Demographic Characteristics, Health Behaviors Before and During Pregnancy, and Pregnancy and Birth Outcomes in Mothers with Different Pregnancy Planning Status

Residential Proximity to Oil and Gas Development and Mental Health in a North American Preconception Cohort Study: 2013-2023

Objectives. To evaluate associations between oil and gas development (OGD) and mental health using cross-sectional data from a preconception cohort study, Pregnancy Study Online. Methods. We analyzed baseline data from a prospective cohort of US and Canadian women aged 21 to 45 years who were attempting conception without fertility treatment (2013-2023). We developed residential proximity measures for active OGD during preconception, including distance from nearest site. At baseline, participants completed validated scales for perceived stress (10-item Perceived Stress Scale, PSS) and depressive symptoms (Major Depression Inventory, MDI) and reported psychotropic medication use. We used log-binomial regression and restricted cubic splines to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results. Among 5725 participants across 37 states and provinces, residence at 2 km versus 20 to 50 km of active OGD was associated with moderate to high perceived stress (PSS ≥ 20 vs < 20: PR = 1.08; 95% CI = 0.98, 1.18), moderate to severe depressive symptoms (MDI ≥ 20 vs < 20: PR = 1.27; 95% CI = 1.11, 1.45), and psychotropic medication use (PR = 1.11; 95% CI = 0.97, 1.28). Conclusions. Among North American pregnancy planners, closer proximity to OGD was associated with adverse preconception mental health symptomatology. (Am J Public Health. 2024;114(9):923-934. https://doi.org/10.2105/AJPH.2024.307730).

Perceptions of Chinese women with a history of gestational diabetes regarding health behaviors and related factors: a directed qualitative content analysis

BACKGROUND

Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy and is associated with adverse outcomes in both mothers and their children. After delivery, women who experience GDM are also at higher risk of both subsequent GDM and type 2 diabetes mellitus (T2DM) than those who do not. Therefore, healthcare providers and public health practitioners need to develop targeted and effective interventions for GDM. In this study, we aimed to explore the perceptions regarding health behaviors and related factors during the inter-pregnancy period among Chinese women with a history of GDM through the lens of the theory of planned behavior (TPB).

METHODS

Between December 2021 and September 2022, 16 pregnant Chinese women with a history of GDM were purposively recruited from a tertiary maternity hospital in Shanghai for face-to-face semi-structured interviews. They were asked questions regarding their health behaviors and related factors. The transcribed data were analyzed using a directed qualitative content analysis method based on the theory of TPB.

RESULTS

The health-related behaviors of the women varied substantially. We identified five domains that influenced women's behaviors according to TPB constructs and based on the data collected: behavioral attitude (perceived benefits of healthy behaviors and the relationship between experience and attitude towards the oral glucose tolerance testing); subjective norms (influences of significant others and traditional cultural beliefs); perceived behavior control (knowledge of the disease, multiple-role conflict, the impact of COVID-19, an unfriendly external environment and difficulty adhering to healthy diets), incentive mechanisms (self-reward and external incentives); preferences of professional and institutional support (making full use of social media platform and providing continuous health management).

CONCLUSIONS

The health-related behaviors of women with a history of GDM were found to be affected by multiple factors. Healthcare professionals are recommended to provide women with sufficient information regarding the disease and to take advantage of the power of the family and other social support networks to improve women's subjective norms and to promote the adoption of a healthy lifestyle.

Impact of unplanned pregnancy on neonatal outcomes: findings of new high-risk newborns in Peru

BACKGROUND

Unplanned pregnancy is a significant public health problem, especially in low- to middle-income countries. The objective of this study was to determine the neonatal outcomes associated with unplanned pregnancy in a public hospital in southern Peru.

METHODS

A cross-sectional analytical study was conducted from June to August 2021 among 306 mothers and their newborns selected by convenience sampling. After obtaining informed consent, mothers were surveyed during their postpartum hospitalization about their pregnancy intentions. Unintended pregnancy was considered when it was mistimed or unwanted. Neonatal outcomes were assessed by reviewing medical records prior to discharge, evaluating the presence of low birth weight, insufficient birth weight, prematurity, respiratory distress syndrome, sepsis and neonatal mortality. Association was measured in terms of prevalence ratio (PR) and beta coefficient and respective 95% CIs, crude and adjusted for variables that obtained a value of p<0.20 in the crude model (maternal age, education and parity).

RESULTS

The overall unplanned pregnancies rate was 65%, of which 40.5% were mistimed pregnancies and 24.5% unwanted pregnancies. Unplanned and mistimed pregnancies were significantly associated with insufficient birth weight [adjusted prevalence ratio (aPR)=2.14; 95% CI 1.01 to 4.56 and aPR=2.43; 95% CI 1.09 to 5.39, respectively] and unwanted pregnancies were significantly associated with preterm birth (aPR=3.49; 95% CI 1.01 to 12.11). Furthermore, adjusted analysis showed that birth weight and gestational age were lower in unplanned, mistimed and unwanted pregnancies.

CONCLUSIONS

Unplanned pregnancy was associated with lower birth weight and shorter gestational age of newborns. These data collected in a public hospital in a developing country may have significant implications today. If pregnancy intention is not included as a neonatal risk factor, insufficient birth weight and preterm birth could increase because a higher proportion of births will be unplanned.

