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

The relation between eHealth literacy and healthy lifestyle behaviours in pregnant women

The aim of this study was to determine the relationship between eHealth literacy and healthy lifestyle behaviours among pregnant women. This cross-sectional study was conducted in five family health centres in a city in the western part of Turkey. The study sample consisted of 201 pregnant women who were admitted to the five family health centres between September and December 2022. A socio-demographic questionnaire, the eHealth Literacy Scale and the Healthy Lifestyle Behaviours in Pregnancy Scale were used to collect data. Multiple linear regression analysis was used to explore predictors of health-promoting behaviours. The mean score of the eHealth Literacy Scale was 29.37 ± 6.20. The mean score of the Healthy Lifestyle Behaviours Scale was 119.69 ± 13.58. Multiple linear regression showed that predictors of healthy lifestyle behaviours among pregnant women were eHealth literacy, using internet to access health information and gestational age. eHealth literacy was found to be an important factor affecting the healthy lifestyle behaviours of pregnant women. This study highlights the importance of considering pregnant women's eHealth literacy in interventions aimed at improving healthy lifestyle behaviours.

Different Levels of Therapeutic Strategies to Recover the Microbiome to Prevent/Delay Acute Lymphoblastic Leukemia (ALL) or Arrest Its Progression in Children

Changes in the components, variety, metabolism, and products of microbiomes, particularly of the gut microbiome (GM), have been revealed to be closely associated with the onset and progression of numerous human illnesses, including hematological neoplasms. Among the latter pathologies, there is acute lymphoblastic leukemia (ALL), the most widespread malignant neoplasm in pediatric subjects. Accordingly, ALL cases present a typical dysfunctional GM during all its clinical stages and resulting inflammation, which contributes to its progression, altered response to therapy, and possible relapses. Children with ALL have GM with characteristic variations in composition, variety, and functions, and such alterations may influence and predict the complications and prognosis of ALL after chemotherapy treatment or stem cell hematopoietic transplants. In addition, growing evidence also reports the ability of GM to influence the formation, growth, and roles of the newborn's hematopoietic system through the process of developmental programming during fetal life as well as its susceptibility to the onset of onco-hematological pathologies, namely ALL. Here, we suggest some therapeutic strategies that can be applied at two levels of intervention to recover the microbiome and consequently prevent/delay ALL or arrest its progression.

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.

Nature-based interventions to support mental health and well-being of young women in pregnancy: exploratory work for future feasibility RCT

Background

The prevalence of mental health and well-being issues among young women is increasing. Pregnancy is a time when new mental health challenges may arise, or existing conditions can be exacerbated. This project presents preparatory work on how nature-based interventions may help to support the mental health and well-being of young pregnant women (aged 16-24 years) in a future study.

Methods

This project was formed of three main phases conducted from March to August 2022: (1) mapping nature activities available across the East Midlands region and two focus groups with providers of nature activities (n = 6); (2) public participation and involvement work to inform future research. This included four focus groups with young women (n = 11), leading to the formation of a new young women's panel (Research Influencers Group). Networking and stakeholder engagement to support future research.

Results

The mapping survey identified 68 nature-based organisations/projects operating in the region, many of whom expressed interest in being involved in future research. The young women's focus groups confirmed the importance of the topic and generated a wealth of information to support the intervention design. A Research Influencer Group of five young women was established from the focus group participants. The Research Influencer Group chose the nature-based intervention and had input into all aspects of the study design. This group will continue into future projects. Focus groups with providers of nature activities have further advanced the study design. The project team have developed relationships with relevant stakeholders and networks that will inform the future trial.

Conclusion

This preparatory co-design work suggested that a nature-based intervention may be acceptable to young women, and providers of such interventions felt it was feasible to offer these activities to young pregnant women. This preparatory work has led to an outline research plan which has been co-produced with public contributors and stakeholders throughout.

Limitations

This preparatory work is limited by small focus group samples, and the possibility that not all providers were reached through the snowballing approach to the mapping survey.

Future work

Future research is needed to test the nature-based intervention; this would be in the form of a feasibility randomised controlled trial of nature-based interventions to promote the mental health and well-being of young pregnant women.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR135167.

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.

Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study

BACKGROUND

Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce.

OBJECTIVE

To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum.

DESIGN

This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum.

METHODS

Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks.

RESULTS

Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions.

CONCLUSION

Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.

