Pregnancy Decisions Research Articles

Pregnancy decision-making in women with physical disabilities.

Women with physical disabilities experience barriers to knowledge about pregnancy and adequate reproductive healthcare, which impedes decision-making processes and negatively impacts their pregnancy planning. The purpose of this study was to learn more about pregnancy decision-making in women with physical disabilities. We conducted a qualitative study utilizing semi-structured interviews with women with physical disabilities. We asked questions regarding pregnancy, parenting, reproductive health, relationships and interactions with the healthcare system. We utilized interview transcripts and notes to form a codebook regarding pregnancy and parenting decision-making, knowledge, and fears. We then organized codes into themes based on pre-existing literature regarding fertility and conceptualization of the self. We completed and analyzed 16 interviews. Themes overall reflected the participants grappling with their own baseline assumptions that they were infertile, as well as managing similar assumptions from others. However, many of the participants recall an exact point where they began to contemplate the fact that having children was possible for them. Finally, disability-related parenting challenges are considered very early in pregnancy decision-making process. Women with physical disabilities experience barriers to contemplating pregnancy including inadequate information on pregnancy and reproductive healthcare that affects their decision-making regarding pregnancy and parenting. All healthcare providers should talk to patients with disabilities about family planning and address possible barriers to contemplating pregnancy.

Prevalence and correlates of male partner involvement in antenatal care services in eastern Kenya: a cross-sectional study.

Introductionmale partner involvement in antenatal care (ANC) contributes to improved maternal health outcomes, but has been wanting in sub-Saharan Africa. We investigated the prevalence and factors associated with male involvement in ANC.Methodsthis was a cross-sectional survey conducted in November and December 2019 in Kitui East sub-county, Kenya. We recruited men above 18 years whose spouses had given birth 12-months prior to the study. Data were collected at the household level using an interviewer-administered questionnaire. Male involvement was defined as provision of physical, psycho-social, decision-making, and financial support, which was measured through twelve questions. Factor scores of the twelve questions were generated by fitting a Rasch model. Participants who scored at least 75% were involved. Bivariate and multivariate logistic regression models were fitted to identify the independent predictors of male involvement.Resultsa total of 300 participants were interviewed. The mean age was 36.7 years (SD=±7.6), 52.3% had primary level education, 64.3% had between 1-3 children, 44.6% were 5 years older than their spouses, while 37.3% earned between $50-$100 per month. The prevalence of male involvement in ANC was 61% (95%C.I: 55.7%, 66.3%) and was positively associated with previous ANC attendance by the spouse (AOR= 4.96, 95% CI: 2.37, 10.38, p<0.001), having 1-2 and 3-4 children (AOR= 4.57, 95% CI: 1.70, 12.31, p=0.003 and AOR= 4.84, 95% CI: 1.59, 14.79, p=0.006) respectively. On the contrary, participants who lacked knowledge on the minimum ANC visits (AOR= 0.37, 95% CI: 0.17, 0.83, p=0.016), unplanned pregnancy (AOR=0.22, 95% CI: 0.10, 0.48, p<0.001), and individual financial decision-making (AOR= 0.42, 95% CI: 0.21, 0.89, p=0.023) were less likely to be involved.Conclusionmore than half of the participants reported involvement in ANC, which was significantly associated with previous ANC experience and having less than four children. Empowering men with knowledge on ANC and joint decision-making with their spouses is imperative in order to improve male involvement.

Does the COVID-19 pandemic alter management choice for nonviable pregnancy, ectopic, or termination?

Rationed health resources, physical distancing, and fiscal limitations during the coronavirus (COVID-19) pandemic may influence physician and patient decisions in early pregnancy. We aim to compare the clinical management for nonviable intrauterine pregnancy (NIP), ectopic pregnancy (EP) and termination of pregnancy (TOP) before and during the pandemic.

