Pregnancy Intendedness and Interpregnancy Interval Pubblico

Abstract

Background. Short or long interpregnancy interval (IPI) is associated with adverse perinatal
outcomes. It is not clear whether pregnancy intendedness is associated with non-optimal IPI or if
both unintended pregnancy and non-optimal IPI are caused by common sociodemographic
factors.
Methods. Using cross-sectional data from the Georgia Pregnancy Risk Assessment Monitoring
System (PRAMS) from 2004-2008 (n=3,133), multivariate logistic and polytomous regression
models were used to calculate odds ratios (ORs) for non-optimal (<18 or >59 months), short (<18
months), and long (>59 months) IPI by pregnancy intention status (mistimed, unwanted, or
ambivalent, compared to intended). ORs adjusting for maternal age, race/ethnicity, marital status,
and education were calculated.
Results. 49.5% of births occurred after a non-optimal IPI. 31.6% and 17.9% of births occurred
after short and long IPIs, respectively. A non-optimal IPI was more likely to occur after an
unintended pregnancy (OR 1.80, 95% confidence interval (CI) 1.40, 2.31). A short IPI was more
likely to occur after a mistimed (OR 2.89, 95% CI 1.95, 4.29), unwanted (OR 2.28, 95% CI 1.46,
3.55), or ambivalent pregnancy (OR 2.11, 95% CI 1.50, 2.96). Long IPI had a weak and non-
significant association with unintended pregnancy (OR 1.14, 95% CI 0.80, 1.60).
Conclusion. The findings suggest that short IPI is associated with unintended pregnancy, even
when controlling for sociodemographic factors. Long IPI appears to be associated with other
factors beyond pregnancy intendedness. The findings have implications for future research on the
health outcomes associated with short IPI as well as the causes of long IPI.

Table of Contents

TABLE OF CONTENTS

CHAPTER I: BACKGROUND.. 1

Introduction.. 1

Background.. 1

Interpregnancy interval 1

Interpregnancy interval and health outcomes. 2

Factors associated with interpregnancy interval 4

Pregnancy intendedness. 5

Pregnancy intendedness and health outcomes. 6

Measurement of pregnancy intendedness. 7

CHAPTER II: MANUSCRIPT.. 12

Abstract. 12

Background.. 13

Materials and Methods. 15

Study population.. 15

Outcome. 15

Exposure. 15

Potential confounders. 17

Analysis. 17

Results. 19

Sample characteristics. 19

Characteristics associated with IPI. 19

Characteristics associated with pregnancy intendedness. 20

Multivariable analysis. 20

Discussion.. 21

References. 25

Tables. 30

Table 1. Comparison of traditional PRAMS categorization of pregnancy intendedness to categorization used in this study.. 30

Table 2a. Number and weighted percentages* of maternal characteristics and pregnancy intention status by interpregnancy interval (dichotomous and categorical) and odds ratios for non-optimal interpregnancy interval, Georgia PRAMS 2004-2008.. 31

Table 2b. Number and weighted percentages* of maternal characteristics and interpregnancy intervals by pregnancy intention status (dichotomous and categorical) and odds ratio for unintended pregnancy, Georgia PRAMS 2004-2008.. 34

Table 3. Adjusted odds ratio (and 95% confidence interval) for interpregnancy interval according to pregnancy intention among Georgia women participating in PRAMS survey, 2004-2008 (n=3,133)*. 37

Table 4. Moderate and long interpregnancy intervals among women ≥30, number and weighted percent, combined and stratified by black non-Hispanic and white non-Hispanic race. 38

Figures. 40

Figure 1. Odds ratio for non-optimal interpregnancy interval among unintended pregnancies by maternal age* 40

CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, POSSIBLE FUTURE DIRECTIONS 41

Summary.. 41

Public health implications. 45

Possible future directions. 46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	interpregnancy interval pregnancy intention
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Georgia state or local health department

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