Maternal Well-Being and Stage of Behaviour Change during Pregnancy: A Secondary Analysis of the PEARS Randomised Controlled Trial

We aimed to determine whether early pregnancy well-being was associated with the stage of behaviour change during an antenatal lifestyle intervention using a secondary analysis of data from the Pregnancy Exercise and Nutrition Research Study (PEARS). Pregnant women (n = 277) with well-being data in early pregnancy were included. Maternal well-being was measured using the World Health Organisation Five-Item Well-Being Index. The intervention consisted of a mobile health (mHealth) phone application, supported by antenatal education and exercise, to prevent gestational diabetes in a population with overweight. Stage of behaviour change was measured in late pregnancy using a five-stage classification. Ordinal logistic regression was used to examine if well-being, the study group, or their interaction, were related to behaviour change. Maternal well-being (OR 1.03, 95% CI 1.01, 1.04, p < 0.01) and the study group (OR 2.25, 95% CI 1.44, 3.51, p < 0.01) both significantly influenced the positive stage of behaviour change. The probability of being at stage 5 increased from 43 to 92% as well-being increased from 0 to 100% and was higher in the intervention (53%) compared to the control (34%) group (p ≤ 0.01 (8.65, 29.27). This study demonstrates the potential importance of well-being in enabling women to engage with a healthy lifestyle, and the role that mHealth technology has in facilitating beneficial behaviour change.

Women's Perspectives on a Reproductive Health Services Screening Question: An Alternative to Pregnancy Intention Screening

Background

Current efforts to integrate reproductive health care into primary care in the United States involve assessing pregnancy intentions and reproductive goals, which are often not meaningful or attainable for some. Alternatively, we designed a reproductive health services-based screening question: "Can I help you with any reproductive health services today, such as preventing pregnancy or planning a healthy pregnancy?" In this study, we describe women's interpretations of this question as part of a larger study, exploring perspectives on reproductive health care quality in primary care.

Materials and Methods

We utilized a third-party research firm to recruit New York women of reproductive age (18-45), who visited a primary care provider in the past year. We conducted five focus groups and eight interviews (N = 30). Semistructured guides queried participants on interpretations of the screening question and preferences for raising reproductive health concerns during a primary care visit. We employed inductive thematic analysis.

Results

Participants interpreted the question as offering contraception or pregnancy counseling and care, although younger participants also understood it as offering sexual and reproductive health services broadly. Participants also connected the question with discussions about their ability to conceive. Some participants described experiences with provider assumptions and implicit bias. Tensions emerged around accepting primary care as a setting for reproductive health due to a perceived lack of specialized training.

Conclusions

Participants interpreted the screening question as intended, indicating face validity. Primary care settings should increase patients' awareness of reproductive health service availability, such as by routinely introducing a services-based screening question.

Measures of Pregnancy Intention: Why Use Them and What Do They Tell Us?

Understanding pregnancy intention is an important public health measure that captures the ability of individuals to access information, resources, and services needed to plan the timing and spacing of pregnancies. Pregnancy intention is a complex construct impacted by social, emotional, financial, cultural, and contextual factors. In this review, we will examine the range of available tools for individuals and populations to evaluate pregnancy intention, the timing of the tools in relation to pregnancy, their interpretation, and use for policy and practice. Traditionally, pregnancy intention was only assessed in population health surveys; however, more sophisticated tools and measures have been developed. These tools can be used at several time points: before pregnancy, during pregnancy, or after the pregnancy has ended. It is important to appreciate the varied contexts globally for women and their partners when assessing pregnancy intention, and the ability of a given tool to capture this when used retrospectively or prospectively. These tools can inform targeted delivery of services for a person or couple before, during, and after pregnancy. This knowledge can inform strategies at an individual, community, and population level as an indicator of access to sexual and reproductive health information and knowledge and uptake of preconception health.

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.

Association between pregnancy intention and psychological distress among women exposed to different levels of restrictions during the COVID-19 pandemic in Australia

Background

The COVID-19 pandemic has had a negative impact on the mental health of people globally. Significant concerns about health and access to services among women of reproductive age considering pregnancy may cause psychological distress, and in turn increase health risks during and after pregnancy for mothers and offspring.

Objectives

To examine the association between pregnancy intention and psychological distress during the COVID-19 pandemic in Australia, and explore if this association differed based on local viral transmission rates and corresponding levels of pandemic restrictions.

