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We analysed the relation of interpregnancy interval to the outcome of the second birth in a subgroup of the main cohort. We defined this subgroup by excluding cases in which the first birth was outside the range 37 43 weeks, the first birth was a perinatal or infant death, or the birth weight of the first child was less than 1500 g. We also excluded cases in which data were missing on potential confounders in the second pregnancy record: maternal age, marital status, height, deprivation category, or adidas superstar slip on tech ink
smoking status. We also excluded cases in which the birth weight vigesimal of the first pregnancy was missing. We defined second births as having been preceded by one pregnancy that did not result in abortion. We defined gestational age at birth as the number of completed weeks of gestation based on the estimated delivery date contained in the clinical record. Over the study period the vast majority of estimates of gestational age in the United Kingdom incorporated ultrasound measurements taken in the first half of pregnancy.19 We defined interpregnancy interval as the interval from the first birth until the estimated date of the last menstrual period before the second pregnancy, expressed in completed months. We calculated the ultrasound corrected date of the last menstrual period by subtracting the gestational age at birth from the date of delivery. In order to avoid bias in categorisation of interpregnancy interval, we used the categories used by a previous large scale study.7
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