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Intention to Become Pregnant and Low Birth Weight and Preterm Birth: A Systematic Review

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Abstract

Increased stress, psychosocial problems, economic disadvantages, and lack of prenatal care are proposed to explain discrepancies in the outcome of unintended pregnancies. Studies of maternal intention and pregnancy outcomes have yielded varied results. Objective is to review studies of the risk of low birth weight (LBW)/preterm births (PTB) associated with unintended pregnancies ending in a live birth. We reviewed studies reporting on maternal intentions and outcomes from Medline, Embase, CINAHL, and bibliographies of identified articles. An unintended pregnancy was further classified as mistimed (not intended at that time) or unwanted (not desired at any time). Studies reporting an association between pregnancy intention and any of the outcomes were included. Study quality was assessed for biases in selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition. Unadjusted and adjusted data from included studies were extracted by two reviewers. There were significantly increased odds of LBW among unintended pregnancies [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.25, 1.48] ending in a live birth. Within the unintended category, mistimed (OR 1.31, 95% CI 1.13, 1.52) and unwanted (OR 1.51, 95% CI 1.29, 1.78) pregnancies were associated with LBW. There were statistically significantly increased odds of PTB among unintended (OR 1.31, 95% CI 1.09, 1.58), and unwanted (OR 1.50, 95% CI 1.41, 1.61) but not for mistimed (OR 1.36, 95% CI 0.96, 1.93) pregnancies. Unintended, unwanted, and mistimed pregnancies ending in a live birth are associated with a significantly increased risk of LBW and PTB.

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Abbreviations

LBW:

Low birth weight

PTB:

Preterm birth

SGA:

Small for gestational age

References

  1. Bitto, A., Gray, R. H., Simpson, J. L., Queenan, J. T., Kambic, R. T., Perez, A., et al. (1997). Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study. American Journal of Public Health, 87(3), 338–343.

    Article  CAS  PubMed  Google Scholar 

  2. Orr, S. T., Miller, C. A., James, S. A., & Babones, S. (2000). Unintended pregnancy and preterm birth. Paediatric and Perinatal Epidemiology, 14(4), 309–313.

    Article  CAS  PubMed  Google Scholar 

  3. Cartwright, A. (1988). Unintended pregnancies that lead to babies. Social Science and Medicine, 27(3), 249–254.

    Article  CAS  PubMed  Google Scholar 

  4. Mohllajee, A. P., Curtis, K. M., Morrow, B., & Marchbanks, P. A. (2007). Pregnancy intention and its relationship to birth and maternal outcomes. Obstetrics and Gynecology, 109(3), 678–686.

    Article  CAS  PubMed  Google Scholar 

  5. Messer, L. C., Dole, N., Kaufman, J. S., & Savitz, D. A. (2005). Pregnancy intendedness, maternal psychosocial factors and preterm birth. Maternal and Child Health Journal, 9(4), 403–412.

    Article  PubMed  Google Scholar 

  6. Joyce, T. J., Kaestner, R., & Korenman, S. (2000). The effect of pregnancy intention on child development. Demography, 37(1), 83–94.

    Article  CAS  PubMed  Google Scholar 

  7. Hellerstedt, W. L., Pirie, P. L., Lando, H. A., Curry, S. J., McBride, C. M., Grothaus, L. C., et al. (1998). Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies. American Journal of Public Health, 88(4), 663–666.

    Article  CAS  PubMed  Google Scholar 

  8. Sable, M. R., Spencer, J. C., Stockbauer, J. W., Schramm, W. F., Howell, V., & Herman, A. A. (1997). Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status. Family Planning Perspectives, 29(2), 76–81.

    Article  CAS  PubMed  Google Scholar 

  9. Morris, N. M., Udry, J. R., & Chase, C. L. (1973). Reduction of Low Birth Weight Birth Rates by the Prevention of Unwanted Pregnancies. American Journal of Public Health, 63(11), 935–938.

