal complications, including low birth weight, preterm birth, respiratory distress, and increased neonatal intensive care unit (NICU) admissions, are of particular concern in this context. [8, 9]

In India, where caesarean section rates are rising steadily and family planning practices vary widely, understanding the impact of short interconceptional intervals becomes vital for guiding obstetric care. [10] Tertiary care centres frequently manage high-risk pregnancies, offering an opportunity to assess the neonatal implications of shortened interpregnancy intervals post-LSCS. Many pregnancies end up in maternal complications and even in emergency hysterectomies and foetal complications like preterm or low birth weight babies or even sometimes neonatal deaths. [11 – 13]

This study aims to evaluate the spectrum of neonatal outcomes associated with short interconceptional periods in women with a prior LSCS, thereby generating evidence to inform postpartum counselling, birth spacing recommendations, and antenatal monitoring strategies to optimize neonatal health.

This prospective analytical study was conducted in the Department of Obstetrics and Gynaecology at Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, with the primary aim of evaluating neonatal outcomes associated with a short interconceptional period in women with a prior lower segment caesarean section (LSCS).

Study Design and Duration:

The study was institutional and prospective in nature, carried out over a period of two years from January 2023 to December 2024.

Study Population and Sample Size:

The study included women who were primarily booked and registered at the tertiary care centre, with a history of one previous LSCS and a short interconceptional interval (defined as less than 18 months), and who were willing to deliver at the institution. A sample size of 150 participants was determined using The Survey System, assuming a 95% confidence level and 8% confidence interval. The sample was considered adequate given the large and undefined population size.

Inclusion Criteria:

1. Women with gestation beyond 28 weeks.
2. Women with one previous LSCS and the current pregnancy being the first conception following LSCS.
3. Willingness to deliver at the study centre.

Exclusion Criteria:

1. Women with a previous classical caesarean or hysterotomy scar.
2. Women with two or more previous LSCS.
3. Women with prior LSCS and current pregnancy following an intervening abortion.

Ethical Considerations and Procedure:

The study was initiated after obtaining ethical clearance from the Institutional Ethics Committee and informed consent from all participants. Detailed antenatal history and clinical assessments were recorded. Socio-demographic data including maternal age, parity, education, and interconceptional interval were documented. Routine antenatal investigations and obstetric sonography, including scar thickness and placental assessment, were conducted. Steroids were administered in indicated cases of preterm risk.

Labour Monitoring and Outcome Measures:

Participants were monitored during labour for gestational age, fetal well-being, and any signs of uterine scar complications. The mode of delivery—vaginal birth after caesarean (VBAC) or repeat caesarean (elective/emergency)—was recorded. Neonatal outcomes were evaluated in terms of birth weight, gestational age, respiratory distress, jaundice, sepsis, NICU admissions, and perinatal mortality.

Statistical Analysis:

Quantitative variables were expressed as mean ± standard deviation and analysed using the unpaired t-test. Qualitative variables were summarised using frequencies and percentages, with statistical associations assessed using the Chi-square test, Fisher’s exact test, and Student’s t-test. A p-value <0.05 was considered statistically significant.

A prospective analytical institutional study involving 150 participants was carried out to assess maternal and neonatal outcomes among women with a previous lower segment caesarean section (LSCS) and a short interconceptional interval. The majority of the study population, 95 women (63.33%), belonged to the 26–30 year age group, followed by 34 women (22.67%) aged between 21–25 years. A smaller proportion, 13 women (8.67%), were below 20 years of age, while only 8 participants were over the age of 30. The mean age of the study subjects was 25.8 years with a standard deviation of ±3.35 years. Regarding the area of residence, 89 patients (59.33%) were from urban settings, whereas 61 patients (40.67%) came from rural areas.

In our study, the distribution of neonatal birth weight among the 150 participants showed that the majority of newborns, 81 (54.00%), had a birth weight between 2.5 to 3 kilograms. This was followed by 47 neonates (31.33%) weighing between 3 to 3.5 kilograms. A smaller proportion of babies, 14 (9.33%), had a birth weight ranging from 3.5 to 4 kilograms. Low birth weight (<2.5 kilograms) was observed in only 8 neonates, accounting for 5.33% of the study population. The mean birth weight of the newborns was 2.88 kilograms with a standard deviation of ±0.39, indicating that most babies had weights within a relatively normal and healthy range. These findings suggest that despite a short interconceptional interval following a previous LSCS, the majority of neonates achieved adequate birth weight at delivery. [Table 1]

Table 1- Association of interconceptional period and Neonatal birth weight.