Associations of unintended pregnancy with autism spectrum disorders and the modification of folic acid supplements

There is limited evidence on the associations of unintended pregnancy with autism spectrum disorders (ASD). This study aimed to examine this relationship and the modification of pre-conceptional and prenatal folic acid supplements. Six thousand and five toddlers aged 16 to 30 months from seven cities of six provinces in China were eligible for participation. Information on unintended pregnancy and folic acid supplements was obtained via questionnaires from caregivers of toddlers. The diagnosis of ASD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Chinese version of the Childhood Autism Rating Scale (CARS). Of the 6005 toddlers in the study (3337 boys and 2668 girls), 71 (1.18%) received the diagnosis of ASD. Generalized linear models with a logit link function showed unintended pregnancy was positively associated with ASD (odds ratios [OR] = 1.69, 95% confidence interval [CI], 1.05-2.79). Stratified estimates indicated that the association remained stable among toddlers of mothers without pre-conceptional and prenatal folic acid supplements (OR = 2.75, 95% CI, 1.04-7.27; n = 1243, 20.70%). Unintended pregnancy was associated with higher odds of ASD in 16-30 months of toddlers, and the association was consistent among toddlers of mothers without prenatal folic acid supplements. Our findings emphasize the need to raise awareness of the risk of unintended pregnancy and the benefits of folic acid supplements among Chinese women.

The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study

PURPOSE

Pregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors.

METHODS

A cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18-39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations.

RESULTS

Survivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior.

CONCLUSIONS

Increasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA.

IMPLICATIONS FOR CANCER SURVIVORS

Screening for immediate intentions can identify AYA survivors in need of early preconception health promotion.

Unplanned pregnancy and the association with maternal health and pregnancy outcomes: A Swedish cohort study

OBJECTIVES

Unplanned pregnancies are common and associated with late initiation and inadequate antenatal care attendance, which may pose health risks to mother and child. How pregnancy planning relates to maternal health and delivery in Sweden, a country with free antenatal care and free abortion, has not been studied previously. Our aims were to study whether pregnancy planning was associated with antenatal care utilization and pregnancy outcomes in a Swedish setting.

METHODS

Data for 2953 women, who answered a questionnaire when recruited at antenatal clinics in Sweden and later gave birth, was linked to the Swedish Medical Birth Register. The degree of pregnancy planning was estimated using the London Measure of Unplanned Pregnancy. Unplanned (comprising unplanned and ambivalent intention to pregnancy) was compared to planned pregnancy. Differences between women with unplanned and planned pregnancy intention and associated pregnancy outcomes were analyzed using Fisher's exact test and logistic regression.

RESULTS

There were 31% unplanned (2% unplanned and 29% ambivalent) pregnancies, whereas most woman (69%) reported their pregnancy to be planned. Women with an unplanned pregnancy enrolled later to antenatal care, but there was no difference in number of visits compared with planned pregnancy. Women with an unplanned pregnancy had higher odds to have induced labor (17% versus 13%; aOR 1.33 95% CI 1.06-1.67) and a longer hospital stay (41% versus 37%; aOR 1.21 95% CI 1.02-1.44). No associations were found between pregnancy planning and pregnancy-induced hypertension, gestational diabetes mellitus, preeclampsia, epidural analgesia use, vacuum extraction delivery, Caesarean section or sphincter rupture.

CONCLUSIONS

Unplanned pregnancy was associated with delayed initiation of antenatal care, higher odds for induction of labor and longer hospital stay, but not with any severe pregnancy outcomes. These findings suggest that women with an unplanned pregnancy cope well in a setting with free abortion and free health care.

Pre- and Perinatal Risk Factors for Child Maltreatment in Military Families Across the First Two Years of Life

Military families are exposed to a unique constellation of risk factors, which may impact maltreatment outcomes. The present study examined prospective relationships between demographic, health, birth-related, and military-specific risk factors identified prior to a child's birth on their risk for maltreatment in the first two years of life. Data from the Millennium Cohort Study, Department of Defense (DoD) operational records and Family Advocacy Program data on met-criteria maltreatment, and Birth and Infant Health Research program data on suspected maltreatment were linked for 9076 service member parents. Discrete time survival analysis showed that preterm birth increased risk of maltreatment while parents' older age, physical health, and service in the Navy or Air Force decreased risk. Building on DoD's New Parent Support Program, findings suggest the need for universal and targeted prevention efforts, beginning during pregnancy, which limit or eliminate risk factors for maltreatment in military families.

Associations of maternal periconceptional alcohol consumption with offspring prehypertension/hypertension at age 6 years: the Growing Up in Singapore Towards healthy Outcomes prospective mother-offspring cohort study

OBJECTIVE

To evaluate the relationship of the levels of maternal alcohol consumption during the 1 year before pregnancy recognition with childhood cardiorenal, metabolic, and neurocognitive health.

METHODS

In 1106 women and their children from the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort, quantity of maternal alcohol consumption in the 12 months prior to pregnancy recognition was categorized as high (≥75th percentile: 1.9 g/day), low (<1.9 g/day), and none, and frequency of alcohol consumption was categorized as high (≥2-3 times/week), low (<2-3 times/week), and none. Offspring MRI-based abdominal fat depot, kidney, and brain volumes, blood pressure, metabolic syndrome score, and cognitive intelligence scores were assessed. Child prehypertension/hypertension at age 6 years was defined using a simplified pediatric threshold of 110/70 mmHg.