Reproductive autonomy and feelings of control over pregnancy among emerging adult clients in a Utah (USA) contraceptive initiative study

ObjectiveResearch has called for more exploration into how reproductive autonomy (which includes agency over pregnancy decisions) is related to structural, relational, and individual elements. Thus, we use surveys to investigate how one potential indicator of reproductive autonomy—feelings of control over pregnancy—may relate to structural, relational, and individual factors in emerging adults’ (age 18–24) lives. MethodsUsing survey data from 2594 emerging adult women participating in a contraceptive initiative in Utah (USA), we analyzed level of agreement with the statement: “I feel that I have control over whether or not I get pregnant,” exploring relationships between sociodemographic characteristics and agreement with the statement. We used chi-square tests and multinomial logistic regression to investigate relationships between individual, relational, and structural factors and feelings of control. ResultsMost participants (86%) agreed with the statement (n = 2231), while the remainder were neutral or disagreed. Participants reporting poverty-level incomes (RRR: 1.80; 95 %CI 1.25–2.59) and previous unwanted pregnancies (RRR: 2.74; 95 %CI: 1.56–4.81) were more likely to describe “neutral” feelings of control. ConclusionFindings indicate a relationship between feelings of control over pregnancy and several factors, and these results may help identify reproductive autonomy access gaps among emerging adults. More work should investigate these relationships as well as the meaning of “neutral” responses when it comes to assessments of control over pregnancy.Trial Registration: Clinicaltrials.gov identifier NCT02734199, Registered 12 April 2016.

Estimating the annual domestic adoption rate and lifetime incidence of infant relinquishment in the United States,

ObjectivesEstimating the rate of infant relinquishment for adoption in the United States (U.S.) can inform understandings of pregnancy decision-making and adoption practice. Yet, private domestic adoptions are not systematically tracked. Most methods of estimating adoptions rely on nonmarital birth rates, despite the changing social context of nonmarital births. This analysis provides updated estimates of the rate of infant relinquishment for private domestic adoption in the United States. Study DesignUsing data from National Council for Adoption, Centers for Disease Control, and Guttmacher Institute, I compiled annual estimates for the number and rates of births, abortions, and adoptions; calculated annual domestic infant adoption rates among all women and unmarried women of reproductive age; estimated the number of adoptions as a proportion of marital and nonmarital births; and estimated the lifetime incidence of relinquishment for U.S. women. ResultsSince 1982, the annual adoption rate per 1000 U.S. women of reproductive age has been between 0.32 and 0.45, decreasing for the last 30 years. The most recent adoption rate translates to a lifetime relinquishment estimate of 0.9% of U.S. women. Based on patterns from 2002 to 2014, I estimate the current number of private domestic adoptions to be approximately 0.5% the annual number of births, or about 18,300 to 20,000 adoptions per year. ConclusionsDespite finding a higher estimate of private domestic adoptions per year than previous estimates, adoption relinquishment rates remain dramatically lower than birth (and thus parenting) and abortion rates in the U.S. ImplicationsNational and state level information about annual adoptions is needed to inform policies regarding adoption, abortion, and support for families.

Pregnancy outcomes after exposure to crisis pregnancy centers among an abortion-seeking sample recruited online.

IntroductionMore than 2,500 crisis pregnancy centers (CPCs), which seek to convince people considering abortion to continue their pregnancies, exist in the United States. However, the characteristics of people who visit CPCs and their pregnancy outcomes are largely unknown. This study sought to describe the characteristics of people considering abortion who report visiting CPCs, and whether CPC visit is associated with abortion or continuing the pregnancy 4 weeks later.MethodsBetween August 2017 to May 2018, we recruited pregnant people searching for abortion services online, and 857 participants completed baseline and 4-week follow-up surveys. We described characteristics associated with visiting a CPC and compared pregnancy and abortion outcomes for those who reported CPC visit to those who did not using mixed-effects multivariable logistic regression.ResultsOverall, 13.1% of respondents visited a confirmed CPC. Living further away from a CPC was associated with lower odds of a CPC visit. At follow-up, respondents who had visited a CPC were significantly less likely to have had an abortion (29.5%) than those who had not visited a CPC (50.5%). In the adjusted models, respondents who had visited a CPC had higher odds of being pregnant and still seeking abortion (aOR: 2.26, 95% CI: 1.37–3.73) or continuing the pregnancy (aOR: 2.35, 95% CI: 1.33–4.15) (versus having had an abortion), than those who had not visited a CPC.ConclusionsCPCs may be providing resources to people who are considering continuing their pregnancy and/or they may be misleading people about the care and referrals they provide related to abortion. Pregnant people need access to accurate information, decision support, and resources to make the pregnancy or abortion decision that is best for them.