Methods

A nationwide online survey was completed by 849 non-pregnant women aged 18–50 years between 15 October and 7 November 2020. Women were asked about their intention to become pregnant, and psychological distress was assessed using the Kessler Psychological Distress Scale (K10). Multivariable regression analysis examined associations between pregnancy intention and psychological distress. An interaction term was added to the model to examine differences in associations by level of viral transmission rates and lockdown restrictions which was determined based on postcode.

Results

Pregnancy intention was not associated with experiencing (very) high psychological distress in the overall study population (odds ratio (OR) 1.42, 95% CI 0.94, 2.11). The interaction term (p = 0.09) suggested potential differences by level of restrictions and viral transmission rates. In stratified analysis among women living in a location with strict lockdown restrictions and high viral transmission rates leading up to and during the study, those planning to become pregnant were more likely to experience (very) high psychological distress (OR 3.39, 2.04, 5.65) compared with women not planning to become pregnant. Pregnancy intention was not associated with psychological distress among women exposed to lower levels of pandemic restrictions and viral transmission rates (OR 1.17, 0.74, 1.85).

Conclusions

Our findings highlight the need to identify and support women planning pregnancy during a public health crisis to mitigate potential short- and long-term intergenerational negative health outcomes associated with psychological distress.

Healthy lifestyle during pregnancy: Uncovering the role of online health information seeking experience

In the new era, many people seek their health-related information through the Internet due to the increasing access to this technology. Searching online health information can affect the health behavior. This study aimed to investigate the correlation between online health information-seeking behavior and a healthy lifestyle during pregnancy in a sample of Iranian pregnant women. This cross-sectional study was conducted among pregnant women admitted to health centers of Eghlid city, Fars province, Iran in 2019. A total of 193 women participated in the study. The required data were gathered using two validated questionnaires to measure the online health information-seeking behavior and the healthy lifestyle practices of the participants. The collected data were analyzed through descriptive statistics and Pearson correlation coefficient using SPSS version 22. Online health information experience and its subscales showed no statistical correlation with a healthy lifestyle. Age and education did not correlate with online health information-seeking behavior. Age had a statistical correlation with a healthy lifestyle, but education had the same correlation only with some subscales of a healthy lifestyle. The findings were surprising, suggesting that online health information-seeking behavior does not affect the lifestyle of pregnant women. These finding and probable explanations are discussed, but due to the limited literature on the subject, further studies are recommended to be conducted.

The Impact of Educational Intervention Based on Pender's Health Promotion Model on Healthy Lifestyle in Women of Reproductive Age in Iran

Background

Lifestyle is one of the most important factors affecting women's health. Women's quality of life and health depends on their health-promoting behaviors and lifestyles. The aim of this study was to determine the impact of an educational intervention based on Pender model on healthy lifestyle in women of reproductive age in Iran.

Methods

This randomized controlled trial study was carried out in women of reproductive age in Iran, from August to December 2019. The samples were divided into experimental (n = 120) and control (n = 120) groups. 6 training sessions were provided for the experimental group. The questionnaire consisted of several items including socio-demographic characteristics, health-promoting lifestyle profile-II (HPLP-II), self-efficacy, social support and constructs of Pender's health promotion model. SPSS-18 software has been applied for statistical analysis.

Results

The mean age of the experimental group was 31.88±7.624 years and for the control group was 30.33±6.89 years. There was no statistically significant relationship between demographic variables such as marital status, education, employment status, age and body mass index with lifestyle in women. Lifestyle in women had a statistically significant relationship with the structure prior health-related behavior (p < 0.001). The score of women in structures of prior health-related behavior, perceived benefits, commitment to action, and social support increased after educational intervention (p < 0.001).

Conclusion

Findings showed that educational intervention based on Pender health promotion model has increased the score of healthy lifestyle in women. Therefore, planning and performing educational interventions to improve health promotion behaviors based on this model is essential.

Intentions of preventive depression management for a healthy pregnancy by gender among unmarried college students in Korea: a cross-sectional study

Background

Early adulthood is a significant period for preventive depression management for a healthy pregnancy. However, previous public health initiatives have not yet emphasized preparation for a healthy pregnancy in this population. In addition, pregnancy planning has traditionally been regarded as women’s responsibility, so intervention strategies may differ by gender. This study explored intentions of preventive depression management for a healthy pregnancy among unmarried college students, as well as factors influencing those intentions, by applying the Theory of Planned Behavior (TPB) model.