RESULTS

The average maternal alcohol consumption in the year prior to pregnancy recognition was 2.5 g/day, which is lower than the daily maximal limit of one standard drink (10 g) recommended for women by Singapore's Ministry of Health. After adjusting for participant characteristics, alcohol consumption at least 1.9 g/day was associated with over two-fold higher risk (risk ratio = 2.18, P = 0.013) of child prehypertension and 15% greater kidney growth between early infancy and age 6 years (P = 0.040) compared with abstinence. Alcohol consumption was not associated with metabolic and neurocognitive health at age 6-7 years. The associations with high frequency of alcohol consumption were concordant with those obtained for quantity of alcohol consumption.

CONCLUSION

Maternal self-reported alcohol consumption at least 1.9 g/day prior to pregnancy recognition was associated with increased risk of child prehypertension and rapid kidney growth. Our findings highlight the potential detrimental effects of low periconceptional alcohol consumption, below national guidelines on offspring cardiorenal health.

Association between pregnancy intention and smoking or alcohol consumption in the preconception and pregnancy periods: A systematic review and meta-analysis

AIMS

To investigate the association between pregnancy intention and smoking or alcohol consumption in preconception and pregnancy periods.

BACKGROUND

Suboptimal lifestyle such as smoking and alcohol consumption can lead to devastating outcomes on the maternal and foetus. Pregnancy intention exerts a significant effect on promoting healthy lifestyle behaviours. However, no reliable evidences confirmed pregnancy intention was associated with smoking and alcohol consumption before and during pregnancy.

DESIGN

Systematic review and meta-analysis.

METHODS

We performed a comprehensive search from databases including PubMed, Cochrane, Web of Science, IEEE Xplore, MEDLINE, ProQuest and Scopus from the inception of these databases up to November, 2020. All eligible studies exploring the association between pregnancy intention and smoking or alcohol consumption were included. The fixed- or random effect pooled measure was used to estimate the odds ratio (OR) or risk ratio (RR) and 95% CI. In addition, the PRISMA checklist was used in this meta-analysis.

RESULTS

A total of 23 studies were included in this systematic review and meta-analysis. During pregnancy, the findings suggested that women with unplanned pregnancy were 68% more likely to consume cigarettes (OR = 1.68, 95% CI = 1.44-1.95) and 44% more likely to consume alcohol (OR = 1.44, 95% CI = 1.15-1.81) than those women with planned pregnancy. Meanwhile, during preconception, women with unplanned pregnancy were 30% more likely to consume cigarettes (OR = 1.30, 95% CI = 1.10-1.53) and 20% more likely to consume alcohol (OR = 1.20, 95% CI = 1.01-1.42) than those women with planned pregnancy.

CONCLUSION

The findings suggested that women with unplanned pregnancy were more likely to follow unhealthy behaviours such as smoking and alcohol consumption before and during pregnancy. Health professionals should consider the women's desire for pregnancy to decrease preconception and pregnancy smoking or alcohol consumption in future studies.

RELEVANCE OF CLINICAL PRACTICE

Pregnancy intention is the key determinant of smoking and alcohol consumption during preconception and pregnancy periods. Offering effective contraception in primary healthcare setting could prevent unplanned pregnancy. Meanwhile, popularising minimal alcohol consumption and comprehensive smoke-free legislation would be beneficial to improve reproductive outcomes.

Effect of Gestational Diabetes Mellitus History on Future Pregnancy Behaviors: The Mutaba'ah Study

Gestational diabetes mellitus (GDM) increases the risk of adverse pregnancy outcomes in any pregnancy and recurrence rates are high in future pregnancies. This study aims to investigate the effect of self-reported history of previous GDM on behaviors in a future pregnancy. This is an interim cross-sectional analysis of the pregnant women who participated in the Mutaba'ah Study between May 2017 and March 2020 in the United Arab Emirates. Participants completed a baseline self-administered questionnaire on sociodemographic and pregnancy-related information about the current pregnancy and previous pregnancies. Regression models assessed the relationships between self-reported history of GDM and pre-pregnancy and pregnancy behaviors in the current pregnancy. Out of 5738 pregnant parous women included in this analysis, nearly 30% (n = 1684) reported a history of GDM in a previous pregnancy. Women with a history of previous GDM were less likely to plan their current pregnancies (adjusted odds ratio (aOR): 0.84, 95% confidence interval (CI) 0.74-0.96) and more likely to be worried about childbirth (aOR: 1.18, 95% CI 1.03-1.36). They had shorter interpregnancy intervals between their previous child and current pregnancy (aOR: 0.88, 95% CI 0.82-0.94, per SD increase). There were no significant differences between women with and without a history of GDM in supplement use, sedentary behavior, or physical activity before and during this current pregnancy. Nearly a third of parous pregnant women in this population had a history of GDM in a previous pregnancy. Pregnant women with a previous history of GDM were similar to their counterparts with no history of GDM in the adopted pre-pregnancy and prenatal health behaviors. More intensive and long-term lifestyle counseling, possibly supported by e-health and social media materials, might be required to empower pregnant women with a history of GDM. This may assist in adopting and maintaining healthy prenatal behaviors early during the pregnancy or the preconception phase to minimize the risk of GDM recurrence and the consequential adverse maternal and infant health outcomes.

