Do Pregnancy Intentions Matter? A Research Note Revisiting Relationships Among Pregnancy, Birth, and Maternal Outcomes

Who receives support during pregnancy? Variation by intendedness

Social support makes a vital contribution to health and life outcomes, particularly during the transition to motherhood in young adulthood, an often-challenging experience. Women should have the right not only to bear children but also to raise them in a secure environment, which is often aided by support. This study gives attention to how pregnancy intendedness contributes to pregnant women's receipt of support. Using novel data from a weekly survey of 18- to 22-year-old women over two and a half years, I investigate how intendedness is associated with the receipt of support and how support types vary throughout pregnancy. This study reveals new insight into the beginning trajectories of young mothers and highlights variation in the provision of support within social networks. Women with intended pregnancies are less likely to receive social support during pregnancy compared to those with unintended pregnancies. A lack of support may impact the health of both mother and child.

Racial/Ethnic Differences in Relationships Between Pregnancy Intentions and Maternal Outcomes

Unplanned or unwanted pregnancies and births are linked to adverse maternal outcomes, but the extent to which such relationships hold for all racial/ethnic groups remains unknown. In this paper, I use large-scale data to estimate unadjusted and inverse propensity weighted associations between a five-level measure of pregnancy intention and six indicators of maternal well-being among separate samples of white, Black, and Hispanic mothers. I find substantial racial/ethnic variation. White and Hispanic mothers who reported that their pregnancies were mistimed, unwanted, or that they were unsure how they felt were significantly more likely to experience adverse outcomes than same-race/ethnicity mothers who reported that their pregnancy was intended, but the pattern was much more tenuous for Black mothers. After adjusting for potential confounding variables, relationships between pregnancy intentions and adverse outcomes remain substantial only for white and Hispanic mothers.

Pregnancy planning and neonatal outcome - a retrospective cohort study

BACKGROUND

Unplanned pregnancy is common, and although some research indicates adverse outcomes for the neonate, such as death, low birth weight, and preterm birth, results are inconsistent. The purpose of the present study was to investigate associated neonatal outcomes of an unplanned pregnancy in a Swedish setting.

METHODS

We conducted a retrospective cohort study in which data from 2953 women were retrieved from the Swedish Pregnancy Planning Study, covering ten Swedish counties from September 2012 through July 2013. Pregnancy intention was measured using the London Measurement of Unplanned Pregnancy. Women with unplanned pregnancies and pregnancies of ambivalent intention were combined and referred to as unplanned. Data on neonatal outcomes: small for gestational age, low birth weight, preterm birth, Apgar score < 7 at 5 min, and severe adverse neonatal outcome defined as death or need for resuscitation at birth, were retrieved from the Swedish Medical Birth Register.

RESULTS

The prevalence of unplanned pregnancies was 30.4%. Compared with women who had planned pregnancies, those with unplanned pregnancies were more likely to give birth to neonates small for gestational age: 3.6% vs. 1.7% (aOR 2.1, 95% CI 1.2-3.7). There were no significant differences in preterm birth, Apgar score < 7 at 5 min, or severe adverse neonatal outcome.

CONCLUSIONS

In a Swedish setting, an unplanned pregnancy might increase the risk for birth of an infant small for gestational age.

Usual Source of Care and Contraceptive Use

BACKGROUND

A high proportion of people in the United States at risk of unintended pregnancy also have limited primary care access.

STUDY DESIGN

We pooled data for analyses from separate 2015-2017 and 2017-2019 waves of the National Survey of Family Growth. Multivariable logistic regression was used to estimate associations between the usual source of health care and self-reported use of a comprehensive range of contraceptive options, as well as alignment between patient preference and the current method.

