How much time should women take between pregnancies?

safespacingpregnancy_largeAfter giving birth, many women aren’t eager to go through the process all over again, but others look forward to having their next baby as soon as possible.

If you’re in the latter camp, it’s important to know that allowing enough time between delivery and conception of the next baby is vital to ensuring that mom and baby both remain healthy.

When it’s safest to get pregnant again

The ideal interval between a live birth and conception of the next pregnancy is 18 to 24 months. At a minimum, there should be at least six months between delivery and conception.

It’s important to note, though, that this relates to timing between delivery and conception – not early miscarriage and conception. There doesn’t seem to be an advantage to waiting to conceive for women who have had a miscarriage.

Why wait?

Research tells us that pregnancies conceived before 18 months after a delivery are associated with several potential complications, including preterm delivery, low birth weight, maternal anemia and congenital anomalies.

The risks seem to increase substantially in pregnancies that were conceived less than six months after the prior delivery.

In women who have had C-sections and are considering a trial of labor after cesarean  – also called a vaginal birth after cesarean – the risk of uterine rupture in labor is higher if there isn’t enough time between delivery and conception. Uterine rupture is a rare but serious condition in which the uterus tears, so it’s really best for these women to wait 18 months between delivery and conception.

It can be difficult to wait, especially when it may have taken a long time to conceive the previous pregnancy. Recognizing that some women who are older or have had infertility in the past may be worried about their ability to conceive if they wait, obstetricians should have a discussion in that case regarding the relative risk and benefits of delaying pregnancy.

Can pregnancies be spaced too far apart?

With five or more years between a prior delivery and conception, there are some increased risks, too. That sweet spot of timing is between about 12 months and five years after the prior delivery.

Research shows us that women who conceived more than five years after their previous delivery had an increased risk of pre-eclampsia, labor that progresses abnormally slowly, cephalopelvic disproportion (in which the baby’s head or body is too large to fit through the mother’s pelvis) and other difficulties in labor.

The bottom line

While it’s one of the most important factors, safe spacing of pregnancies is just one of many aspects to consider when timing a pregnancy.

For example, the World Health Organization recommends two years of breastfeeding, and the American Academy of Pediatrics recommends breastfeeding for at least a baby’s first year of life, with continued breastfeeding having benefits for the baby. And breastfeeding while pregnant is safe, but it presents its own challenges.

Assessing your family’s social, emotional and financial resources is critical, too. In preparing, women should take a folic acid supplement for three months prior to conception. Folic acid is so important for a growing fetus that many healthcare providers even recommend that all women of childbearing age take a daily supplement that contains folic acid.

As with many health decisions, it’s best to talk with your healthcare provider about your individual health conditions when you’re ready to get pregnant again.

 

Lisa Keder is a general obstetrician gynecologist at The Ohio State University Wexner Medical Center and a professor of obstetrics and gynecology at The Ohio State University College of Medicine.

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