Perinatal emotional states: a comparative study between two cohorts recruited in a Mediterranean environment

Experiencing negative emotional states during pregnancy has been linked to adverse outcomes for mother and offspring. Our study aims were to compare the perinatal emotional states and obstetrical variables between pregnant women recruited in Spain (n = 202) and Italy (n = 103), and to investigate prenatal anxiety related factors. The study had two phases. In the 1^st phase (3^rd trimester of pregnancy), prenatal anxiety was assessed using the State-Trait Anxiety Inventory (STAI); other prenatal and sociodemographic variables were also collected. In the 2^nd phase (40 days postpartum), the STAI and the Edinburgh Postnatal Depression Scale were administered. Compared to the Spanish sample, the Italian sample presented higher STAI state and STAI factor 1 mean scores (22.5 vs. 18.6 and 10.0 vs. 7.2), shorter gestations (mean gestation weeks: 39.1 vs. 39.8), more unplanned pregnancies (31.1% vs. 16.4%), and more cesareans deliveries (42.5% vs. 16.0%). Low socioeconomic levels, younger ages, previous miscarriages and unplanned pregnancies were related to prenatal anxiety. Postpartum depression rates was 31.3% and there were no differences between countries. Our results suggested that it may be interesting in both countries to create a prenatal monitoring protocol that attaches more importance to emotional wellbeing both during pregnancy and in the long term.

Plasma glycemic measures and fecundability in a Singapore preconception cohort study

OBJECTIVE

To examine the association between plasma glycemia in women attempting to conceive and fecundability, as measured by time to pregnancy.

DESIGN

Prospective preconception population-based study.

SETTING

Hospital.

PATIENT(S)

Asian preconception women, 18-45 years old, attempting conception for ≤12 cycles at study entry.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

We ascertained time to pregnancy within a year of glycemic assessment in menstrual cycles. We estimated fecundability ratios (FRs) and 95% confidence intervals using discrete-time proportional hazards models, adjusting for age, ethnicity, education, body mass index, and cycle regularity and accounting for left truncation and right censoring.

RESULT(S)

We studied a population sample of 766 women from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes prospective cohort. Compared with women with normoglycemia, women with dysglycemia (prediabetes and diabetes, defined by the American Diabetes Association) had a lower FR (0.56). Compared with the respective lowest quintiles, women in the highest quintile of fasting glucose (≥5.1 mmol/L) had an FR of 0.60, while women in the highest 2-hour postload glucose quintile (≥6.9 mmol/L) had an FR of 0.66. Overall, the FRs decreased generally across the range of fasting and 2-hour plasma glucose. Glycated hemoglobin was not associated with fecundability.

CONCLUSION(S)

Increasing preconception plasma glucose is associated with reduced fecundability, even within the normal range of glucose concentrations.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03531658.

Psychosocial status and prenatal care of unintended pregnancies among low-income women

Background

Nearly half of all pregnancies in the United States are reported as unintended and rates are highest among women of low socioeconomic status. The purpose of this study was to examine the associations between unintended pregnancies and maternal mental health and timing of prenatal care among low-income women.

Methods

In this cross-sectional study, 870 women, whom were participating in the First 1000 Days program in three community health centers in the Boston area, were enrolled at their first prenatal visit from August 2016 – September 2017. We assessed pregnancy intention by self-report using the Pregnancy Risk Assessment Monitoring System. We used self-reported survey information and electronic health record data to assess the following outcomes: current stress, current depression, and timing of initial prenatal visit. We used multivariable logistic regression models to examine associations and adjusted for sociodemographic factors.

Results

Women were a mean (SD) age of 29.3 (6.1), and 39.2% reported that their pregnancy was unintended. 50.6% of women were Hispanic, 28.4% were White, 10.1% were Black, and 10.9% were other races. 78.9% of women reported an annual household income <$50,000. Overall, 26.7% of women reported current stress, 8.2% reported current depression, and 18.3% of women initiated prenatal care after their first trimester. In multivariable analyses, women with unintended pregnancies had higher odds of experiencing current stress (OR: 1.72; 95% CI: 1.22, 2.41), current depression (OR: 1.83; 95% CI: 1.04, 3.20), and initiation of prenatal care post-first trimester (OR: 1.84; 95% CI: 1.23, 2.74).

Conclusions

Unintended pregnancies were associated with current stress and depression, and delayed prenatal care in this sample of low-income women suggesting the importance of identifying high-risk women and tailoring interventions to support women’s needs.

Trial registration

ClinicalTrials.gov (NCT03191591; Retrospectively registered on June 19, 2017).

Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control

Tobacco use has unique, adverse health consequences for reproductive-aged women, particularly should these women become pregnant. Thus, successful efforts to reduce tobacco use among this population have strong potential to improve public health and reduce health disparities. The present review examines contributions to reducing tobacco use among women of childbearing age spanning the domains of tobacco regulatory science and tobacco control from the passage of the Family Smoking Prevention and Tobacco Control Act in 2009 through September 2019. In the domain of tobacco regulatory science, such efforts include research conducted by various National Institutes of Health/Food and Drug Administration (FDA)-supported Tobacco Centers of Regulatory Science, epidemiological surveillance studies, as well as studies examining the potential impact of tobacco regulatory policies currently under consideration by the FDA (e.g., reduced nicotine content cigarettes, health warning labels). Tobacco control efforts within this same 10-year timeframe include developments in pharmacological and psychosocial approaches to promoting tobacco cessation, mHealth interventions, and tobacco control policy. Emerging issues pertinent to ongoing efforts to reduce tobacco use within the domains of both tobacco regulatory science and tobacco control are also reviewed, including e-cigarettes, comorbid health conditions, course of tobacco and other drugs of abuse, and obstacles to the dissemination and implementation of evidence-based treatment and policy. Although the past decade has seen numerous important contributions to reducing tobacco use among reproductive-aged women within both domains, existing obstacles must be surmounted to continue reducing tobacco use and protecting health among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Relationship Between Pregnancy Intentions and Diet or Physical Activity Behaviors in the Preconception and Antenatal Periods: A Systematic Review and Meta-Analysis

INTRODUCTION

Healthy preconception and antenatal diet and physical activity behaviors may optimize maternal and offspring outcomes. These behaviors are thought to be linked to pregnancy intentions. The aim of this study was to conduct a systematic review and meta-analysis to determine the association between women's pregnancy intentions and diet or physical activity behaviors in the preconception and antenatal periods.

