Unintended pregnancy significantly associated with adverse maternal and infant health outcomes compared to intended pregnancy

1. In this systematic review and meta-analysis, among 524 522 participants, when compared with intended pregnancy, unintended pregnancy was associated with higher odds of maternal depression during pregnancy and post-partum, maternal experience of interpersonal violence, preterm birth, and infant low birth weight.

2. Further research should include studies specifically designed to identify associations of unintended pregnancy with maternal and infant health outcomes that minimize bias with prospective measurement of pregnancy intention.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Reducing unintended pregnancy is a Healthy People 2030 public health priority. In the United States, from 2017 to 2019, approximately 38% of pregnancies were unintended. Unintended pregnancies are known to be associated with adverse maternal and infant health and welfare outcomes, however, estimates of these associations specific to the current US population are lacking. As such, the objective of this systematic review and meta-analysis was to estimate associations of unintended pregnancy with maternal and infant health outcomes during pregnancy and postpartum. Databases sources included Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsychINFO, SocINDEX, and MEDLINE. Studies included were relevant to US populations that compared key maternal, and infant health outcomes for unintended vs intended pregnancies. The main outcomes included prenatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth, and infant low birth weight. A total of 36 studies were included (N = 524 522 participants), where unintended pregnancy was found to be significantly associated with higher odds of depression during pregnancy and post-partum, interpersonal violence, preterm birth, and infant low birth weight, in comparison to intended pregnancy. A total of 23 studies reported adjusted estimates of the association between unintended pregnancy and maternal depression during pregnancy and postpartum. The strengths of this study included a comprehensive literature search, focused eligibility criteria, and individual study quality assessment. A limitation of this study was that it had a narrow scope and only assessed 5 maternal and infant health outcomes.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC)

In-Depth [systematic review and meta-analysis]: This study evaluated associations of unintended pregnancy with maternal and infant health and welfare outcomes during pregnancy and postpartum. A total of 36 studies were included (14 cohort studies; 22 cross-sectional studies), with a cumulative participant total of 524 522. Databases sources included Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsychINFO, SocINDEX, and MEDLINE. When compared with intended pregnancy, unintended pregnancy was found to be 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%, 15 studies [n = 41 054]) and post-partum (15.7% vs 9.6%; aOR, 1.51 [95% CI, 1.40-1.70]; I² =71%; 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 = 87547]).

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