    Article  CAS  PubMed  Google Scholar 

  10. Stroup, D. F., Berlin, J. A., Morton, S. C., Olkin, I., Williamson, G. D., Rennie, D., et al. (2000). Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. The Journal of the American Medical Association, 283(15), 2008–2012.

    Article  CAS  Google Scholar 

  11. Higgins, P. T, Green. S. (2008). Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration 2008 [cited 2008 Mar 1] (Version 5.0.0) Available from: URL: www.cochrane-handbook.org.

  12. Peters, J., & Mengersen, K. (2008). Selective reporting of adjusted estimates in observational epidemiology studies: Reasons and implications for meta-analyses. Evaluation & the Health Professions, 31(4), 370–389.

    Article  Google Scholar 

  13. Higgins, J. P., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21(11), 1539–1558.

    Article  PubMed  Google Scholar 

  14. Afable-Munsuz, A., & Braveman, P. (2008). Pregnancy intention and preterm birth: differential associations among a diverse population of women. Perspectives on Sexual and Reproductive Health, 40(2), 66–73.

    Article  PubMed  Google Scholar 

  15. Durousseau, S., & Chavez, G. F. (2003). Associations of intrauterine growth restriction among term infants and maternal pregnancy intendedness, initial happiness about being pregnant, and sense of control. Pediatrics, 111(5 Part 2), 1171–1175.

    PubMed  Google Scholar 

  16. Eggleston, E., Tsui, A. O., & Kotelchuck, M. (2001). Unintended pregnancy and low birthweight in Ecuador. American Journal of Public Health, 91(5), 808–810.

    Article  CAS  PubMed  Google Scholar 

  17. Gadow, E. C., Paz, J. E., Lopez-Camelo, J. S., Dutra, M. G., Queenan, J. T., Simpson, J. L., Jennings, V. H., Castilla, E. E. (1998). Unintended pregnancies in women delivering at 18 South American hospitals. NFP-ECLAMC Group. Latin American Collaborative Study of Congenital Malformations. Human Reproduction, 13(7), 1991–1995.

    Google Scholar 

  18. Hultin, M., Ottosson, J. O. (1971). Perinatal conditions of unwanted children. Acta psychiatrica Scandinavica Supplementum, 59–76.

  19. Kost, K., Landry, D. J., & Darroch, J. E. (1998). The effects of pregnancy planning status on birth outcomes and infant care. Family Planning Perspectives, 30(5), 223–230.

    Article  CAS  PubMed  Google Scholar 

  20. Pulley, L., Klerman, L. V., Tang, H., & Baker, B. A. (2002). The extent of pregnancy mistiming and its association with maternal characteristics and behaviors and pregnancy outcomes. Perspectives on Sexual and Reproductive Health, 34(4), 206–211.

    Article  PubMed  Google Scholar 

  21. Sharma, R., Synkewecz, C., Raggio, T., & Mattison, D. R. (1994). Intermediate variables as determinants of adverse pregnancy outcome in high risk inner-city populations. Journal of the National Medical Association, 86(11), 857–860.

    CAS  PubMed  Google Scholar 

  22. Baydar, N. (1995). Consequences for children of their birth planning status. Family planning perspectives, 27(6), 228–34, 245.

    Google Scholar 

  23. Keeton, K., & Hayward, R. A. (2007). Pregnancy intention and birth outcomes: does the relationship differ by age or race? Journal of Women’s Health(Larchmt), 16(4), 510–516.

    Article  Google Scholar 

  24. McCormick, M. C., Brooks-Gunn, J., Shorter, T., Wallace, C. Y., Holmes, J. H., & Heagarty, M. C. (1987). The planning of pregnancy among low-income women in central Harlem. American Journal of Obstetrics and Gynecology, 156(1), 145–149.

    CAS  PubMed  Google Scholar 

  25. Unintended pregnancy–New York, 1988–1989. MMWR Morbidity and mortality weekly report 1991, 40(42):723–725.

  26. Bouchard, G. (2005). Adult couples facing a planned or an unplaned pregnancy: Two realities. Journal of Family Issues, 26, 619–637.