METHODS

MEDLINE Complete, PsycINFO, CINAHL Complete, Global Health, Embase, and INFORMIT: Health Subset were searched in September 2018 for studies that evaluated relationships between pregnancy intentions and dietary and physical activity behaviors. Risk of bias was assessed, and random effects meta-analyses were conducted for dietary (food groups; energy and macronutrients; diet quality; and caffeine, iodine, and folate intake) and physical activity outcomes.

RESULTS

Of 2623 screened records, 19 eligible studies were identified. The overall risk of bias was moderate to high. Twelve studies measured diet and physical activity behaviors during preconception, 5 during pregnancy, and 2 across both periods. Eleven studies measured pregnancy intention retrospectively, and 8 prospectively measured pregnancy intention. The number of studies available for meta-analyses of individual dietary and physical activity outcomes ranged from 2 to 5. Pregnancy intentions were not associated with preconception fruit, vegetable, or caffeine intake or physical activity. Antenatally, women with intended pregnancies were more likely to report healthier diets, lower caffeine intake, and higher physical activity. Insufficient studies were available to conduct subgroup comparisons for prospective or retrospective assessment.

DISCUSSION

Pregnancy intentions were not associated with preconception diet or physical activity behaviors. In contrast, antenatally, women with intended pregnancies demonstrated better diet and physical activity behaviors. Given the small number of studies available for meta-analyses, further research is needed to consolidate our findings. Meanwhile, health professionals can assess women's pregnancy intentions during preconception and pregnancy and encourage a healthy lifestyle.

Gender Differences in Factors Influencing Self-Efficacy Toward Pregnancy Planning among College Students in Korea

The purpose of this study was to examine factors influencing college students' self-efficacy toward pregnancy planning by gender using the health belief model (HBM). Utilizing a comparative descriptive design, a total of 819 college students were recruited. A survey was administered to gather information on health beliefs related to pregnancy planning, self-efficacy toward pregnancy planning, fertility knowledge, and general characteristics. The main variables were compared by gender. The factors influencing self-efficacy toward pregnancy planning were identified using hierarchical regression analysis. Female students (476) had lower self-efficacy toward pregnancy planning than male students (343). The significant factors influencing self-efficacy toward pregnancy planning in female students were: depression (β = -0.09, p = 0.030), fertility knowledge (β = 0.08, p = 0.025), barriers (β = -0.57, p < 0.001), and cues to action (β = 0.16, p < 0.001), whereas the corresponding factors in male students were benefits (β = 0.12, p = 0.020), barriers (β = -0.44, p < 0.001), and cues to action (β = 0.16, p = 0.001). The present study confirmed the suitability of the HBM as a conceptual framework for identifying factors influencing self-efficacy toward pregnancy planning. Based on the findings of this study, gender-based similarities and differences in factors influencing self-efficacy should be considered when taking steps to promote self-efficacy toward pregnancy planning among college students.

Defining preconception: exploring the concept of a preconception population

Background

Health prior to conception can significantly impact offspring health, however, a clear definition of the attributes of the preconception population is currently lacking. We aimed to use existing literature to explore the concept and attributes of a preconception population by: [1] identifying characteristics and research recruitment methods; and [2] generating an attribute-based working definition of a preconception population.

Methods

A rapid review of current literature using CINAHL and the subject heading ‘pre-pregnancy care’ was conducted (Stage 1). Data extracted included definitions of preconception, participant inclusion/exclusion criteria, participant characteristics, and recruitment methods. Stage 2 involved a wider search of relevant publications beyond peer-reviewed literature followed by a concept analysis of the phrase “preconception population” applying Walker and Avant’s framework (Stage 2).

Results

Twenty-three papers (19 studies) were included in Stage 1. “Preconception” was explicitly defined in one study. Twelve studies specified participants must be planning a pregnancy. Stage 2 included 33 publications. Four key perspectives for the concept of the preconception population were derived: [1] intentional; [2] potential; [3] public health; and [4] life course.

Conclusions

Adopting these perspectives may allow researchers to accurately define, identify and recruit preconception populations and to develop interventions that are appropriately broad or tailored depending on population needs. We hope the definitions will facilitate research with this population and will subsequently improve the wellbeing of preconception men and women, which is essential to ensuring the health of future generations.