Analysis of families with fetal congenital abnormalities but negative prenatal diagnosis by whole exome sequencing

Objective: To evaluate the value of whole exome sequencing (WES) in prenatal clinical application. Methods: A total of 1 152 cases of congenital abnormal [including structural malformation, nuchal translucency (NT) thickening and intrauterine growth restriction] with traditional prenatal diagnosis [including G-band karyotype analysis and chromosome microarray analysis (CMA)] negative were analyzed. The congenital abnormal fetuses were divided into retrospective group and prospective group according to the time of WES detection, that is whether the pregnancy termination or not. According to the specific location of fetal malformation and their family history, the cohort was divided into subgroups. The clinical prognosis of all fetuses were followed up, and the effect of WES test results on pregnancy decision-making and clinical intervention were analyzed. According to the follow-up results, the data of fetuses with new phenotypes in the third trimester or after birth were re-analyzed. Results: Among 1 152 families who received WES, 5 families were excluded because of nonbiological parents. Among the remaining 1 147 families, 152 fetuses obtained positive diagnosis (13.3%,152/1 147), including 74 fetuses in the retrospective group (16.1%,74/460) and 78 fetuses in the prospective group (11.4%,78/687). In fetuses with negative CMA and G-band karyotype analysis results but new phenotypes in the third trimester or after birth, the positive rate by WES data re-analysis was 4.9% (8/163). A total of 34 (21.3%, 34/160) fetuses were directly affected by the corresponding positive molecular diagnosis. Among 68 cases of live births with diagnostic variation grade 4, 29 cases (42.7%, 29/68) received appropriate medical intervention through rapid review of WES results. Conclusions: WES could increase the detection rate of abnormal fetuses with negative G-banding karyotype analysis and CMA by 13.3%. Prenatal WES could guide pregnancy decision-making and early clinical intervention. It might be an effective strategy to pay attention to the special follow-up of the third trimester and postnatal fetus and to re-analyze the WES data.

The influence of kinship networks and family relationships on pregnancy dynamics in North Greenland

The purpose of this study was to explore the influence of kinship networks and family relationships on pregnancy dynamics in a settlement in North Greenland. We utilized community-based participatory research framework using ecological systems theory to conduct semistructured interviews with 26 women and 17 men living in Kullorsuaq, Greenland. The extent to which Greenland’s cultural traditions related to naming and adoption practices, intergenerational relationships and communication, educational pursuits, and material resources intersect with pregnancy dynamics in an Arctic Indigenous community is discussed. Results highlight the importance of familial and community connections in pregnancy decision making in Greenlandic culture. Findings suggest that public health programs, health care services, and policies address the involvement of kinship and family networks as well as community level pathways to promote sexual and reproductive health in Greenland.

