How Soon Can I Get Pregnant Again?

[00:00:00] Jessica Stewart-Gonzalez: Welcome to The Parenting Brief. I’m your host, Jessica Stewart-Gonzalez, an Arizona working mom and Chief of the Office of Children’s Health at the Arizona Department of Health Services. We’re answering your biggest parenting questions up next.

[00:00:23] How long should you wait after giving birth, before getting pregnant again? It’s a big choice for families, and there’s a lot of misinformation out there. Today, we’re sharing expert advice to help you make the best decision for your family, while keeping both mom and baby’s health in mind.

[00:00:42] With us today is Dr. Siobhan Dolan, an OBGYN and clinical geneticist. Thank you so much for being here with us today. 

[00:00:50] Dr. Siobhan Dolan: It’s great to be here. 

[00:00:51] Jessica Stewart-Gonzalez: So one of the things that comes up with families and their family planning is the timing of when to have more children. [00:01:00] Most are considering things like, do they want more than one child in diapers at a time, or the cost of childcare for multiple children.

[00:01:07] But one of the things that should also be considered is the health of mom and those health related considerations. Is there an ideal amount of time to wait after you give birth, before getting pregnant again, or does that timing not really matter? 

[00:01:25] Dr. Siobhan Dolan: It definitely does matter. So there’s a measure called “interpregnancy interval.”

[00:01:32] It’s sometimes abbreviated IPI. And what that is is the time between the birth of one child and the conception of the next child, and if that is measured and is found to be less than six months, there is an increased risk of adverse outcomes. They include preterm birth, low birth weight, small for gestational age.

[00:01:58] So [00:02:00] essentially, the sense from a medical standpoint is that mom’s body hasn’t had a chance to sort of replenish and we see these adverse outcomes with a second pregnancy if the interval is less than six months. On the other end of the spectrum, if the interval, again, the IPI, the time between the birth of one child and the conception of the next, if that number is a big number, like over 24 months or then even over 60 months in some cases, which would be out to five years, we actually also see an increase in adverse outcomes.

[00:02:38] The longer you get out it. The issue there has to do with maternal age. We know that as moms get older – through no fault of their own, it’s just biology – we see an increased risk of genetic conditions. So the kind of optimal window is thought to be [00:03:00] between about 18 to 24 months. That is a range, right? And is not an absolute single point in time.

[00:03:09] But it gives you a feel not too short, not too long. The sort of window of “just right” is in the 18 to 24 month range. 

[00:03:19] Jessica Stewart-Gonzalez: There potentially are risks no matter your age, no matter the time between pregnancies, but as we are seeing women choosing to have children later, late twenties and into their early forties, this may come with their own set of those health considerations, but could also add pressure to having multiple children quickly.

[00:03:43] Is there any advice for people in that situation? 

[00:03:47] Dr. Siobhan Dolan: Yeah, you’re absolutely right that as you – let’s say you’re in your late thirties, early forties, you are in a conundrum between wanting to have time between your pregnancies, but [00:04:00] also the reality that with advancing maternal age, there are greater risks of genetic conditions.

[00:04:06] So it’s a balancing act, and for each individual, the balancing act can be customized along with, you know, talking to their provider, talking to their partner, seeing what makes the most sense. One of the other issues is that as women get older, not only are there the genetic risks of the fetus, but the maternal risks, right?

[00:04:26] At 42, having a pregnancy, if you have heart disease, if you have hypertension, if you have diabetes, it’s a strain on one’s body. For you to deliver your child and then get pregnant very quickly is gonna put a tremendous strain on you, your body’s ability to, you know, go through the process of labor and delivery and all the cardiovascular changes that are required to deliver a baby, to manage all those fluids, and then to get back to your pre-pregnancy state.

[00:04:56] So I think that’s another factor to factor [00:05:00] into your decision making, but I would sort of stop and think it through a little bit, because the notion that you just deliver, reset everything starts from, you know, scratch again. We used to think that, and the data suggests that that’s not true at all, and we certainly want to educate families so they can make pregnancy-related decisions with good data.

[00:05:21] Jessica Stewart-Gonzalez: It’s one thing to talk about healthy individuals, healthy pregnancies, and healthy babies who are born, but I also wanna talk about circumstances in which a family experiences a loss, either through miscarriage or stillbirth. Is that spacing still the same recommended timeframe? 

[00:05:37] Dr. Siobhan Dolan: For sure. And I, that’s a really good question.

[00:05:39] So, I’d say there’s sort of two parts to that answer. The first is the psychological coping and there’s certainly a grief reaction, and I’d say that’s regardless of the gestational age. If you lose a pregnancy at two months or you know, nine months, you know, certainly at nine months if you have a demise closer to [00:06:00] term, more people in your life might be aware of the pregnancy.

[00:06:03] But I’d say the loss is devastating for families. So I’d say in those circumstances, you need to give yourself time for bereavement. Give yourself time to process the loss. And you know, sometimes that means seeking help, counseling, sometimes medication, you know, each family’s different. But really taking the time to psychologically and emotionally deal with the loss.

[00:06:30] Now on the more physical side. An earlier loss, like in the first trimester, up till about 12 or 13 weeks, it’s thought for women to wait about two to three months to have their period about two or three times and then go ahead and try to become pregnant again if they choose to. 

[00:06:47] There’s not a lot of solid scientific data behind that, like that two months is better than one, that three is better than two. In general, I think we give this guidance for a couple reasons. One, so a [00:07:00] person’s period can reset. And then we also have a sense of when their last period was so we can start to time out their pregnancy and their due date. 

[00:07:08] Now, further along, if you’re, you know, 36, 37, 38 weeks, and tragically have a demise, that has created the physical strains on your body of a full-term pregnancy, even if tragically the baby’s not born alive. So in that instance, you’d be more in line with the 18 to 24 month window, which is to say, giving your body, your heart, your vascular system, et cetera, a chance to readapt to non-pregnant state, which takes about three months to start with, and then giving your body a chance to nutritionally replete itself and so forth.

[00:07:49] But again, never ever less than six months. It’s what we call a rapid repeat pregnancy. The data there is unfortunately quite poor, and we don’t want people to end [00:08:00] up in that window having an adverse outcome. 

[00:08:03] Jessica Stewart-Gonzalez: As families are making these decisions for those subsequent births and what that birth spacing looks like, what are some of the birth control options that are available for families while they’re in between pregnancies?

[00:08:16] Dr. Siobhan Dolan: So what we offer folks nowadays is what we call L-A-R-C, sometimes abbreviated LARC, long-acting reversible contraception. So there are two major methods of long-acting reversible contraception, i.e., it’s not something you have to think about again and again at each active intercourse, but it’s reversible.

[00:08:39] So when you want to become pregnant again, you get it removed. And the two major methods are what’s called an IUD, intrauterine device, or an implant. And the intrauterine device or the implant can be both placed right around the time of delivery. And again, if you want to become pregnant sooner, you talk [00:09:00] to your doctor, you get it removed, you can become pregnant sooner.

[00:09:03] It’s not like someone’s going to hold you to the 18 months. We just want everyone to be fully informed about the data and then help them out because it is hard to take care of everybody and yourself.

[00:09:18] Jessica Stewart-Gonzalez: Click on the show notes to learn more about the importance of birth spacing. Share this episode with the friends and family in your life that are still growing their families. Tap the follow button to get a notification when our next episode is live. Until next time, this is Jessica. You’ve got this.