Maternal Dietary Intakes, Red Blood Cell Indices and Risk for Anemia in the First, Second and Third Trimesters of Pregnancy and at Predelivery

As anemia remains a major public health problem in Ghana, we examined the effect of dietary intakes, and antenatal care (ANC) practices on red cell indices and anemia prevalence during the pregnancy continuum for 415 women. Dietary history was taken using the Food and Agriculture Organization minimum dietary diversity indicator for women (MDD-W). Intake of ≥5 food groups was a proxy for micronutrient adequacy. Odds for anemia and meeting the MDD-W were estimated using ordinal and binary logistic regressions respectively. Intakes of 41.4% were micronutrient inadequate. At any time point in pregnancy, 54.4% were anemic (mild = 31.1%; moderate = 23.1%; severe = 0.2%) with 10%-point variation across the first (57.3%), second (56.4%) and third (53.3%) trimesters and pre-delivery (47.7%); 27.8% were anemic throughout pregnancy while 17.1% were never anemic. Morphologically, microcytic (79.4%) and hypochromic (29.3%) anemia were most prevalent, indicating nutritional deficiencies. Planning the pregnancy was a significant determinant for meeting the MDD-W. Overall, adolescence, poor diet, suboptimum ANC and underweight were associated with moderate and severe anemia. In specific time-points, dietary counselling, malaria, iron-folic acid supplementation, sickle cell disease and preeclampsia were observed. Decline of anemia during pregnancy suggests the positive impact of ANC services and supports strengthening education on dietary diversification during ANC.

Sexual behaviours among adolescents in a rural setting in eastern Uganda: a cross-sectional study

OBJECTIVE

Globally as adolescents transition into adulthood, some engage in risky sexual behaviours. Such risky behaviours expose adolescents to unintended pregnancy and sexually transmitted infections (STIs), including HIV infection. Our objective was to examine sexual practices of adolescents (aged 10-19 years) in eastern Uganda and identify factors associated with having ever had sexual intercourse.

METHODS

Face-to-face interviews were conducted using a standardised questionnaire among randomly selected adolescents residing within the Iganga-Mayuge Health and Demographic Surveillance Site in eastern Uganda. Crude and adjusted prevalence rate ratios (PRR) were estimated using the Modified Poisson regression model to identify factors associated with adolescents having ever had sex.

RESULTS

Of the 598 adolescents studied, 108 (18.1%) reported ever having had sexual intercourse, of whom 20 (18.5%) had ever gotten pregnant. Adolescents who reported to be out of school, 76 (12.7%), were more likely to have ever had sexual intercourse (PRR = 1.82, CI = 1.09-3.01). Females were less likely to ever have had sexual intercourse (PRR 0.69 (0.51-0.93) than males. History of ever having had sexual intercourse was associated with adolescents sexting (PRR = 1.54, CI: 1.14-2.08), watching sexually explicit films (PRR = 2.29 Cl: 1.60 - 3.29) and experiencing verbal jokes about sexual intentions (PRR = 1.76, Cl: 1.27 - 2.44).

CONCLUSIONS

A majority of participants reported not being sexually active; however, interventions should be required for both sexually active and not sexually active adolescents. Programmes targeted at adolescents in this and similar communities should include comprehensive sex education, and contraceptive distribution among adolescents. In particular, urgent interventions are needed to guide adolescents as they use social media.

Validation of the London Measure of Unplanned Pregnancy among pregnant Australian women

Introduction

Globally, over half of pregnancies in developed countries are unplanned. Identifying and understanding the prevalence and complexity surrounding pregnancy preparation among Australian women is vital to enable sensitive, responsive approaches to addressing preconception and long-term health improvements for these women with varying motivation levels.

Aim

This study evaluated the reliability and validity of a comprehensive pregnancy planning/intention measure (London Measure of Unplanned Pregnancy) in a population of pregnant women (over 18 years of age) in Australia.

Methods

A psychometric evaluation, within a cross-sectional study comprising cognitive interviews (to assess comprehension and acceptability) and a field test. Pregnant women aged over 18 years were recruited in early pregnancy (approximately 12 weeks’ gestation). Reliability (internal consistency) was assessed using Cronbach’s alpha, corrected item-total correlations and inter-item correlations, and stability via a test-retest. Construct validity was assessed using principal components analysis and hypothesis testing.

Results

Six women participated in cognitive interviews and 317 in the field test. The London Measure of Unplanned Pregnancy was acceptable and well comprehended. Reliability testing demonstrated good internal consistency (alpha = 0.81, all corrected item-total correlations >0.20, all inter-item correlations positive) and excellent stability (weighted kappa = 0.92). Validity testing confirmed the unidimensional structure of the measure and all hypotheses were confirmed.

Conclusions

The London Measure of Unplanned Pregnancy is a valid and reliable measure of pregnancy planning/intention for the Australian population. Implementation of this measure into all maternity healthcare, research and policy settings will provide accurate population-level pregnancy planning estimates to inform, monitor and evaluate interventions to improve preconception health in Australia.

Female adiposity and time-to-pregnancy: a multiethnic prospective cohort

STUDY QUESTION

Are higher overall and central adiposity associated with reduced fecundability, measured by time-to-pregnancy (TTP), in Asian women?

SUMMARY ANSWER

Higher overall adiposity, but not central adiposity, was associated with longer TTP in Asian women.

WHAT IS KNOWN ALREADY

High body mass index (BMI) has been associated with a longer TTP, although the associations of body composition and distribution with TTP are less clear. There are no previous studies of TTP in Asian women, who have a relatively higher percentage of body fat and abdominal fat at relatively lower BMI.

