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01-12-2020 | Mood Disorders | Research article

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

Authors: Alanna M. Cruz-Bendezú, Grace V. Lovell, Brianna Roche, Meghan Perkins, Tiffany L. Blake-Lamb, Elsie M. Taveras, Meg Simione

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Abstract

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).

Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med. 2016;374(9):843–52. https://doi.org/10.1056/NEJMsa1506575.CrossRefPubMedPubMedCentral

Kim TY, Dagher RK, Chen J. Racial/ethnic differences in unintended pregnancy: evidence from a national sample of U.S. women. Am J Prev Med. 2016;50(4):427–35 doi:S0749–3797(15)00629–7.CrossRefPubMed

McCrory C, McNally S. The effect of pregnancy intention on maternal prenatal behaviours and parent and child health: results of an irish cohort study. Paediatr Perinat Epidemiol. 2013;27(2):208–15. https://doi.org/10.1111/ppe.12027.CrossRefPubMed

Hellerstedt WL, Pirie PL, Lando HA, et al. Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies. Am J Public Health. 1998;88(4):663–6.CrossRefPubMedPubMedCentral

Toivonen KI, Oinonen KA, Duchene KM. Preconception health behaviours: A scoping review. Prev Med. 2017 Mar;96:1-15. https://doi.org/10.1016/j.ypmed.2016.11.022.

Hill B, Kothe EJ, Currie S, et al. A systematic mapping review of the associations between pregnancy intentions and health-related lifestyle behaviours or psychological wellbeing. Prev Med Rep. 2019;14:1–8.

Hall KS, Richards JL, Harris KM. Social disparities in the relationship between depression and unintended pregnancy during adolescence and young adulthood. J Adolesc Health. 2017;60(6):688–97 doi:S1054-139X(16)30948-X.CrossRefPubMedPubMedCentral

Cheng D, Schwarz EB, Douglas E, Horon I. Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception. 2009;79(3):194–8. https://doi.org/10.1016/j.contraception.2008.09.009.CrossRefPubMed

Cheng TS, Loy SL, Cheung YB, Godfrey KM, Peter D. Demographic characteristics, health behaviors before and during pregnancy, and pregnancy and birth outcomes in mothers with different pregnancy planning status. Prev Sci. 2016;17(8):960–9. https://doi.org/10.1007/s11121-016-0694-8.CrossRefPubMedPubMedCentral

10.

Mohllajee AP, Curtis KM, Morrow B, Marchbanks PA. Pregnancy intention and its relationship to birth and maternal outcomes. Obstet Gynecol. 2007;109(3):678–86 doi:109/3/678.CrossRefPubMed

11.

Abajobir AA, Maravilla JC, Alati R, Najman JM. A systematic review and meta-analysis of the association between unintended pregnancy and perinatal depression. J Affect Disord. 2016;192:56–63. https://doi.org/10.1016/j.jad.2015.12.008.CrossRefPubMed

12.

Messer LC, Dole N, Kaufman JS, Savitz DA. Pregnancy intendedness, maternal psychosocial factors and preterm birth. Matern Child Health J. 2005;9(4):403–12. https://doi.org/10.1007/s10995-005-0021-7.CrossRefPubMed

13.

Dibaba Y, Fantahun M, Hindin MJ. The effects of pregnancy intention on the use of antenatal care services: systematic review and meta-analysis. Reprod Health. 2013;10:50. https://doi.org/10.1186/1742-4755-10-50.CrossRefPubMedPubMedCentral

14.

Orr ST, James SA, Reiter JP. Unintended pregnancy and prenatal behaviors among urban, black women in Baltimore, Maryland: the Baltimore preterm birth study. Ann Epidemiol. 2008;18(7):545–51. https://doi.org/10.1016/j.annepidem.2008.03.005.CrossRefPubMed

15.

Blake-Lamb T, Arauz Boudreau A, Matathia S, et al. Strengthening integration of clinical and public health systems to prevent maternal-child obesity in the first 1,000Days: a collective impact approach. Contemp Clin Trials. 2018;65:46–52.CrossRefPubMed

16.

Shulman HB, D’Angelo DV, Harrison L, Smith RA, Warner L. The pregnancy risk assessment monitoring system (PRAMS): overview of design and methodology. Am J Public Health. 2018;108(10):1305–13.CrossRefPubMedPubMedCentral

17.

Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–85.CrossRefPubMed

18.

Harvard Medical School. GUTS: growing up today survey. Growing up today girls’ surveyhttp://nhs2survey.org/gutswordpress/wp-content/uploads/2018/06/1999girls.pdf. Date accessed 7/13/2020; 2019.