Methods

For this cross-sectional survey, 828 unmarried college students aged 18–29 were recruited from a national university in Korea from July to September 2019. The chi-square test and t-test were used to compare gender differences in general characteristics, the current level of depression, and constructs of the extended TPB. Hierarchical regression was performed to identify factors influencing the intention of preventive depression management for a healthy pregnancy.

Results

The intention to manage depression was significantly higher in men than in women (t = 2.36, p = 0.019). The factors affecting the intention of preventive depression management for a healthy pregnancy were components of TPB in both women and men, of which self-efficacy had the greatest effect (female: β = 0.34, p < 0.001, male: β = 0.30, p < 0.001). The current level of depression was a significant factor for women only (β = 0.10, p = 0.014).

Conclusions

Our study results underscore the need for nurses to perform preventive interventions and provide directions to develop interventions to improve the intention of depression management for unmarried college students. It is necessary to intervene with all the constructs of the TPB, especially self-efficacy, for both men and women. It is also important to check and address the current depression status of unmarried female college students.

Starting in early adulthood, such as college students in the preconception stage, it is necessary to take care of one’s mental health (including depression) in order to have a healthy pregnancy in the future. The early identification of adults needing depression management is also a major challenge. In this study, an online survey was conducted to investigate levels of depression among Korean college students and their intention to manage depression for a healthy future pregnancy, as well as to identify the influencing factors.

Convenience recruitment was conducted by e-mail at one university in Korea, and 828 male and female college students responded to the survey. An analysis of the factors affecting the intention to manage depression for a healthy future pregnancy identified the components of the Theory of Planned Behavior as influencing factors in both men and women. In particular, self-efficacy had the greatest influence. However, the current level of depression was only a significant factor among women.

These findings could help nurses recognize differences in gender characteristics for the intention of preventive depression management for a healthy pregnancy, and provide evidence to develop and implement the intervention. These efforts will ultimately reduce high-risk pregnancies due to poor mental health.

The association of unplanned pregnancy with perinatal depression: a longitudinal cohort study

Perinatal depression is common, affecting approximately 7-13% of women. Studies have shown an association between unplanned pregnancy and perinatal depressive symptoms, but many used a cross-sectional design and limited postnatal follow-up. The current study investigated the association of unplanned pregnancy with perinatal depressive symptoms using a longitudinal cohort study that followed women from the first trimester until 12 months postpartum. Pregnant women (N = 1928) provided demographic and clinical data and information about pregnancy intention at the first trimester. Depressive symptoms were assessed during each trimester of pregnancy and five times postpartum using the Edinburgh Postnatal Depression Scale (EPDS) until 12 months postpartum. Mixed model analyses were used to investigate the association between an unplanned pregnancy and the level of depressive symptoms. Women with an unplanned pregnancy (N = 111, 5.8%) reported persistently higher levels of depressive symptoms during the entire perinatal period compared to women with a planned pregnancy, after adjustment for confounders (p < 0.001). However, the course of depressive symptom scores over time in women with an unplanned pregnancy was similar to that of women with a planned pregnancy. Lower age (p = 0.006), unemployment (p = 0.004), and history of depression (p < 0.001) were significantly associated with higher levels of perinatal depressive symptoms. An unplanned pregnancy may have a long-lasting negative impact on a woman's perinatal mental health. Therefore, women with an unplanned pregnancy may benefit from systematic follow-up during the perinatal period with contingent mental health support.

The risk and protective factors of heightened prenatal anxiety and depression during the COVID-19 lockdown

While pregnant women are already at-risk for developing symptoms of anxiety and depression, this is heightened during the COVID-19 pandemic. We compared anxiety and depression symptoms, as indicators of psychological distress, before and during COVID-19, and investigated the role of partner, social network and healthcare support on COVID-19-related worries and consequently on psychological distress. A national survey, conducted during the first lockdown in The Netherlands, assessed COVID-19 experiences and psychological distress (N = 1421), whereas a comparison sample (N = 1439) was screened for psychological distress in 2017-2018. During COVID-19, the percentage of mothers scoring above the questionnaires' clinical cut-offs doubled for depression (6% and 12%) and anxiety (24% and 52%). Women reported increased partner support during COVID-19, compared to pre-pandemic, but decreased social and healthcare support. Higher support resulted in lower COVID-19-related worries, which in turn contributed to less psychological distress. Results suggest that a global pandemic exerts a heavy toll on pregnant women's mental health. Psychological distress was substantially higher during the pandemic than the pre-pandemic years. We identified a protective role of partner, social, and healthcare support, with important implications for the current and future crisis management. Whether increased psychological distress is transient or persistent, and whether and how it affects the future generation remains to be determined.