STUDY DESIGN, SIZE, DURATION

Prospective preconception cohort using data from 477 Asian (Chinese, Malay and Indian) women who were planning to conceive and enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) study, 2015-2017.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women's mean age was 30.7 years. Overall adiposity was assessed by BMI, sum of 4-site skinfold thicknesses (SFT) and total body fat percentage (TBF%, measured using air displacement plethysmography); central adiposity was assessed by waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and A body Shape Index (ABSI). Pregnancy occurring within one year from recruitment was ascertained by ultrasonography. Those who did not conceive within one year of recruitment, were lost to follow-up, or initiated fertility treatment were censored. TTP was measured in cycles. Discrete-time proportional hazards models were used to estimate the fecundability ratio (FR) and 95% confidence interval (CI) for each anthropometric measure in association with fecundability, adjusting for confounders.

MAIN RESULTS AND THE ROLE OF CHANCE

Compared to women with a normal BMI of 18.5-22.9 kg/m2, women with higher BMI of 23-27.4 and ≥27.5 kg/m2 showed lower FR of 0.66 (95% CI 0.45, 0.97) and 0.53 (0.31, 0.89), respectively. Compared to women in the lowest quartile of SFT (25-52.9 mm), those in the highest quartile of ≥90.1 mm showed lower FR of 0.58 (95% CI 0.36, 0.95). Compared to women in the lowest quartile of TBF% (13.6-27.2%), those in the upper two quartiles of 33.0-39.7% and ≥39.8% showed lower FR of 0.56 (95% CI 0.32, 0.98) and 0.43 (0.24, 0.80), respectively. Association of high BMI with reduced fecundability was particularly evident among nulliparous women. Measures of central adiposity (WC, WHR, WHtR, ABSI) were not associated with fecundability.

LIMITATIONS REASONS FOR CAUTION

Small sample size could restrict power of analysis.The analysis was confined to planned pregnancies, which could limit generalizability of findings to non-planned pregnancies, estimated at around 44% in Singapore. Information on the date of last menstrual period for each month was not available, hence the accuracy of self-reported menstrual cycle length could not be validated, potentially introducing error into TTP estimation. Measures of exposures and covariates such as cycle length were not performed repeatedly over time; cycle length might have changed during the period before getting pregnant.

WIDER IMPLICATIONS OF THE FINDINGS

Other than using BMI as the surrogate measure of body fat, we provide additional evidence showing that higher amounts of subcutaneous fat that based on the measure of SFT at the sites of biceps, triceps, suprailiac and subscapular, and TBF% are associated with longer TTP. Achieving optimal weight and reducing total percentage body fat may be a potential intervention target to improve female fertility. The null results observed between central adiposity and TTP requires confirmation in further studies.

STUDY FUNDING/COMPETING INTEREST(S)

This research is supported by Singapore National Research Foundation under its Translational and Clinical Research Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council, (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. Y.S.C., K.M.G., F.Y. and Y.S.L. have received reimbursement to speak at conferences sponsored by companies selling nutritional products. Y.S.C., K.M.G. and S.Y.C. are part of an academic consortium that has received research funding from Abbott, Nutrition, Nestle and Danone. Other authors declared no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Associations of growth from birth to puberty with glycemic indicators at ~17.5 years: Evidence from Hong Kong's "Children of 1997" birth cohort

BACKGROUND

From an evolutionary biology perspective, where growth and reproduction trade-off against longevity, we assessed the associations of growth from birth to puberty by phase with later glycemic indicators and any differences by sex.

METHODS

In the population-representative Hong Kong Chinese "Children of 1997" birth cohort (n = 8327), the relation of initial size (weight-for-age z score (WAZ) at birth, length/height-for-age z score (LAZ) at 3 months or body-mass-index-for-age z score (BAZ) at 3 months based on the World Health Organization growth standards/references) and growth at different phases (WAZ gains from 0 to 2 and 2 to 8 years, LAZ or BAZ gains from 3 months to 3 years, 3 to 8 years and 8 to 14 years) with fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) at ~17.5 years, was assessed using adjusted partial least squares regression. Additional analyses further considered growth in late and early infancy.

RESULTS

This study included 3276 of the cohort participants. Higher WAZ gain from 2 to 8 years, LAZ and BAZ gains from 3 to 8 years were consistently associated with higher FPG, adjusted for maternal and infant characteristics, family history of diabetes and household income. Also, higher BAZ gain from 3 to 8 years was associated with higher HbA1c. These associations did not differ by sex.

CONCLUSIONS

Our findings suggest different mechanisms could underlie the pathogenesis of glucose intolerance. Factors that drive specific growth at different phases need to be evaluated to better inform child growth management for long-term health outcomes.

A systematic mapping review of the associations between pregnancy intentions and health-related lifestyle behaviours or psychological wellbeing

The aim of this study was to conduct a systematic mapping review of the literature that explored associations of pregnancy intentions with health-related lifestyle behaviours and psychological wellbeing before and during pregnancy. Six databases were searched (May 2017) for papers relating to pregnancy intentions, health-related lifestyle behaviours, and psychological wellbeing. The literature was mapped according to the preconception or pregnancy period; prospective or retrospective variable assessment; and reported lifestyle behaviours and psychological wellbeing outcomes. Of 19,430 retrieved records, 303 studies were eligible. Pregnancy intentions were considered during the preconception period in 103 studies (only 23 assessed prospectively), and during the pregnancy period in 208 studies (141 prospectively). Associations between pregnancy intention and preconception behaviours/psychological wellbeing were primarily reported for supplement use (n = 58) and were lacking for diet/exercise, and psychological factors. For behaviours/psychological wellbeing during pregnancy, associations with pregnancy intention were focused on prenatal care (n = 79), depression (n = 61), and smoking (n = 56) and were lacking for diet/exercise. Only 7 studies assessed pregnancy intentions with a validated tool. Despite a large body of literature, there were several methodological limitations identified, namely assessment of pregnancy intentions with non-validated measures and the reliance on retrospective assessment. Future primary studies are needed to fill gaps in our understanding regarding energy-balance-related behaviours. Future studies (including reviews/meta-analyses) should take care to address the noted limitations to provide a comprehensive and accurate understanding of the relationships between pregnancy intentions and health-related lifestyle behaviours and psychological wellbeing before and during pregnancy.

