Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study

Association of interpregnancy interval and risk of adverse pregnancy outcomes in woman by different previous gestational ages

BACKGROUND

With an increasing proportion of multiparas, proper interpregnancy intervals (IPIs) are urgently needed. However, the association between IPIs and adverse perinatal outcomes has always been debated. This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.

METHODS

We used individual data from China's National Maternal Near Miss Surveillance System between 2014 and 2019. Multivariable Poisson models with restricted cubic splines were used. Each adverse outcome was analyzed separately in the overall model and stratified models. The stratified models included different categories of fertility policy periods (2014-2015, 2016-2017, and 2018-2019) and infant gestational age in previous pregnancy (<28 weeks, 28-36 weeks, and ≥37 weeks).

RESULTS

There were 781,731 pregnancies enrolled in this study. A short IPI (≤6 months) was associated with an increased risk of preterm birth (OR [95% CI]: 1.63 [1.55, 1.71] for vaginal delivery [VD] and 1.10 [1.03, 1.19] for cesarean section [CS]), low Apgar scores and small for gestational age (SGA), and a decreased risk of diabetes mellitus in pregnancy, preeclampsia or eclampsia, and gestational hypertension. A long IPI (≥60 months) was associated with an increased risk of preterm birth (OR [95% CI]: 1.18 [1.11, 1.26] for VD and 1.39 [1.32, 1.47] for CS), placenta previa, postpartum hemorrhage, diabetes mellitus in pregnancy, preeclampsia or eclampsia, and gestational hypertension. Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes. The estimated risk of preterm birth, low Apgar scores, SGA, diabetes mellitus in pregnancy, and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.

CONCLUSION

For pregnant women with shorter or longer IPIs, more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.

Determinants of unintended pregnancies among currently married women in Uganda

BACKGROUND

Unintended pregnancies are no longer bound to teenagers or school-going children, married women in Uganda, as well do experience such pregnancies though little has been investigated on them. This study examines the determinants of unintended pregnancies among currently married women in Uganda.

METHODS

In this study, we used data from the 2016 Uganda Demographic and Health Survey (UDHS) which comprised of 10,958 married women aged 15-49 years who have ever been pregnant. The analysis was done using descriptive analysis, logistic regression, and the generalized structural equation model.

RESULTS

The study showed that 37% of pregnancies among married women were unintended. Young women, living in poor households, staying in rural areas, women in the Eastern and Northern region, Muslim women, lack of knowledge on ovulation period, discontinuation of contraceptives, non-use of and intention for contraceptives, high age at sexual debut, high age at first birth, and high parity were directly associated with a higher risk of unintended pregnancies. Relatedly, discontinuation of contraceptives regardless of the place of residence, region, woman's age, education, household wealth, access to family planning messages were associated with higher odds of unintended pregnancies. Older women and those in rural areas who had more children were also at a higher risk of similar pregnancies. However, having more children while using contraceptives, being educated, living in a wealthier household, and having access to family planning messages significantly lowered the risk of unintended pregnancies.

CONCLUSION

Increased access to family planning messages, empowering women as well as having improved household incomes are key preventive measures of unintended pregnancies. There is a need to provide quality contraceptive counseling through outreaches so that women are informed about the different contraceptive methods and the possible side effects. Having a variety of contraceptive methods to choose from and making them accessible and affordable will also encourage women to make informed choices and reduce contraceptive discontinuation. All these coupled together will help women have their desired family sizes, increase the uptake of contraceptives and significantly reduce unintended pregnancies.

Proportion of unplanned pregnancies, their determinants and health outcomes of women delivering at a teaching hospital in Sri Lanka

BACKGROUND

Unplanned pregnancy is a significant public health issue in both low- and high-income countries. The burden of unplanned pregnancy is reflected in women opting for pregnancy terminations and it can be detrimental to the women and her family as well as the health system and society. Solid data on the proportion of unplanned pregnancies are using more specific tools such as the London Measure of Unplanned Pregnancy (LMUP) needed to address the issue in Sri Lankan contexts. The objective was to describe the proportion of unplanned pregnancies, their determinants and the health outcomes of women delivering at Colombo North Teaching Hospital-Ragama (CNTH).