In our study, a significant association was observed between the interconceptional period and neonatal birth weight (p<0.05). Among the 24 patients with an interconceptional interval of ≤6 months, 7 neonates (4.7%) had a birth weight of less than 2.5 kg, indicating a higher incidence of low birth weight in this group. In contrast, only 1 neonate (0.7%) with an interconceptional period of 6–12 months and none in the 12–18 months group had a birth weight below 2.5 kg. The highest proportion of normal birth weight (2.5–3 kg) was seen in the group with an interconceptional interval of more than 12 months, where 47 neonates (31.4%) fell into this category. Higher birth weights (3–3.5 kg and 3.5–4 kg) were also more frequent in the group with longer interconceptional periods. These findings indicate that a shorter interconceptional interval, particularly ≤6 months, is associated with a greater risk of delivering low birth weight infants. (p<0.05) [table 1]

In Neonatal outcomes, respiratory distress was present in 24 (16%) patients, neonatal jaundice in 19 (12.67%), neonatal sepsis in 3(2%). Some neonates had more than one complication. 75.33% neonates were normal and had no complications. [Table 2]

Table 2- Association of Interconceptional period and Neonatal Outcomes

In our study, respiratory distress was most common among neonates born after an interconceptional period of ≤6 months (12 cases, 8%), compared to 9 cases (5.8%) in the 6–12 months group and 3 cases (2.1%) in the 12–18 months group, with a significant association (p<0.05). Similarly, neonatal jaundice was observed in 10 cases (6.7%) in the ≤6 months group, 8 cases (5.3%) in the 6–12 months group, and only 1 case (0.7%) in the >12–18 months group, also showing a significant association (p<0.05). Neonatal sepsis was rare and not significantly associated with interconceptional period (p>0.05). These findings highlight increased neonatal complications with shorter interconceptional intervals.

In our study, NICU admissions were highest among neonates born to mothers with an interconceptional period of ≤6 months, accounting for 16 cases (10.7%). This was followed by 14 cases (9.3%) in the 6–12 months group, while only 2 neonates (1.3%) required NICU admission in the 12–18 months group. Out of the total 150 cases, 32 neonates (21.3%) required NICU care, showing a significant association between shorter interconceptional period and increased NICU admissions (p<0.05). These findings suggest that shorter birth spacing may lead to higher neonatal morbidity requiring intensive care. 

In our study assessing neonatal outcomes in women with a previous lower segment caesarean section (LSCS) and a short interconceptional period, we observed a significant association between shorter birth intervals and adverse neonatal outcomes. A higher incidence of low birth weight, respiratory distress, neonatal jaundice, and increased NICU admissions was noted among neonates born to mothers with an interconceptional period of ≤6 months. These findings highlight the importance of adequate birth spacing following caesarean delivery, as insufficient recovery time may compromise uterine healing and fetal development, thereby increasing the risk of neonatal complications and the need for intensive neonatal care.

In our study, maximum number of patients delivered babies of weight of >2.5-3 Kgs (54%) followed by >3-3.5 kgs (31.33%). Majority of the patients with interconceptional period of ≤6 months had low birth weight (<2.5Kg). This difference was statistically significant. In the study done by Fatima Al-Jasmi et al the median birth weight was 2565 grams. [14] Similarly study by Nabukera SK et al [15] mentioned that short ICP associated with low birth weight. Bao-Ping Zhu et al [16] shown association of low birth weight and short interconceptional period. Bouchra Koullali et al [17] concluded that short interpregnancy interval associated with low birth weight. Several studies have reported an association between short IPI and low birth weight (LBW, birth weight <2500 grams). [4 – 6]

Most common neonatal outcome in our study was respiratory distress (16%), followed by neonatal jaundice (12.67%). 3 cases of neonatal sepsis were also noted. Respiratory distress and Neonatal Jaundice cases were more in ≤6 months interconceptional group as compared to >12-18months. This difference was statistically significant. 21% neonates required NICU admission. NICU admission required was more in babies in the group of interconceptional period ≤6 months and >6-12 months as compared to >12-18months interconceptional period. This difference was statistically significant.

 A population-based retrospective cohort study by DeFranco EA et al [18] mentioned that the frequency of neonatal morbidity was lowest following ICP of 12 to <24 months (4.1 percent) compared with ≤6 months (5.7 percent), 6 to <12 compared with ≤6 months, 6 to <12 months. Study done by Fatima Al-Jasmi et al [14] concluded that short interpregnancy interval is a risk factor for spontaneous preterm birth. Some other studies also showed that interpregnancy intervals of < 6 months have been associated with higher rates of preterm birth [4, 5], neonatal complications and neonatal death, [8] increased risk of infant mortality has also been associated with IPI of < 18 months,  risk of stillbirth and spontaneous abortion may also be increased with very short and very long interpregnancy intervals. [4, 5]

Bouchra Koullali et al concluded that short interpregnancy interval associated with preterm birth and neonatal complications. [17] Subsequently published studies have confirmed these findings. [19 – 21]

Our study highlights the significant impact of short interconceptional intervals on neonatal outcomes in women with a previous lower segment caesarean section (LSCS). Among the 150 women studied, those with an interconceptional period of ≤6 months experienced higher rates of adverse neonatal outcomes, including low birth weight in 7 out of 24 cases (29.2%) and NICU admissions in 16 neonates (66.7%). In contrast, improved neonatal outcomes were seen in women with longer intervals of 12–18 months, with only 2 NICU admissions and no cases of low birth weight.

These findings underscore the importance of appropriate birth spacing, especially following caesarean delivery, to allow adequate uterine healing and reduce neonatal complications. A minimum interconceptional period of more than 12 months appears to be associated with better neonatal health indicators. Strengthening postpartum family planning counselling and ensuring follow-up in the postnatal period can help reduce the risks linked to closely spaced pregnancies. Promoting awareness among patients and healthcare providers regarding the risks of short interconceptional periods is vital for improving maternal and neonatal outcomes. We recommend adequate spacing between pregnancies, especially in women with a history of LSCS, to ensure safer delivery and healthier mothers and newborns.

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