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.

Pregnancy Intention: Associations with Maternal Behaviors and Experiences During and After Pregnancy

Background: The associations between levels of pregnancy intention and adverse behaviors or experiences during pregnancy and postpartum have not been well described. Materials and Methods: We used 2018 Pregnancy Risk Assessment Monitoring System data from 31 jurisdictions in the United States (n = 32,777) to estimate prevalence of inadequate prenatal care (PNC), inappropriate gestational weight gain, depression during pregnancy, intimate partner violence (IPV) during pregnancy, third trimester smoking, no breastfeeding, no postpartum visit, postpartum depressive symptoms, and postpartum smoking by categories of pregnancy intention: unwanted, ambivalent (i.e., unsure), mistimed (i.e., wanted later), or wanted (i.e., wanted then/sooner). Regression models estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) of associations between pregnancy intention and maternal behaviors or experiences. Results: Approximately 16% of women reported pregnancy ambivalence. Women with pregnancy ambivalence (versus wanted pregnancies) had higher prevalence of all adverse maternal behaviors and experiences. Separate models found women with unwanted pregnancy (vs. ambivalent) had higher prevalence for depression during pregnancy (aPR: 1.40, 95% CI: 1.21-1.63), IPV (aPR: 1.75, 95% CI: 1.11-2.77), no breastfeeding (aPR: 1.22, 95% CI: 1.04-1.44), no postpartum visit (aPR: 1.28, 95% CI: 1.06-1.55), and postpartum depressive symptoms (aPR: 1.19, 95% CI: 1.00-1.42); Women with mistimed pregnancy (vs. ambivalent) had lower prevalence for inadequate PNC (aPR: 0.89, 95% CI: 0.81-0.98), third trimester smoking (aPR: 0.68, 95% CI: 0.57-0.80), no breastfeeding (aPR: 0.85, 95% CI: 0.74-0.98), and postpartum smoking (aPR: 0.83, 95% CI: 0.73-0.95). Discussion: The results emphasize the importance of recommended screening and care during the preconception, prenatal, and postpartum periods.

Maternal Mental Health Mediates the Relationship Between Household Food Insecurity and Early Child Development in Brazil

BACKGROUND

Optimal early child development (ECD) is fundamental for every child to achieve their developmental potential and thrive. Household food insecurity (HFI) is a risk factor for suboptimal development, but there is still a need to better understand the pathways that explain this relationship.

OBJECTIVE

To evaluate whether maternal mental health and infant's diet mediate the association between HFI and ECD using structural equation modeling.

METHODS

Cross-sectional study with 474 mother-infant dyads. Mothers answered a questionnaire that evaluated variables through validated instruments. Structural equation modeling analyses were conducted to obtain standardized effects (β) and bias-corrected 95% CI, enabling comparisons between the magnitude of the effects. The following observed variables were included: HFI, ECD, consumption of a healthy and diverse diet, the presence of a partner in the household, wanted pregnancy, and current breastfeeding. Latent variables were included to evaluate mental health, poverty, and neonatal health.

RESULTS

Poor maternal mental health mediated the relationship between HFI and ECD (β = -.05), but a healthy and diverse diet was not a mediator in this relationship. Poverty was related to lower development scores directly (β = .21) and indirectly (β = .02). Not having a partner (β = .05) and having an unwanted pregnancy (β = .02) predicted indirectly lower development scores.

CONCLUSIONS

Poor maternal mental health mediates the relationship between HFI and ECD, and ECD is influenced by poverty, single motherhood, and unwanted pregnancy through different pathways. Therefore, public policies and interventions that aim to promote an optimal ECD should also approach these aspects.

Fertility treatment and oral contraceptive discontinuation for identification of pregnancy planning in routinely collected health data - an application to analgesic and antibiotic utilisation

BACKGROUND

Women with unplanned pregnancies use folic acid less frequently, and more often use potentially teratogenic medications in the first trimester. Yet most studies based on routinely collected data lack information on pregnancy planning. Further, only pregnancies proceeding beyond a certain gestational age appear in routinely collected data, creating the possibility for collider-stratification bias. If pregnancy intention could be identified, pregnancies could be ascertained earlier. This study aimed to investigate fertility treatment and discontinuation of oral contraception (OC) as proxies for pregnancy planning by describing variations in patterns of prescription fills for antibiotics and analgesics during the peri-pregnancy period by these proxies of pregnancy intention.

