Age Differences in the Consequences of Unintended Pregnancy Open Access

Abstract

Background. Intention of pregnancy includes intended, mistimed, and unwanted pregnancies. As of 2008, 51% of all pregnancies among women ages 15-44 years were unintended. Prior studies have shown that the quality of preconception, prenatal, and postpartum care differs between pregnancies that are mistimed or unwanted as compared to intended. However, despite age-differences in health promoting and risk-taking behaviors, existing research has not evaluated whether these behaviors are similarly associated with unintended pregnancy across all maternal age groups.

Methods. This secondary analysis used descriptive statistics and logistic regression to evaluate a cross-sectional population-based sample using the Pregnancy Risk Assessment Monitoring System from eight states from 2010-2011. The prevalence and odds of outcomes related to the quality of preconception, prenatal, and postpartum care by preconception pregnancy intention (i.e., intended, mistimed, or unwanted) were calculated. Behaviors that were analyzed include taking folate/multivitamin supplements; pregnancy recognition; alcohol consumption; smoking; contraception; feelings of depression; infant sleep position; and breastfeeding. Healthcare utilization measures that were evaluated include prophylactic dental care; initiation of prenatal care; and maternal/infant well checkups. Age stratified analyses were conducted for all outcomes.

Results. Women who had given birth in the previous 2-9 months with unwanted pregnancies were uniformly at decreased odds of early initiation of prenatal care relative to those with intended pregnancies. Women with unintended pregnancies were similar to those with intended pregnancies in prenatal alcohol consumption, well-baby checkup, and infant sleep position on back at all age groups. All other maternal behaviors differed in odds by maternal age groups. Women aged 25-34 with unintended pregnancies had the highest prevalence; teenagers with unintended pregnancies were almost indistinguishable from those with intended pregnancies.

Conclusion. Given that the odds of maternal behaviors and healthcare utilization measures differed across age groups, perinatal counseling should be targeted to at-risk age groups in all but four of the outcomes that did not vary by age group.

Table of Contents

BACKGROUND. 1

Demographic Characteristics Associated with Unintended Pregnancies. 2

Association of Pregnancy Intendedness and Age. 2

Health Outcomes Associated with Unintended Pregnancies. 3

Folic Acid. 4

Pregnancy Recognition. 4

Healthcare Utilization. 5

Alcohol Use. 6

Tobacco Use. 7

Household Rules Allowing Smoking. 8

Breastfeeding. 9

Sleep Position. 10

Contraception. 11

Postpartum Depression. 11

Goal and Objectives. 12

MATERIALS AND METHODS. 14

Data Source. 14

Study Population. 14

Data Collection. 15

Data Measures. 15

Outcomes. 15

Exposure. 17

Covariates. 17

RESULTS. 19

DISCUSSION. 22

BIBLIOGRAPHY. 30

Table 1. Characteristics of Mothers by Age Group, Pregnancy Risk Assessment Monitoring System, 2010-2011. 40

Table 2. Health-Promoting and Risk-Taking Behaviors by Pregnancy Intention, Pregnancy Risk Assessment Monitoring System, 2010-2011. 42

Table 3. Health-Promoting and Risk-Taking Behaviors by Age Group, Pregnancy Risk Assessment Monitoring System, 2010-2011. 43

Table 4. Odds of Health-Promoting and Risk-Taking Behaviors Among Mistimed Versus Intended Pregnancies by Age Group, Pregnancy Risk Assessment Monitoring System, 2010-2011. 44

Table 5. Odds of Perinatal Behaviors Among Unwanted Versus Intended Pregnancies by Age Group, Pregnancy Risk Assessment Monitoring System, 2010-2011. 45

Table 6. Perinatal Behaviors Among Unwanted/Mistimed Versus Intended Pregnancies by Age Group, Pregnancy Risk Assessment Monitoring System, 2010-2011. 46

Figure 1. Analysis Framework, Pregnancy Risk Assessment Monitoring System, 2010-2011. 47

APPENDICES. 48

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	postpartum prenatal care perinatal age advanced maternal age unintended pregnancy pregnancy recognition healthcare utilization sleep position prenatal folic acid preconception pregnancy intention alchol PRAMS breastfeeding baby well checkup age differences maternal well checkup smoking maternal behavior
Committee Chair / Thesis Advisor	Gazmararian, Julie A, Emory University
Committee Members	Pazol, Karen, CDC
Partnering Agencies	CDC

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