RESULTS

Compared with having a private doctor or Health Maintenance Organization, not having a usual source of care was associated with lower odds of using short-term hormonal methods (OR=0.54, 95% CI: 0.40-0.73, for an 11 percentage point lower rate); higher odds of using time-based methods (OR=1.47, 95% CI: 1.10-1.97, for a 6 percentage point higher rate); and higher odds of preferring a contraceptive method other than the one most recently used (OR=1.39, 95% CI: 1.01-1.90, for a 6 percentage point higher probability). Reliance on an emergency department as a usual source of care was not associated with contraceptive use or satisfaction with the method used. Reliance on urgent care was associated only with higher odds of using time-based methods (OR=1.60, 95% CI: 1.03-2.50, for a 7 percentage point higher rate). Clinic-based usual care was not associated with any differences in contraceptive use but was associated with preferring a contraceptive method other than the one most recently used (OR=1.65, 95% CI: 1.21-2.25, for an 8 percentage point higher probability).

CONCLUSIONS

All sources of usual care can improve contraceptive access.

Sequencing of Births by Wantedness: Implications for Changes in Mid-Life Health Among Aging NLSY79 Women

OBJECTIVES

As life course frameworks highlight and gerontological studies confirm, the health implications of early birth timing (e.g., adolescent births) and unplanned births (e.g., unwanted or mistimed births) extend years after those births into mid and later life. Yet past research often overlooks the considerable diversity in sequencing and timing of unplanned births even within the same individual (e.g., having both wanted and unwanted births), which are likely fundamental for women's long-term health trajectories. We develop a holistic understanding of birth timing and wantedness to provide insight into when and how childbearing histories matter for aging women's health.

METHODS

We use sequence analysis with hierarchical cluster method and estimate regression models using the 1979 National Longitudinal Survey of Youth (N = 3,231) to examine how timing and patterning of births by wantedness are associated with changes in physical and mental health from ages 40 to 50.

RESULTS

We identify 7 clusters of childbearing sequences. Of those 7 clusters, respondents with sequences characterized by wanted births in their 20s and 30s had the smallest declines in health in mid-life, whereas respondents with sequences with mainly unwanted births at any age or with mainly mistimed births beginning in adolescence had the greatest health declines. Adjusting for social and economic variables accounted for some, but not all, health differences across childbearing clusters.

DISCUSSION

This project demonstrates the need for comprehensive life course perspectives on long-term health implications of birth wantedness and timing, recognizing diversity within and between individuals.

Estimation of Multiyear Consequences for Abortion Access in Georgia Under a Law Limiting Abortion to Early Pregnancy

Importance

Following the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization, Georgia's law limiting abortion to early pregnancy, House Bill 481 (HB481), was allowed to go into effect in July 2022.

Objectives

To estimate anticipated multiyear effects of HB481, which prohibits abortions after detection of embryonic cardiac activity, on abortion incidence in Georgia, and to examine inequities by race, age, and socioeconomic status.

Design, Setting, and Participants

This repeated cross-sectional analysis used abortion surveillance data from January 1, 2007, to December 31, 2017, to estimate future effects of HB481 on abortion care in Georgia, with a focus on the 2 most recent years of data (2016 and 2017). Abortion surveillance data were obtained from the 2007-2017 Georgia Department of Public Health's Induced Termination of Pregnancy files. Linear regression was used to estimate trends in abortions provided at less than 6 weeks' gestation and at 6 weeks' gestation or later in Georgia, and χ2 analyses were used to compare group differences by race, age, and educational attainment. Data were analyzed from July 26 to September 22, 2022.

Exposures

HB481, Georgia's law limiting abortion to early pregnancy.

Main Outcome and Measures

Weeks' gestation at abortion (<6 vs ≥6 weeks).

Results

From January 1, 2007, to December 31, 2017, there were 360 972 reported abortions in Georgia, with an annual mean (SD) of 32 816 (1812) abortions. Estimates from 2016 to 2017 suggest that 3854 abortions in Georgia (11.6%) would likely meet eligibility requirements for abortion care under HB481. Fewer abortions obtained by Black patients (1943 [9.6%] vs 1280 [16.2%] for White patients), patients younger than 20 years (261 [9.1%] vs 168 [15.0%] for those 40 years and older), and patients with fewer years of education (392 [9.2%] with less than a high school diploma and 1065 [9.6%] with a high school diploma vs 2395 [13.5%] for those with some college) would likely meet eligibility requirements under HB481.

