Intendedness of Pregnancy and Preterm Delivery

The term unintended refers to those pregnancies that are unwanted or mistimed (i.e., they occur earlier than desired by the parents). Intentions are measured by self-report by using standard survey questions that can distinguish between whether the woman wanted a child now, not now but at some point (mistimed), or not at all (unwanted). These questions are answered after conception and in many studies are answered after delivery, which may introduce retrospective bias.

It is estimated that approximately 60 percent of all pregnancies are unintended, and of these, about half end in a live birth (IOM, 1995). Women with unintended pregnancies are less likely to seek early prenatal care (Bitto et al., 1997; IOM, 1995; Kost et al., 1998; Pagnini and Reichman, 2000) and are more likely to use alcohol or tobacco (IOM, 1995). They also appear to be more likely to experience high levels of exposure to psychosocial stress and depressive symptoms (Orr and Miller, 1997). Although unintended pregnancies occur among women across the sociodemographic spectrum, they are disproportionately likely among mothers who are adolescent, unmarried, or over age 40 (Bitto et al., 1997; IOM, 1995). The child of an unwanted pregnancy (as opposed to the child of a wanted or a mistimed pregnancy) is at greater risk of low birth weight, death in the first year of life, abuse, and receiving insufficient resources for optimal early child development (IOM, 1995). Additional consequences occur for the parents of unwanted pregnancies. For example, a study that used data from the Pregnancy Risk Assessment Monitoring System database of 39,348 women in 14 states who delivered a live-born infant (Goodwin et al., 2000) found that women with unintended pregnancies had a 2.5 times greater risk of physical abuse.

Having an unintended pregnancy is estimated to increase the odds of delivering an infant of low birth weight by about 1.2 to 1.8 (IOM, 1995). However, only three studies on intentions and preterm birth were available as of 1995, and of those three studies, two were unpublished. On the basis of the findings from these preliminary studies, IOM (1995) indicated that the increased risk of low birth weight because of an unintended pregnancy appeared to be related to preterm delivery rather than intrauterine growth restriction. Subsequently, at least one further study has been conducted with a sample of 922 African-American, low-income pregnant women recruited in four hospital-based prenatal clinics in Baltimore, Maryland (Orr et al., 2000). Women with unintended pregnancies were 1.82 times more likely to deliver their infants pre-term, after adjustment for clinical and behavioral factors associated with preterm delivery.

Thus, although the research available on the association of the intendedness of pregnancy and preterm delivery is limited, that which is available suggests that women with unintended pregnancies are more likely to deliver preterm, and as a consequence, their infants are at higher risk of being of low birth weight. Understanding the pathways from unintended conception to preterm labor and delivery by the use of multilevel approaches would be useful in elucidating the etiology of preterm birth for at least some subgroups of women. Unmeasured socioeconomic factors that may be confounded with unintended pregnancies must be carefully controlled in future studies. In addition, it is critical to refine measures of intendedness to be sure they are valid and reliable if this arena of research is to be pursued. Reducing unintended pregnancies through family planning and other mechanisms could indirectly reduce the rates of preterm delivery and related adversities (IOM, 1995). Disparities in pregnancy outcomes, including preterm birth, could also be reduced by paying attention to the intendedness of a pregnancy (Hogue and Vasquez, 2002).

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