Clinical characteristics and prenatal diagnosis of fetuses with sex chromosomal aneuploidies detected by non-invasive prenatal testing during early and midterm pregnancies

To analyze the indication, karyotyping result, ultrasound finding, pregnancy decision and follow-up of fetuses with sex chromosome aneuploidies (SCA) detected by non-invasive prenatal testing (NIPT) during early and midterm pregnancies. The results of 225 singleton pregnancies with fetal SCA detected by NIPT were reviewed and analyzed. The 225 cases included 45,X (n=37), 47,XXY (n=74), 47,XXX (n=50), 47,XYY (n=56) and mosaicisms (n=8), among which 121 (53.8%) have opted to terminate the pregnancy, including 45,X (n=31), 47,XXY (n=61), 47,XXX (n=14), 47,XYY (n=12) and 3 mosaicisms. The remainder 104 (46.2%) have elected to continue with the pregnancy, among which three have opted to terminate due to abnormalities detected by ultrasonography, and two had spontaneous abortions. NIPT as a first-tier screening method can effectively detect fetal trisomies 21, 13 and 18 as well as SCA. The types of fetal SCA and presence of ultrasound abnormalities are critical factors for the termination of pregnancy.

Motivos associados a opção da mulher pela gestação tardia

Objetivo: Conhecer os motivos associados à opção de mulheres pela gestação em idade avançada. Método: Trata-se de um estudo qualitativo, realizado com quinze mulheres com idade igual ou superior a 35 anos, primigestas que optaram pela gestação tardia e que estavam tentando engravidar a menos de um ano. Para a coleta de dados aplicou-se a entrevista semiestruturada e a análise dos dados seguiu a análise de conteúdo. Resultados: Da análise dos dados emergiram quatro categorias temáticas: obstáculos encontrados pelas mulheres na busca pela maternidade; influências na decisão pela gestação tardia; a perspectiva sociocultural da maternidade e as representações da maternidade tardia na percepção das mulheres. A maternidade em idade avançada converge com a redução da fertilidade a nível mundial, constituindo um problema de saúde pública. A busca por tratamentos de fertilização assistida e com ela a peregrinação em clínicas, elevados custos com tratamentos e o desgaste emocional são constantes neste processo. Conclusões: Foi possível conhecer que à opção da mulher pela gestação tardia é influenciada por múltiplos fatores, dentre eles, a busca a inserção da mulher no mercado de trabalho, formação profissional, estabilidade financeira, dentre outros. Palavras-chave: Infertilidade. Gravidez Tardia. Mulheres. Fertilização.

Did I learn enough to practice? Reflections of new nurse practitioner graduates in providing sexual and reproductive health care.

The Centers for Disease Control and Prevention and the US Office of Population Health have published guidelines for providing family planning services. The study explores how nurse practitioners (NPs) perceived their preparation and competency in providing a range of sexual and reproductive health care in their first two years of community-based practice. Qualitative. Thematic analysis used to analyze data from structured and open-ended interview questions. Through snowballing recruitment, 35 NPs participated in interviews. Participants were most confident and likely to provide contraceptive and sexually transmitted infection services. Participants felt less prepared to provide male sexual health and care to the lesbian, gay, bisexual, transgender, queer, and intersex+ population. Nurse practitioners expressed interest in building skills with discussing healthy sexuality across the life span, specifically postmenopausal sexual concerns, teen sexuality, trauma-informed care related to sexual violence, and early pregnancy decision making. Some participants had little preparation in early pregnancy decision making/options counseling. Faculty need to examine barriers to teaching these skills because the curriculum should address all legal pregnancy options, including discussing the NP's professional obligations. More preparation was needed in the clinical management of erectile dysfunction, polycystic ovary syndrome, herpes, syphilis, abnormal uterine bleeding, dyspareunia, pelvic pain, miscarriage management, and how to discuss prostate cancer screening. The recommendations of the quality family planning, with additions, form a sound basis for sexual and reproductive health care standards, education, and clinical practice, should be part of NP education.

