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To the Editor: In their meta-analysis on birth spacing and risk of adverse perinatal outcomes, Dr Conde-Agudelo and colleagues¹ found a significant association between short and long interpregnancy intervals and adverse perinatal outcomes. They suggest that health care personnel should provide family planning based on these data, advising women to wait 2 to 5 years before conceiving again.

Two factors were not taken into account in the analysis. First, there are no data on whether these pregnancies were planned and no data on how long it took women to become pregnant. Fecundity itself may be a factor determining pregnancy outcome. Subfertility has been associated with worse pregnancy outcome, even after correction for age, parity, and infertility treatment.^2-3 It might be that a "high fecundity rate" is related to worse pregnancy outcomes, as well.

Westendorp et al⁴ describe a relationship between fecundity and the innate immune system in which women who . . . [Full Text of this Article]

H. C. J. Scheepers, MD, PhD
l.scheepers@obgyn.umcn.nl

Didi Braat, MD, PhD
Department of Obstetrics & Gynaecology
Radboud University Nijmegen Medical Centre
Nijmegen, the Netherlands

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