METHODS

A cross-sectional study was carried out among 494 consecutive pregnant women selected by non-probability consecutive sampling who were admitted for the confinement at CNTH. A pre-tested structured interviewer-administered questionnaire was used to collect data on antenatal women and intentionality measured by self-administered six-item LMUP. Maternal and newborn health outcomes were ascertained in each post-partum women before discharge. Data were analyzed with the Mann-Whitney U tests, Kruskal-Wallis tests and spearman rank correlation. We also evaluated the psychometric properties of the Sinhalese version of LMUP.

RESULTS

The response rate was 97.8 and 17.2% of pregnancies ending at birth were unplanned, 12.7% were ambivalent and 70.1% were planned. Associated factor profile of women with unplanned pregnancies includes; not married women (p = 0.001), educated up to the passing of GCE ordinary level by women (p <  0.001) and spouse (p <  0.001), primiparity (p = 0.002) and inadequate knowledge on emergency contraceptives (p = 0.037). Less planned pregnancies were also significantly associated with anemia (p = 0.004), low mood for last 2 weeks (p <  0.001), having a partner with problematic alcohol consumption (p <  0.001), presence of Gender-Based Violence (GBV) (p < 0.001), poor relationship satisfaction with partner (p < 0.001) and family (p < 0.001). Inadequate pre-pregnancy preparation and antenatal care were associated with an unplanned pregnancy. No differences were found in neonatal outcomes. Sinhalese version of the LMUP scale was found to be accepted, valid and reliable with the Cronbach's alpha of 0.936.

CONCLUSIONS

A sizeable proportion of pregnancies were unplanned. Teenage pregnancies, non-marital relationships and inadequate knowledge on emergency contraceptives, maternal anemia, low mood, and GBV were modifiable associated factors which could be prevented by evidence-based locally applicable approaches.

Pregnancy Intention and Pregnancy Outcome: Systematic Review and Meta-Analysis

Introduction Previous systematic reviews concluded that rigorous research on the relationships between pregnancy intentions and pregnancy outcomes is limited. They further noted that most studies were conducted in high-income countries and had methodological limitations. We aim to assess the current evidence base for the relationship between pregnancy intention and miscarriage, stillbirth, low birthweight (LBW) and neonatal mortality. In March 2015 Embase, PubMed, Scopus and PsychInfo were searched for studies investigating the relationship between pregnancy intention and the outcomes of interest. Methods Studies published since 1975 and in English, French or Spanish were included. Two reviewers screened titles and abstracts, read the full text of identified articles and extracted data. Meta-analyses were conducted where possible. Results Thirty-seven studies assessing the relationships between pregnancy intention and LBW were identified. A meta-analysis of 17 of these studies found that unintended pregnancies are associated with 1.41 times greater odds of having a LBW baby (95%CI 1.31, 1.51). Eight studies looking at miscarriage, stillbirth or neonatal death were found. The limited data concerning pregnancy loss and neonatal mortality precluded meta-analysis but suggest these outcomes may be more common in unintended pregnancies. Discussion While there seems to be an increased risk of adverse pregnancy outcome in unintended pregnancies, there has been little improvement in either the quantity of evidence from low-income countries or in the quality of evidence generally. Longitudinal studies of pregnancy intention and pregnancy outcome, where pregnancy intention is assessed prospectively with a validated measure and where analyses include confounding or mediating factors, are required in both high- and low-income countries.

Are pregnancy planning and timing associated with preterm or small for gestational age births?

OBJECTIVE

To investigate whether unplanned or poorly timed pregnancies (self-reported at enrollment) are associated with preterm or small for gestational age births.

DESIGN

Prospective cohort study.

SETTING

Not applicable.

PATIENT(S)

Two thousand six hundred fifty-four pregnant women <18 weeks estimated gestational age with a singleton pregnancy.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Preterm and small for gestational age births.

RESULT(S)

In adjusted analyses, pregnancy planning was not statistically significantly associated with preterm (odds ratio [OR] 1.18; 95% confidence interval [CI], 0.85-1.65) or small for gestational age birth (OR 1.17; 95% CI, 0.69-1.97). Similarly, poorly timed pregnancies were not statistically significantly associated with preterm (OR 0.85; 95% CI, 0.53-1.38) or small for gestational age birth (OR 0.92; 95% CI, 0.65-1.29). Combining pregnancy planning (yes/no) and timing (yes/no) into a 4-level category showed no statistically significant association with preterm birth or small for gestational age.