    Article  Google Scholar 

  27. Korenman, S., Kaestner, R., & Joyce, T. (2002). Consequences for infants of parental disagreement in pregnancy intention. Perspectives on Sexual and Reproductive Health, 34(4), 198–205.

    Article  PubMed  Google Scholar 

  28. Lakha, F., & Glasier, A. (2006). Unintended pregnancy and use of emergency contraception among a large cohort of women attending for antenatal care or abortion in Scotland. Lancet, 368(9549), 1782–1787.

    Article  PubMed  Google Scholar 

  29. Santelli, J., Rochat, R., Hatfield-Timajchy, K., Gilbert, B. C., Curtis, K., Cabral, R., et al. (2003). The measurement and meaning of unintended pregnancy. Perspectives on Sexual and Reproductive Health, 35(2), 94–101.

    Article  PubMed  Google Scholar 

  30. Kaufmann, R. B., Morris, L., & Spitz, A. M. (1997). Comparison of two question sequences for assessing pregnancy intentions. American Journal of Epidemiology, 145(9), 810–816.

    CAS  PubMed  Google Scholar 

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Acknowledgments

We would sincerely like to thank Elizabeth Uleryk, Chief Librarian at the Hospital for Sick Children, Toronto, for her contribution in developing search strategy and running searches on a periodic basis. We would also like to thank Karen Wade from Toronto Public Health Department for her critical review of this manuscript. Funding: This study was supported by funding from Canadian Institute of Health Research (CIHR) Knowledge Synthesis/Translation grant # KRS 86242. CIHR has no role in analyses, writing of the report, interpretation of data or decision to submit the manuscript.

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Authors and Affiliations

  1. Department of Paediatrics, Mount Sinai Hospital, 775A-600 University Avenue, Toronto, ON, M5G 1X5, Canada

    Prakesh S. Shah, Taiba Balkhair & Arne Ohlsson

  2. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah, Taiba Balkhair & Arne Ohlsson

  3. Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada

    Arne Ohlsson

  4. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah & Arne Ohlsson

  5. Research Institute of the Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Joseph Beyene

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Joseph Beyene & Fran Scott

  7. Toronto Public Health, Toronto, ON, Canada

    Fran Scott

  8. Alberta Perinatal Health Program, University of Calgary, Calgary, AB, Canada

    Corine Frick

  9. Faculty of Nursing, University of Calgary, Calgary, AB, Canada

    Corine Frick

Authors
  1. Prakesh S. Shah
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  2. Taiba Balkhair
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Corresponding author

Correspondence to Prakesh S. Shah.

Additional information

On behalf of Knowledge Synthesis Group on LBW/preterm birth.

Members of Knowledge Synthesis Group on determinants of LBW/preterm births: Prakesh Shah, University of Toronto, Toronto, Canada; Arne Ohlsson, University of Toronto, Canada; Vibhuti Shah, University of Toronto, Toronto, Canada; Kellie E Murphy, University of Toronto, Canada; Sarah D McDonald, McMaster University, Hamilton, Canada; Eileen Hutton, McMaster University, Hamilton, Canada; Christine Newburn-Cook, University of Alberta, Edmonton, Canada; Corine Frick, University of Calgary, Calgary, Canada; Fran Scott, University of Toronto and Toronto Public Health, Toronto, Canada; Victoria Allen, Dalhousie University, Halifax, Canada; Joseph Beyene, University of Toronto, Toronto, Canada.

Appendix

Appendix

See Appendix Tables 5 and 6.

Table 5 Assessment of quality of included studies
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Table 6 Outcomes reported in individual studies
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Shah, P.S., Balkhair, T., Ohlsson, A. et al. Intention to Become Pregnant and Low Birth Weight and Preterm Birth: A Systematic Review. Matern Child Health J 15, 205–216 (2011). https://doi.org/10.1007/s10995-009-0546-2

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  • DOI: https://doi.org/10.1007/s10995-009-0546-2

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