Although a recent study reported that women should wait at least two years between pregnancies, local doctors said such guidelines might not be practical for all women.

Wednesday, April 07, 1999

Although a recent study reported that women should wait at least two years between pregnancies, local doctors said such guidelines might not be practical for all women.

The Centers for Disease Control and Prevention released a study last month that shows waiting 18 to 23 months after giving birth to get pregnant again may be ideal for producing a healthy, full-term baby.

Having babies too close together can be bad for the infants’ health, having them too far apart – 10 years – may be even worse, the study reported.

Both situations raise the risk that the new baby will be premature or small, which can cause long-term health problems, even death, the study showed.

Doctors from the Albert Lea Medical Center-Mayo Health System don’t dispute the study, but say waiting two and a half years may not be an option for some couples.

&uot;It’s easy to tell a woman who’s 18 or 20 to wait two years before getting pregnant again,&uot; said Dr. Joseph Lombardi.

But couples today are waiting to have children, often until their 30’s. And as a woman gets older, it’s harder to conceive.

&uot;For a woman in her 30’s, waiting two years could mean she won’t be able to have another child,&uot; Dr. Steve Thorn said.

&t;B&gtWeighing the risks&ltB&gt

Throughout his medical training, Lombardi was taught 12 months was a safe interval. He feels if it were truly that unhealthy to wait less than 18 months, the CDC would be more aggressive in releasing the findings and notifying physicians.

Becoming pregnant again within a year may not result in premature births or undersize babies, but the risks are higher. Both Thorn and Lombardi feel if a woman is healthy, it may not be necessary to wait 18 to 23 months to have another child.

&uot;We’re talking about women who are healthy and take good care of themselves,&uot; Thorn said. &uot;That means women who exercise and don’t smoke or drink.&uot;

It’s simply a matter of weighing the risks, they say.

Compared with babies born during the ideal interval, those whose moms became pregnant again within six months had a 30 percent to 40 percent greater chance of producing premature or undersize babies. Those who waited 10 years for another child were twice as likely to have an unusually small baby and 50 percent more likely to deliver prematurely.

Dr. Bao-Ping Zhu, who directed the study, said babies conceived too soon probably have problems because the mother is recovering from vitamin depletion, blood loss and reproductive system damage from the prior birth – all while stressed by having to care for a newborn.

Thorn and Lombardi, who strongly advocate prenatal and even preconception care, said if women begin taking the necessary vitamins and minerals prior to conception, both mother and baby will fare better.

And Sandy Clawson, a nurse practitioner, pointed out that the U.S. has one of the highest pre-term labor rates in the world. Thorn said the U.S. ranks 13th for pre-term labor births.

It’s a statistic Clawson finds surprising considering the country’s advanced technology and health care.

&uot;Our grandmothers didn’t plan births. They were going to have a baby and they would either be lucky or they wouldn’t,&uot; Clawson said. She thinks greater emphasis on prenatal health care was the key to changing that.

&uot;There’s a lot of education involved. Women of the 90’s – and soon the next century – want the education. They are eager to learn what they can,&uot; Clawson said.

&uot;The OB staff and the nursing staff here are such great teachers,&uot; Thorn said.

&t;B&gtIndividuals face different risks, decisions&ltB&gt

Every woman and every situation is different, the doctors pointed out. Some may be at higher risks, while others may not have any problems giving birth less than two years apart. Women who do face a higher risk may still go ahead with another pregnancy if waiting two years isn’t a possibility. But in either case, Thorn and Lombardi said they would help the couple through the situation.

Each couple makes the decision to space their children based on many factors, in addition to health.

Angie and Gary Geesmen of Alden, Minn. are expecting their third in mid-April. They have two sons, Bobby, age nine and Tommy, age four.

The couple decided they wanted three children, about four to five years apart.

&uot;It’s much easier to take care of one at a time than three,&uot; Gary said.

&uot;We can enjoy them at each age level and they’re not competing so much,&uot; Angie said.

The couple said children who are spaced about five years apart will be more self-confident and less competitive.

&uot;They’re at different ages now where they’re not fighting over the same toy. Well, not usually,&uot; Gary noted while eying his Tommy’s Game Boy.

&uot;They take their roles as big brother and little brother seriously,&uot; Angie said.

While Bobby is already looking out for Tommy, the couple thinks both boys will watch over the new addition to the family as well.

Reducing the jealousy factor is one reason Sherrie Christensen and her husband decided to wait six years before having another child.

&uot;With the age gap, I think my daughter will be a good little helper. She so excited already,&uot; Christensen said.

While both women waited four to six years, according to the CDC, neither should be at a higher risk.

Zhu theorized that the reason getting pregnant after a long interval is risky is that the body becomes primed for birth during the earlier pregnancy, with the uterus enlarging and blood flow to the womb increasing, but those benefits decline over time.

The CDC study was based on 173,205 births in Utah from 1989 to 1996.

Zhu said many Utah women did choose roughly the best interval between pregnancies: 15 percent of infants in the study were conceived after an 18- to 23-month lag and 43 percent after a lag of 12 to 29 months.

Among American women, the average interval between first and second births is about 2 1/2 years, according to Susan Tew, a spokeswoman for the Alan Guttmacher Institute, reproductive health organization in New York.

The American College of Obstetricians and Gynecologists says that waiting 1 1/2 to two years between births is best.