Abstract
BackgroundOver half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP). Some women seek TOP, but ultimately continue their pregnancy. Data are limited about their utilization of prenatal care and their perinatal outcomes. Our primary outcome was to investigate differences in guideline-based prenatal care utilization in women who consider but do not have an abortion.MethodsRetrospective cohort study of patients having obstetrical dating ultrasound (US) from 2011–2018 at a single academic medical center that offers TOP. Contemplators completed US with intention of TOP but instead continued the pregnancy to live birth. A 2:1 group of non-contemplators completed US and continued to live birth. A prenatal care utilization scoring system was used to compare groups. Secondary outcomes investigated differences in adverse pregnancy outcomes and postpartum care.ResultsThere were 94 contemplators and 183 non-contemplators. Inadequate prenatal care utilization initially was more common in contemplators than non-contemplators (62.8% vs 85.8%, p < 0.01) but was not significant after adjustment (aOR 1.0, 95% CI 0.40 – 2.56). There were no differences in adverse obstetric or neonatal outcomes. Contemplators were significantly more likely to have a postpartum contraceptive method (PPCM) upon hospital discharge (aOR 4.8, 95% CI 1.16 – 20.0) and significantly more likely to use a highly-effective PPCM (aOR 6.4, 95% CI 2.34 – 17.4).ConclusionsReversal of intention for TOP is not associated with differences in prenatal care utilization, but is associated with increased uptake of postpartum contraceptive method.
Highlights
Over half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP)
While abortions are common and legal in the US, there are still many barriers that pregnant people face in accessing abortion care, including lack of insurance coverage, not knowing how to obtain care, inability to afford or coordinate transportation, missed wages, misinformation or delays in access arising from crisis
Demographics Data were collected on 94 contemplators and 183 noncontemplators, for a total of 277 participants
Summary
Over half of all pregnancies in the United States are unintended, and 18% result in termination of pregnancy (TOP). There is a small but expanding body of literature on the subpopulation of pregnant people who consider abortion, but continue with pregnancy Most of these studies investigate the experiences of turnaways, including effects on mental health, educational attainment, poverty, neonatal outcomes, and subsequent pregnancy outcomes [7, 15,16,17,18,19,20,21]. Studies have reported initiation of prenatal care at later gestational ages [22], though some authors report that change in decision-making towards abortion is protective [23] As compared to those who enter prenatal care without considering abortion, these people have considerably increased health and social service needs which can affect prenatal care utilization [24]
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