19.

Maurer DM. Screening for depression. Am Fam Physician. 2012;85(2):139–44 doi:d10072.PubMed

20.

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150:782–6 doi:S0007125000214712.CrossRefPubMed

21.

AAP Committee on Fetus and Newborn. Guidelines for perinatal care. 7th ed. Elk Grove: American College of Obstetricians and Gynecologists Committee on Obstetric Practice; 2012.

22.

Selchau K, Babuca M, Bower K, et al. First trimester prenatal care initiation among hispanic women along the U.S. -Mexico border. Matern Child Health J. 2017;21(Suppl 1):11–8. https://doi.org/10.1007/s10995-017-2374-0.CrossRefPubMedPubMedCentral

23.

Kost K, Lindberg L. Pregnancy intentions, maternal behaviors, and infant health: investigating relationships with new measures and propensity score analysis. Demography. 2015;52(1):83–111. https://doi.org/10.1007/s13524-014-0359-9.CrossRefPubMed

24.

Taylor CR, Alexander GR, Hepworth JT. Clustering of U.S. women receiving no prenatal care: differences in pregnancy outcomes and implications for targeting interventions. Matern Child Health J. 2005;9(2):125–33. https://doi.org/10.1007/s10995-005-4869-3.CrossRefPubMed

25.

Agency for Healthcare Research and Quality. 2015 National Healthcare Quality and disparities report and 5th anniversary update on the National Quality Strategy. Rockville; 2016.

26.

R Core Team. R: a language and environment for statistical computing; 2018.

27.

Buuren SV, Groothuis-Oudshoorn K. Mice: multivariate imputation by chained equations in R. J Stat Softw. 2010;45(3):1–68.

28.

Harel O, Mitchell EM, Perkins NJ, et al. Multiple imputation for incomplete data in epidemiologic studies. Am J Epidemiol. 2018;187(3):576–84.CrossRefPubMed

29.

Fellenzer JL, Cibula DA. Intendedness of pregnancy and other predictive factors for symptoms of prenatal depression in a population-based study. Matern Child Health J. 2014;18:2426–36. https://doi.org/10.1007/s10995-014-1481-4.CrossRefPubMed

30.

Maxson P, Miranda ML. Pregnancy intention, demographic differences, and psychosocial health. J Womens Health. 2011;20(8):1215–23. https://doi.org/10.1089/jwh.2010.2379.CrossRef

31.

Mollborn S, Morningstar E. Investigating the relationship between teenage childbearing and psychological distress using longitudinal evidence. J Health Soc Behav. 2009;50(3):310–26.CrossRefPubMedPubMedCentral

32.

Hall KS, Kusunoki Y, Gatny H, Barber J. Social discrimination, stress, and risk of unintended pregnancy among young women. J Adolesc Health. 2015;56(3):330–7. https://doi.org/10.1016/j.jadohealth.2014.11.008.CrossRefPubMedPubMedCentral

33.

Aiken ARA, Borrero S, Callegari LS, Dehlendorf C. Rethinking the pregnancy planning paradigm: unintended conceptions or unrepresentative concepts. Perspect Sex Reprod Health. 2016;48(3):147–51. https://doi.org/10.1363/48e10316.CrossRefPubMedPubMedCentral

34.

Kost K, Zolna M. Challenging unintended pregnancy as an indicator of reproductive autonomy: a response. Contraception. 2019;100:5–9.CrossRefPubMed

35.

Devoe JE, Baez A, Angier H, Krois L, Edlund C, Carney PA. Insurance + access not equal to health care: typology of barriers to health care access for low-income families. Ann Fam Med. 2007;5(6):511–8.CrossRefPubMedPubMedCentral

36.

Starfield B, Gervas J, Mangin D. Clinical care and health disparities. Annu Rev Public Health. 2012;33:89–106. https://doi.org/10.1146/annurev-publhealth-031811-124528.CrossRefPubMed

37.

Potter JE, Stevenson AJ, Coleman-Minahan K, et al. Challenging unintended pregnancy as an indicator of reproductive autonomy. Contraception. 2019;100(1):1–4. https://doi.org/10.1016/j.contraception.2019.02.005.CrossRefPubMedPubMedCentral

Title: Psychosocial status and prenatal care of unintended pregnancies among low-income women
Authors: Alanna M. Cruz-Bendezú
Grace V. Lovell
Brianna Roche
Meghan Perkins
Tiffany L. Blake-Lamb
Elsie M. Taveras
Meg Simione
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Prenatal Care
Published in: BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-020-03302-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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