Factors associated with rapid repeat pregnancies in women at high risk for adverse birth outcomes

Rapid repeat pregnancy (RRP), defined as a live birth within 27 months of a prior delivery, is associated with adverse maternal and infant outcomes and reflects underlying social inequities. Our objective is to identify factors associated with RRP among women participating in a community health worker (CHW)-led maternal health intervention. We conducted a cross-sectional evaluation of pregnant or postpartum women enrolled in the WeCare CHW program at seventeen federally qualified health centers in central Indiana. CHWs delivered individualized health coaching, care coordination, and referrals addressing social determinants of health. Maternal and infant health indicators were assessed using validated and internally developed screening instruments, and RRP was ascertained during program enrollment. Multivariable logistic regression model estimated odds ratios and their 95% confidence intervals for factors associated with RRP, adjusting for covariates. Overall, 26% (232/894) of participants experienced RRP. In adjusted analyses, younger age at first birth was associated with higher risk of RRP (adjusted OR = 0.95 with one-year increase in age; 95% CI = 0.92–0.98, p < 0.001). Screening positive for anxiety on one occasion (aOR = 1.90; 95% CI = 1.09 to 3.33, p = 0.024), experiencing food insecurity on two or more occasions (aOR = 1.99; 95% CI = 1.23 to 3.24, p = 0.005), and having a history of miscarriage (aOR = 2.80; 95% CI = 1.07 to 7.34, p = 0.036) were independently associated with RRP. Hispanic ethnicity was associated with lower odds of RRP (aOR = 0.57; 95% CI = 0.34 to 0.97, p = 0.037), whereas married participants had higher odds of RRP than unmarried participants (aOR 1.74, 95% CI = 1.08 to 2.80; p = 0.022). Among women engaged in a CHW-led intervention, anxiety, chronic food insecurity, and prior pregnancy loss were key factors associated with RRP. These findings highlight the need for preventive strategies that address both psychosocial and structural factors of reproductive health.