CONCLUSION(S)

In a large cohort with antenatally assessed pregnancy planning and timing, outcome data collected from medical record abstraction, and robust analysis adjusting for multiple confounding factors including maternal demographics, medical conditions, and other risk factors, neither pregnancy planning nor pregnancy timing showed a statistically significant association with preterm or small for gestational age infants. This study improves upon previous analyses that lacked adjustment for confounding and used retrospective self-reporting to assess pregnancy planning and timing, and preterm and small for gestational age births. Findings may differ in higher risk populations with higher prevalence of preterm or small for gestational age births.

Unwanted childbearing and household food insecurity in the United States

Household food insecurity is a population health concern disproportionately affecting families with children in the United States. Unwanted childbearing may place unanticipated strain on families to meet basic needs, heightening the risk for household food insecurity. We investigated the association between mother's and father's report of unwanted childbearing and exposure to household food insecurity among children residing in two-parent households in the United States. Data from the Early Childhood Longitudinal Study - Birth Cohort, a nationally representative cohort of US children (n ∼ 6150), were used to estimate the odds of household food insecurity when children were aged 9 months and 2 years, separately, based on parental report of unwanted childbearing. The majority of children were reported as wanted by both parents (74.4%). Of the sample, report of unwanted childbearing by father-only was 20.0%, mother-only was 3.4% and joint mother and father was 2.2%. Household food insecurity was higher when children were 9 months compared with 2 years. In adjusted models accounting for confounders, children born to mothers and fathers who jointly reported unwanted childbearing were at higher odds of exposure to household food insecurity at 9 months [adjusted odds ratio (AOR) = 3.31; 95% confidence interval (CI): 1.97, 5.57] and 2 years (AOR = 2.52; 95% CI: 1.12, 5.68). In two-parent households, we found that children raised by parents reporting unwanted childbearing were more likely to be exposed to food insecurity and potentially related stressors. Further studies that prospectively measure wantedness before the child's birth will aid in confirming the direction of this association.

Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya

Background

The prevalence of unintended pregnancy in Kenya continues to be high. The 2003 Kenya Demographic and Health Survey (KDHS) showed that nearly 50% of unmarried women aged 15–19 and 45% of the married women reported their current pregnancies as mistimed or unwanted. The 2008–09 KDHS showed that 43% of married women in Kenya reported their current pregnancies were unintended. Unintended pregnancy is one of the most critical factors contributing to schoolgirl drop out in Kenya. Up to 13,000 Kenyan girls drop out of school every year as a result of unintended pregnancy. Unsafe pregnancy termination contributes immensely to maternal mortality which currently estimated at 488 deaths per 100 000 live births. In Kenya, the determinants of prevalence and determinants of unintended pregnancy among women in diverse social and economic situations, particularly in urban areas, are poorly understood due to lack of data. This paper addresses the prevalence and the determinants of unintended pregnancy among women in slum and non-slum settlements of Nairobi.

Methods

This study used the data that was collected among a random sample of 1262 slum and non-slum women aged 15–49 years in Nairobi. The data was analyzed using simple percentages and logistic regression.

Results

The study found that 24 percent of all the women had unintended pregnancy. The prevalence of unintended pregnancy was 21 per cent among women in slum settlements compared to 27 per cent among those in non-slum settlements. Marital status, employment status, ethnicity and type of settlement were significantly associated with unintended pregnancy. Logistic analysis results indicate that age, marital status and type of settlement had statistically significantly effects on unintended pregnancy. Young women aged 15–19 were significantly more likely than older women to experience unintended pregnancy. Similarly, unmarried women showed elevated risk for unintended pregnancy than ever-married women. Women in non-slum settlements were significantly more likely to experience unintended pregnancy than their counterparts in slum settlements.

The determinants of unintended pregnancy differed between women in each type of settlement. Among slum women, age, parity and marital status each had significant net effect on unintended pregnancy. But for non-slum women, it was marital status and ethnicity that had significant net effects.

Conclusion

The study found a high prevalence of unintended pregnancy among the study population and indicated that young and unmarried women, irrespective of their educational attainment and household wealth status, have a higher likelihood of experiencing unintended pregnancy. Except for the results on educational attainments and household wealth, these results compared well with the results reported in the literature.