METHODS

Fertility treatment with clomiphene and discontinuation of OC were identified in the Norwegian Prescription Database (NorPD) and linked with data from the Medical Birth Registry of Norway for the years 2006 to 2017. Filled prescriptions for antibiotics and analgesics from NorPD were displayed for women on fertility treatment, women who discontinued OC before pregnancy, and women who discontinued during pregnancy.

RESULTS

Of 172,585 included pregnancies, fertility treatment was identified in 19,449, and OC discontinuation before or during pregnancy in 153,136. Women who discontinued OC during pregnancy were less likely to use preconception folic acid (25.4%) than women who discontinued before pregnancy (32.9%), and women on fertility treatment (51.0%). Proportions of first trimester prescription fills were 4.9% (analgesics) and 12.8% (antibiotics) for women who discontinued OC during pregnancy, compared to 4.0 and 11.4% in women who discontinued OC before pregnancy, and 4.7 and 11.0% in women on fertility treatment.

CONCLUSIONS

There were no substantial differences in patterns of prescription fills for analgesics and antibiotics before or during pregnancy by fertility treatment and OC discontinuation. This suggests that there were few differences in medication use between women with planned and unplanned pregnancies, or that fertility treatment and timing of OC discontinuation from routinely collected health data cannot stand alone in the identification of unplanned pregnancies. A narrower definition of OC discontinuation during pregnancy seemed to be a better proxy, but this should be confirmed in other studies.

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).

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.

Preconception Health and Lifestyle Behaviours of Women Planning a Pregnancy: A Cross-Sectional Study

Preconception care and lifestyle behaviours significantly influence health outcomes of women and future generations. A cross-sectional survey of Australian women in preconception, stratified by pregnancy planning stage (active planners (currently trying to conceive) vs. non-active planners (pregnancy planned within 1–5 years)), assessed health behaviours and their alignment to preconception care guidelines. Overall, 294 women with a mean (SD) age of 30.7 (4.3) years were recruited and 38.9% were overweight or obese. Approximately half of women (54.4%) reported weight gain within the previous 12 months, of which 69.5% gained ≥ 3kg. The vast majority of women (90.2%) were unaware of reproductive life plans, and 16.8% over the age of 25 had not undertaken cervical screening. Of active planners (n = 121), 47.1% had sought medical/health advice in preparation for pregnancy and 81.0% had commenced supplementation with folic acid, iodine or a preconception multivitamin. High-risk lifestyle behaviours including cigarette smoking (7.3%), consumption of alcohol (85.3%) and excessive alcohol consumption within three months (56.3%), were frequently reported in women who were actively trying to conceive. Results indicate that women who are actively planning a pregnancy require support to optimise health and lifestyle in preparation for pregnancy to improve alignment with current preconception care recommendations.

Lifestyle and Psychological Factors Associated with Pregnancy Intentions: Findings from a Longitudinal Cohort Study of Australian Women

BACKGROUND

Preconception is a critical time for the establishment of healthy lifestyle behaviours and psychological well-being to reduce adverse maternal and offspring outcomes. This study aimed to explore relationships between preconception lifestyle and psychological factors and prospectively assessed short- (currently trying to conceive) and long-term (future parenthood aspirations) pregnancy intentions.

METHODS

Data from Wave 3 (age 25-30 years; n = 7656) and Wave 5 (age 31-36 years; n = 4735) from the Australian Longitudinal Study of Women's Health were used. Pregnancy intentions and parenthood aspirations were evaluated. Logistic regressions explored cross-sectional associations between demographic, lifestyle and psychological factors and pregnancy intentions/parenthood aspirations.

RESULTS

In multivariable models, parity and marital status were associated consistently with pregnancy intentions and parenthood aspirations. Few lifestyle behaviours and no psychological factors were associated with pregnancy intentions. Alcohol intake was the only behaviour associated with aspirations to have a first child. Aspirations for a second/subsequent child were associated negatively with physical activity, sitting time, diet quality, lower anxiety and higher stress.

CONCLUSIONS

It appears that women are not changing their behaviours when they form a decision to try to conceive. Interventions are needed that address women's preconception needs, to optimise lifestyle and improve health outcomes for women and their families.