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Reliance on the assessment of pregnancy intentions with non-validated measures

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Reliance on retrospective assessment

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Studies on preconception pregnancy intentions and diet/exercise lacking

Psychometric Properties of the Short Form of the Health Practices Questionnaire-II Chinese Version

OBJECTIVE

To examine the psychometric properties of the Health Practice Questionnaire-II Chinese version (HPQ-II CV), a self-report instrument designed to measure the health behaviors of pregnant women.

DESIGN

Cross-sectional, psychometric design.

SETTING

Prenatal clinics of four hospitals in southern Taiwan.

PARTICIPANTS

Two convenience samples, 368 pregnant women in Phase 1 and 289 pregnant women in Phase 2.

METHODS

In Phase 1, the 34-item HPQ-II was translated into Chinese. Then, we explored the factor structure of the HPQ-II CV using exploratory factor analysis, determined the factors of the HPQ-II CV, and shortened the length of the scale. In Phase 2, we used confirmatory factor analysis to cross-validate the factor structure of the 13-item HPQ-II CV.

RESULTS

In Phase 1, we used item analysis to reduce the 34-item HPQ-II CV to 21 items. Using exploratory factor analysis and parallel analysis, we shortened the 21-item HPQ-II CV to 15 items grouped in four factors: Taking Safety Measures (4 items), Eating A Healthy Diet (3 items), Coping With Uncertainty (3 items), and Seeking Help From Professionals (5 items), which accounted for 45.70% of the total variance. In Phase 2, two items were removed from the 15-item HPQ-II CV after confirmatory factor analysis. Cronbach's alpha coefficient of the 13-item HPQ-II CV was .80, and the cross-sample validity supported the best-fit model for the 13-item HPQ-II CV.

CONCLUSION

We found acceptable validity and reliability statistics for the 13-item HPQ-II CV when administered to pregnant, Taiwanese women.

Factors associated with pregnancy intention among women who have experienced a short birth interval: findings from the 2009 to 2011 Mississippi and 2009 Tennessee Pregnancy Risk Assessment Monitoring System

PURPOSE

One-third of all pregnancies in the United States are conceived within 18 months of a prior live birth. Preventing unintended pregnancies may help to decrease the prevalence of pregnancies with these short interpregnancy intervals. However, data on factors associated with pregnancy intention among women who have had short birth intervals are sparse. Pregnancy Risk Assessment Monitoring System data were used to further evaluate these associations.

METHODS

Because only Mississippi and Tennessee Pregnancy Risk Assessment Monitoring System include a survey question about birth interval length, this analysis was limited to women from those states who recently had a short birth interval (n = 384). Pregnancy intention and demographic, lifestyle, and reproductive data were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Nearly 76% of women with short birth intervals reported their pregnancy as unintended. Women who were non-Hispanic black or consumed alcohol during pregnancy had statistically significant increased odds of reporting the pregnancy with a short birth interval as being unintended (OR = 3.98; 95% CI: 1.73-9.16 and OR = 10.56; 95% CI: 1.80-61.83, respectively).

CONCLUSIONS

Although all women should be counseled on postpartum contraceptive use, findings suggest that important subpopulations of women may benefit from more targeted counseling during prenatal care visits and the immediate postpartum hospital stay regarding the importance of using contraception to not only better space pregnancies but also prevent unintended pregnancies.

The Associations of Breast Feeding with Infant Growth and Body Mass Index to 16 years: 'Children of 1997'

BACKGROUND

Controversial findings concerning associations of breast feeding with growth have been reported. This study examined whether the associations of breast feeding with early growth trajectories and body mass index to 16 years differed by sex or age.

METHODS

In Hong Kong's 'Children of 1997' population-representative birth cohort, contemporaneously reported breast-feeding status in the first 3 months was classified as exclusive breast feeding (BF) (n = 470), mixed feeding (MF) (n = 2693), and formula feeding (FF) (n = 4204). Adjusted sex- and age-specific associations of breast feeding with infant growth (gains in weight-for-age z scores (WAZ), length/height-for-age z scores (LAZ), and body-mass-index-for-age z score (BAZ) based on the World Health Organization standards/references from birth to 36 months) were assessed using linear regression and mixed modelling, respectively. Adjusted sex-specific associations of breast feeding with average BAZ from 3 months to 16 years were assessed using generalized estimating equation. Potential confounders were maternal and infant characteristics, and household income.

RESULTS

Among 7367 children, associations of breast feeding with infant growth did not vary by sex, but WAZ gains varied by age. Greater WAZ gains were observed in BF than FF infants from 0 to 3 months but in FF than BF infants from 3 to 9 months. Breast feeding was not associated with overall BAZ from 3 months to 16 years, with no differences by sex.

CONCLUSIONS

Our findings suggest that breast feeding may only have short-term effects on growth. Further studies of the role of breast feeding in other metabolic diseases may be needed.