The results indicate the need for effective programs and strategies to increase access to contraceptive services and related education, information and communication among the study population, particularly among the young and unmarried women. Increased access to family planning services is key to reducing unintended pregnancy among the study population. This calls for concerted efforts by all the stakeholders to improve access to family planning services among the study population. Increased access should be accompanied with improvement in the quality of care and availability of information about effective utilization of family planning methods.

Effects of unplanned pregnancy on neonatal health in Turkey: a case-control study

The aim of this study was to investigate effects of unplanned pregnancy on neonatal health. This is a retrospective case-control study and included 314 babies selected with a non-probability method. Data were collected with a questionnaire of descriptive characteristics and neonatal health and Parent Infant Interaction Assessment Scale. A significantly higher rate of the babies born to the women with unplanned pregnancy had meconium in their amniotic fluid (14.6% vs. 7.0%; P = 0.029), needed special care (20.4% vs. 11.5%; P = 0.031) and were kept in the incubators (12.7% vs. 4.5%; P = 0.009). Both the babies born to the women with unplanned pregnancy and the babies born to the women with planned pregnancy were first fed with breast milk (96.8% of the unplanned group; 98.1% of the planned group), but a higher rate of the babies born to the women with unplanned pregnancy had problems with breast-feeding. (19.1% vs. 5.1%; P = 0.000). The babies born to the women with unplanned pregnancy got significantly lower scores on Parent Infant Interaction Assessment Scale (4.86 ± 1.98 in the unplanned group; 8.52 ± 1.43 in the planned group; P = 0.000). We found that a higher rate of the babies born to the women with unplanned pregnancy needed special care, had problems with breast-feeding and negative parent-infant interaction. We recommend that women with unplanned pregnancy should be given priority on prenatal, intrapartum and postpartum care and that measures which protect and promote neonatal health should be taken.

Emergency contraception and the knowledge of community pharmacists in isfahan, iran

OBJECTIVES

Emergency contraception (EC) is a special contraception method that prevents pregnancy after an unsafe sexual contact. Pharmacists, as the most available member of medical team have a unique role in patient education for appropriate use of contraceptive methods. In this study, we assessed the pharmacists' knowledge about emergency contraception.

METHODS

A researcher made questionnaire was developed and used according to national guide line and electronic databanks. A group of experts and pharmacists validated the questionnaire. Reliability was measured by Half-Split Test. The questionnaires were filled by pharmacists.

RESULTS

Average knowledge score were 8.12 ± 0.28 for women and 7.83 ± 0.31 for men (from a maximum of 15) which showed no significant difference between men and women (P = 0.492). There was no significant difference between pharmacists who had precipitated in continuing education programs and that of those who had not (P = 0.286). Scores of pharmacists who graduated 13 years ago or more did not significantly differ from others (P = 0.287).

CONCLUSIONS

Because of low scores of pharmacist's knowledge about EC and the importance of unintended pregnancy prevention, its improvement is an urgent need. Regular and frequent continuing education programs could be one of the recommended interventions.

Exploring knowledge and attitudes related to pregnancy and preconception health in women with chronic medical conditions

Women with chronic medical conditions are at increased risk for pregnancy-related complications, yet little research has addressed how women with diabetes, hypertension, and obesity perceive their pregnancy-associated risks or make reproductive health decisions. Focus groups were conducted with 72 non-pregnant women stratified by chronic condition (diabetes, hypertension, obesity) and by previous live birth. Participants discussed their intention for future pregnancy, preconception health optimization, perceived risk of adverse pregnancy outcomes, and contraceptive beliefs. Four major themes were identified, with some variation across medical conditions and parity: (1) Knowledge about pregnancy risks related to chronic medical conditions was limited; (2) Pregnancy intentions were affected by diabetes and hypertension, (3) Knowledge about optimizing preconception health was limited; and (4) Lack of control over ability to avoid unintended pregnancy, including limited knowledge about how medical conditions might affect contraceptive choices. Women with diabetes and hypertension, but not obesity, were generally aware of increased risk for pregnancy complications, and often expressed less intention for future pregnancy as a result. However, diabetic and hypertensive women had little knowledge about the specific complications they were at risk for, even among those who had previously experienced pregnancy complications. Neither chronic condition nor perceived risk ensured intent to engage in preconception health promotion. We observed knowledge deficits about pregnancy-related risks in women with diabetes, hypertension, and obesity, as well as lack of intent to engage in preconception health promotion and pregnancy planning. These findings have important implications for the development of preconception care for women with chronic medical conditions.