Conclusions and Relevance

These findings suggest that Georgia's law limiting abortion to early pregnancy (HB481) would eliminate access to abortion for nearly 90% of patients in Georgia, and disproportionately harm patients who are Black, younger, and in lower socioeconomic status groups.

Measuring Fertility Intentions During Times of Crisis: An Example Using Survey Data Amid the Covid-19 Pandemic

Fertility intentions-intentions regarding whether and when to have children-predict reproductive health outcomes. Measuring fertility intentions is difficult, particularly during macrostructural shocks, for at least two reasons: (1) fertility intentions may be especially volatile during periods of uncertainty and (2) macrostructural shocks may constrain data collection. We propose a set of indicators that capture how a macrostructural shock directly alters fertility intentions, with a particular focus on the Coronavirus disease 2019 (Covid-19) pandemic. We advance the conceptualization and construct of fertility intentions measures in three ways. First, we demonstrate the value of direct questions about whether women attributed changes in fertility intentions to the pandemic. Second, we highlight the importance of a typology that delineates fertility postponement, advancement, foregoing, and indecision. Third, we demonstrate the importance of incorporating a granular time window within a two-year period to capture short-term changes to fertility intentions. We exemplify the value of our proposed measures using survey data from a probabilistic sample of women aged 18-34 in Pernambuco, Brazil. We discuss the self-reported change in intentions due to Covid in wave 1 as well as panel change across waves. We further ground our contributions by uncovering important variations by social origin and parity.

Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes: A Systematic Review and Meta-analysis

Importance

Unintended pregnancy is common in the US and is associated with adverse maternal and infant health outcomes; however, estimates of these associations specific to current US populations are lacking.

Objective

To evaluate associations of unintended pregnancy with maternal and infant health outcomes during pregnancy and post partum with studies relevant to current clinical practice and public health in the US.

Data Sources

Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE databases (January 1, 2000, to June 15, 2022) and manual review of reference lists.

Study Selection

Epidemiologic studies relevant to US populations that compared key maternal and infant health outcomes for unintended vs intended pregnancies and met prespecified eligibility criteria were included after investigators' independent dual review of abstracts and full-text articles.

Data Extraction and Synthesis

Investigators abstracted data from publications on study methods, participant characteristics, settings, pregnancy intention, comparators, confounders, and outcomes; data were validated by a second investigator. Risk of bias was independently dual rated by investigators using criteria developed by the US Preventive Services Task Force. Results of studies controlling for confounders were combined by using a profile likelihood random-effects model.

Main Outcomes and Measures

Prenatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth, and infant low birth weight.

Results

Thirty-six studies (N = 524 522 participants) were included (14 cohort studies rated good or fair quality; 22 cross-sectional studies); 12 studies used large population-based data sources. Compared with intended pregnancy, unintended pregnancy was significantly associated with higher odds of depression during pregnancy (23.3% vs 13.9%; adjusted odds ratio [aOR], 1.59 [95% CI, 1.35-1.92]; I2 = 85.0%; 15 studies [n = 41 054]) and post partum (15.7% vs 9.6%; aOR, 1.51 [95% CI, 1.40-1.70]; I2 = 7.1%; 10 studies [n = 82 673]), interpersonal violence (14.6% vs 5.5%; aOR, 2.22 [95% CI, 1.41-2.91]; I2 = 64.1%; 5 studies [n = 42 306]), preterm birth (9.4% vs 7.7%; aOR, 1.21 [95% CI, 1.12-1.31]; I2 = 1.7%; 10 studies [n = 94 351]), and infant low birth weight (7.3% vs 5.2%; aOR, 1.09 [95% CI, 1.02-1.21]; I2 = 0.0%; 8 studies [n = 87 547]). Results were similar in sensitivity analyses based on controlling for history of depression for prenatal and postpartum depression and on study design and definition of unintended pregnancy for relevant outcomes. Studies provided limited sociodemographic data and measurement of confounders and outcomes varied.

Conclusions and Relevance

In this systematic review and meta-analysis of epidemiologic observational studies relevant to US populations, unintended pregnancy, compared with intended pregnancy, was significantly associated with adverse maternal and infant outcomes.

Trial Registration

PROSPERO Identifier: CRD42020192981.