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Women whose subsequent interpregnancy interval was less than six months were more likely than other women to have had a first birth complicated by intrauterine growth restriction (odds ratio 1.3, 95% confidence interval 1.1 to 1.5), extremely preterm birth (4.1, 3.2 to https://www.canadagoosemontreal.nu 5.3), moderately preterm birth (1.5, 1.3 to 1.7), or perinatal death (24.4, 18.9 to 31.5). They were also shorter, less likely to be married, and more likely to be aged less than 20 years at the time of the second birth, to smoke, and to live in an area of high socioeconomic deprivation. When the outcome of the second birth was analysed in relation to the preceding interpregnancy interval and the analysis https://en.wikipedia.org/wiki/Canada_goose confined to women whose first birth was a term live birth (n = 69 055), no significant association occurred (adjusted for age, marital status, height, socioeconomic deprivation, smoking, previous birth weight vigesimal, and previous caesarean delivery) between interpregnancy interval and intrauterine growth restriction or stillbirth. Women with very short interpregnancy intervals are more likely to have had complications such as perinatal death, preterm birth, and intrauterine growth restriction in their first pregnancy.11 A short interpregnancy interval is also associated with known demographic risk factors for complications of pregnancy.12 13 Many previous studies of the association between interpregnancy https://www.canadagoosemontreal.nu interval and the risk of adverse outcome have lacked information on maternal demographic factors and have had either no information on the outcome of previous pregnancies or minimal information. None of the studies that were powered to detect differences in rare but important outcomes, such as perinatal death and extremely preterm birth, had data on key obstetric and demographic confounders.6 7 9 10 We report the relation between interpregnancy interval and the outcome of first and second births in a cohort of 89 143 women.

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Data collectionQualitative data collected at each case study site consisted of trust documents, transcripts of semi structured interviews (conducted face to face, by telephone, and by email), and on site observations and accompanying field notes (table 1). We also reviewed specialist IT publications, national media reports, and publications by parliamentary and professional bodies to track the wider context (macro environment) in which implementations took place.

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