Unintended births: patterns by race and ethnicity and relationship type

CONTEXT

Childbearing intentions vary by race and ethnicity and by relationship type. However, few studies have examined whether they differ by race and ethnicity within relationship type.

METHODS

Data from the Early Childhood Longitudinal Study were used to examine the childbearing intentions of 9,100 mothers of a cohort of children born in 2001. Multivariate and multinomial regression analyses were conducted to examine whether relationship type (married, cohabiting or neither) helps explain racial and ethnic differences in childbearing intentions and whether associations between race and ethnicity and childbearing intentions vary by relationship type.

RESULTS

Blacks were more likely than whites to have had an unintended birth (odds ratio, 2.5); the relationship held among married (2.6), but not unmarried, mothers. For most relationship types, black mothers had higher relative risks than whites of having had an unwanted birth, rather than an intended or a mistimed one. Asian married mothers were more likely than their white counterparts to have had an unwanted, rather than intended, birth (1.9). The odds of an unintended birth were lower among foreign-born Hispanic cohabiting women than among white cohabiting women (0.6), a finding driven by the lower risk of unwanted than of other births among foreign-born Hispanics (0.3–0.5). Few differences were apparent between native-born Hispanics and white mothers.

CONCLUSIONS

Racial and ethnic differences in childbearing intentions are frequently contingent on relationship context. Differences between whites and blacks are largely attributable to married women. Assessment of childbearing intendedness among Hispanics should take nativity into account.

The effects of unintended pregnancy on infant, child, and parental health: a review of the literature

This article provides a critical review of studies assessing the effects of unintended pregnancy on the health of infants, children, and parents in developed and developing countries. A framework for determining and measuring the pathways between unintended pregnancy and future health outcomes is outlined. The review highlights persistent gaps in the literature, indicating a need for more studies in developing countries and for further research to assess the impact of unintended pregnancy on parental health and long-term health outcomes for children and families. The challenges in measuring and assessing these health impacts are also discussed, highlighting avenues in which further research efforts could substantially bolster existing knowledge.

Contraceptive use by diabetic and obese women

PURPOSE

Women with chronic medical conditions are at increased risk for adverse pregnancy outcomes, yet contraceptive use by these women has not been well described. The purpose of this study was to describe contraceptive use by diabetic and overweight/obese women compared with women without these conditions.

METHODS

Using cross-sectional data from the 11 states participating in the optional Family Planning Module of the Behavioral Risk Factor Surveillance System in 2000, we analyzed contraceptive use among 7,943 sexually active women of reproductive age (18-44) who were not trying to conceive. Using logistic regression techniques, we modeled the effect of diabetes and overweight/obesity on contraceptive nonuse, controlling for age, race/ethnicity, marital status, education, income, and health insurance coverage.

MAIN FINDINGS

Contraceptive nonuse was reported by 1,500 (18.9%) of the total sample, 31 (25.8%) diabetic women, 371 (20.0%) overweight women, and 385 (23.4%) obese women. In the multivariable model, obesity was significantly associated with contraceptive nonuse (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.16-1.55), but there were no significant differences in contraceptive nonuse for diabetic women (adjusted OR 1.23, 95% CI 0.80-1.87) or overweight women (adjusted OR 1.14, 95% CI 0.99-1.31). Older, Black, Hispanic, married, less educated, and women without health insurance were more likely to report contraceptive nonuse.

CONCLUSION

Among women with need for contraception, obese women were more likely to report contraceptive nonuse than normal weight women. Because women with chronic conditions like obesity are at higher risk of pregnancy-related complications and adverse pregnancy outcomes, proper contraceptive use and unintended pregnancy avoidance is a priority.

Placental transfer of rosiglitazone in the first trimester of human pregnancy

OBJECTIVE

To determine the degree of placental transfer of rosiglitazone in early human pregnancy.

DESIGN

Prospective observational study.

SETTING

University teaching hospital.

PATIENT(S)

Thirty-one women undergoing surgical termination of pregnancy between 8 and 12 weeks' gestation.