Preconception and Interconception Pediatric Primary Care Utilization of Pregnant and Parenting Teens

PurposeGaps in preventive care may contribute to adverse outcomes among pregnant teens. This study quantified teen preventive care utilization before and after pregnancy. MethodsA continuous retrospective cohort identified 150 teens with a positive pregnancy test (July 2015 to May 2017) at two pediatric primary care sites. Chart review assessed office visits for 18 months before and after the pregnancy test. We also assessed contraceptive counseling, pregnancy outcomes (live birth, miscarriage, termination), and continuity with a single clinician. Demographic factors included age, race, ethnicity, primary insurance, and residential zip code. Logistic regression identified factors associated with visits after pregnancy. Separately, for a cohort of 47 parenting teens who received primary care at the same site as their infants, we assessed teen–infant care after birth. ResultsTeens were predominantly non-Latina black (91%) and Medicaid insured (71%). Before pregnancy, most teens had preventive visits (66%) and reported contraceptive use (65%). After pregnancy, 52% discussed pregnancy decisions within a month, 55% reported contraceptive use, and 64% had any primary care visit. Postpregnancy visits were associated with teen age (<18 vs. ≥18 years odds ratio 2.84, 95% confidence interval 1.17–6.90) and pregnancy outcome (termination vs. live birth odds ratio 4.02, 95% confidence interval 1.47–11.01). Among parenting teens, there were more infant visits than teen visits, and continuity was higher for infants. ConclusionIn a primary care cohort of pregnant teens, gaps persisted in pediatric clinical follow-up after pregnancy. Particularly in situations where pregnancy led to a birth, pregnancy frequently prompted a transition away from pediatric care.

Noninvasive prenatal testing for assessing foetal sex chromosome aneuploidy: a retrospective study of 45,773 cases

ObjectiveTo assess the positive predictive value (PPV) of noninvasive prenatal testing (NIPT) as a screening test for sex chromosome aneuploidy (SCA) with different maternal characteristics and prenatal decisions in positive cases.Materials and methodsWe retrospectively analysed 45,773 singleton pregnancies with different characteristics that were subjected to NIPT in the Maternity and Child Health Hospital of Anhui Province. The results were validated by karyotyping. Clinical data, diagnostic results, and data on pregnancy outcomes were collected.ResultsIn total, 314 cases were SCA positive by NIPT; among those, 143 underwent invasive prenatal diagnostic testing, and 58 were true-positive. Overall, the PPVs for 45,X, 47,XXX, 47,XXY and 47,XYY were 12.5%, 51.72%, 66.67% and 83.33%, respectively. Interestingly, when only pregnant women of advanced maternal age (AMA) were screened, the PPVs for 45,X, 47,XXX, 47,XXY and 47,XYY were 23.81%, 53.33%, 78.95%, and 66.67%, respectively. The frequency of SCA was significantly higher in the AMA group than in the non-AMA group. The frequencies of 47,XXX and 47,XXY were significantly correlated with maternal age.ConclusionNIPT performed better in predicting sex chromosome trisomies than monosomy X, and patients with 45,X positive foetuses were more eager to terminate pregnancy than those with 47,XXX and 47,XYY. AMA may be a risk factor of having a foetus with SCA. Our findings may assist in genetic counselling of AMA pregnant women. Our pre- and posttest counselling are essential for familiarizing pregnant women with the benefits and limitations of NIPT, which may ease their anxiety and enable them to make informed choices for further diagnosis and pregnancy decisions.

The MSBase pregnancy, neonatal outcomes, and women's health registry.

Background:Family planning and pregnancy decisions are key considerations in the management of women with multiple sclerosis (MS), who are typically diagnosed between the ages of 20–40 years. Despite a strong evidence base that pregnancy is not harmful for women with MS, many knowledge gaps remain. These include: best management strategies through pregnancy in the era of highly effective disease-modifying therapies (DMT); foetal risks associated with DMT exposure in utero or in relation to breastfeeding; knowledge base around the use of assisted reproductive technologies; the long-term impact of pregnancy on disease outcomes, as well as the impact of long-term DMT use on women’s health and cancer risk.Methods:Here, we describe the new MSBase pregnancy, neonatal outcomes and women’s health registry. We provide the rationale for, and detailed description of, the variables collected within the registry, together with data acquisition details.Conclusion:The present paper will act as a reference document for future studies.

