Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes

Authors

Heidi D. Nelson MD, MPH, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
Blair G. Darney PhD, Oregon Health & Science University, Portland
Katherine A. Aherns MPH, PhD, Muskie School of Public Service, University of Southern Maine
Amanda Burgess MPPM, Public Health Program of the Muskie School of Public Service, University of Southern Maine,
Rebecca M. Jungbauer DrPH, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
Chandler Atchison MPH, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
Karen B. Eden PhD, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
Rose Goueth PhD, MS, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
Rongwei Fu, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland

Document Type

Article

Publication Date

11-2022

Publication Title

JAMA, 328(17), 1714-1729

Abstract

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.

Recommended Citation

Nelson, H. D., Darney, B. G., Ahrens, K., Burgess, A., Jungbauer, R. M., Cantor, A., Atchison, C., Eden, K. B., Goueth, R., & Fu, R. (2022). Associations of Unintended Pregnancy with Maternal and Infant Health Outcomes: A Systematic Review and Meta-Analysis. JAMA, 328(17), 1714-1729. https://doi.org/10.1001/jama.2022.19097