INTERVENTION(S)

Each woman was given two doses of rosiglitazone (4 mg) before the procedure.

MAIN OUTCOME MEASURE(S)

Rosiglitazone concentration in fetal tissue and coelomic and amniotic fluids.

RESULT(S)

The mean maternal serum rosiglitazone concentration was 110.3 +/- 47.9 ng/mL. Rosiglitazone was detectable in 19 fetal samples (61.3%). The mean fetal tissue concentration was 52.7 +/- 26.3 ng/g. Rosiglitazone was more likely to be detected in fetal tissue if the gestation at termination was 10 weeks or more compared with earlier gestation. Coelomic fluid was obtained in 22 cases, and rosiglitazone was detected in 13 samples (59.1%). The mean concentration was 22.8 +/- 7.0 ng/mL. Rosiglitazone was detectable in only two of the 31 amniotic fluid samples, with concentrations of 10.3 and 12.6 ng/mL.

CONCLUSION(S)

The risk of placental transfer of rosiglitazone is much higher at or after 10 weeks of gestation. Absence of detectable rosiglitazone in amniotic fluid despite its presence in fetal tissue suggests that fetuses may have the ability to metabolize rosiglitazone, and little parent drug was excreted unchanged in urine.

A study of diclofenac-induced teratogenicity during organogenesis using a whole rat embryo culture model

BACKGROUND

Diclofenac is a non-steroidal anti-inflammatory drug, commonly used by reproductive age women for the treatment of a variety of conditions. However, there is limited information regarding the teratogenic effects of this drug.

METHODS

The effect of diclofenac on the developing embryo during the critical period of organogenesis was investigated by using a whole rat embryo culture model. Embryos were exposed to various concentrations of diclofenac and scored for growth and differentiation at the end of the culture period.

RESULTS

Total developmental score and score for caudal neural tube, flexion and hindlimb were significantly lower in embryos exposed to high concentrations of diclofenac (7.5 and 15.0 microg/ml), but no difference in these parameters was observed when embryos were exposed to low concentration of diclofenac (1.5, 2.5 and 5.0 microg/ml). No significant differences in yolk sac diameter, crown-rump length and number of somites was found between embryos in the experimental and the control group.

CONCLUSIONS

Our study has demonstrated that diclofenac exerts direct teratogenic effects on rat embryos. Until more is known about the effects of diclofenac (especially in moderate to high doses) in women of reproductive age, we suggest its use should be treated with caution.

Concept Analysis of Pregnancy Planning Drawn from Women of Childbearing Age

Pregnancy planning is becoming an important issue in preconception health promotion. Unfortunately, its definition and measurement remain imprecise. This article will develop an operational definition and identify essential components of the concept of pregnancy planning. Six steps from Walker and Avant’s concept analysis procedure were used. Data were collected through a literature review, interviews with key informants, and three focus groups. The concept analysis yielded a conceptual framework comprising three essential components: attitude, timing, and sexual behavior. Pregnancy planning is defined as the adoption of an attitude centered on conception, including sexual behaviors (proceptive or contraceptive) and timing. Moreover, pregnancy planning is not a clear-cut phenomenon with questions that can be answered simply with “yes” or “no”. Rather, it is a dynamic process that evolves according to contextual factors. From these results, an instrument evaluating the intensity of pregnancy planning can be developed for epidemiological research and promotional purposes.

Unintended pregnancy and low birthweight in Ecuador

OBJECTIVES

This study assessed the relationship between unintended pregnancy and infant birthweight in Ecuador, differentiating between unwanted and mistimed pregnancies.

METHODS

Analyses focused on a subsample of women (n = 2490) interviewed in the 1994 Ecuador Demographic and Maternal-Child Health Survey. Logistic regression was used to assess the relationship between pregnancy intention status and low birthweight after control for other factors.

RESULTS

Infants from unwanted pregnancies were more likely than infants from planned pregnancies to have low birthweight (odds ratio = 1.64, 95% confidence interval = 1.22, 2.20). Mistimed pregnancy was not associated with low birthweight.

CONCLUSIONS

Unwanted pregnancy, but not mistimed pregnancy, is associated with low birthweight in Ecuador. Further research is needed to understand the mechanism through which pregnancy intention status affects birthweight.