Pregnancy and Childbirth Expectations During COVID-19 in a Convenience Sample of Women in the United States.

The COVID-19 pandemic has transformed the health care landscape and shifted individuals’ expectations for and interactions with essential health services, including pregnancy-related care. This study explores alterations to individuals’ pregnancy and childbirth decisions during an infectious disease pandemic. A convenience sample of 380 pregnant individuals with an expected delivery date between April and December 2020 consented to enroll and complete an online questionnaire on their pregnancy and childbirth expectations during the COVID-19 pandemic; a subset of respondents (n = 18) participated in semi-structured phone interviews. Survey data were analyzed quantitatively while interview data were analyzed using a thematic content analysis until a consensus on key themes was achieved. Respondents reported substantial stressors related to shifting policies of health care facilities and rapidly changing information about COVID-19 disease risks. As a result, respondents considered modifying their prenatal and childbirth plans, including the location of their birth (25%), health care provider (19%), and delivery mode (13%). These findings illuminate the concerns and choices pregnant individuals face during the COVID-19 pandemic and offer recommendations to engage in compassionate, supportive, and person-centered care during a time of unprecedented risk and uncertainty.

Understanding the meaning of autonomy in adolescent pregnancy decision-making: lessons from Ghana.

Introductionadolescent pregnancy in Ghana, like in most low and middle income countries, is an issue of immense public health importance. Pregnant adolescents are faced with the stronger dilemma of either terminating the unwanted pregnancy or keeping it. This discourse which is based on findings from empirical research in Accra Ghana aims at contributing to the usefulness of understanding the meaning and scope of autonomy when it comes to providing ethically grounded, and adolescent friendly, reproductive health care services to pregnant adolescents. The aim of this work was to document the meaning and determinants of autonomous decision making among pregnant adolescents in the James Town area of Accra, Ghana.Methodsthirty (30) semi-structured in depth interviews were conducted among adolescents who had been pregnant at least once, 23 in depth interviews among purposively selected stakeholders (parents, teachers, NGO staff working in reproductive health, community volunteers), and 8 focus group discussions among parents, teachers, adolescent students who had not been pregnant before, and adolescents who had at least one pregnancy in the past. Data were transcribed verbatim and analyzed thematically.Resultsmost adolescents reported that the final decision to continue a pregnancy to term or go in for an abortion was taken by them. The partner´s willingness to take responsibility of the pregnant adolescent and baby, as well as financial considerations, were main players in deciding upon the pregnancy outcomes. Cultural desirability for children and health care provider/father paternalism (power dynamics) in the decision-making process were central considerations in the decision-making process. Unaffordable and unfriendly safe abortion services pushed adolescents to either continue pregnancies to term against their will, or opt to visit unsafe abortion care providers.Conclusionadolescents stand to make truly autonomous decisions if they are provided with the right information, at the right time, at the right place, by the right persons, and in the right way. Health system, economic, and cultural factors play significant roles in rendering pregnant adolescent autonomy meaningful when deciding upon their pregnancy outcomes. Continuing pregnancies to term against one´s will or being forced to go in for an abortion are ethically unjustified. Further research is required to examine the long-term consequences of forced pregnancy terminations or births.

Development of a new pregnancy informational and decisional needs survey for women with physical disabilities

BackgroundWhile the literature on pregnancy and disability is growing, generating important knowledge of barriers to care and health risks, there is limited literature on pregnancy decision-making and informational needs. Such knowledge is critical for the development of interventions to mitigate the challenges women with disabilities and health care providers face in making this important decision. Objective/Hypothesis: Develop a survey of pregnancy decisional and informational needs of women with physical disabilities. MethodsWe developed a conceptual framework that guided item writing, defined the characteristics of the target population, engaged stakeholders with disabilities to collaborate with investigators, and tested the interpretability and relevance of items, and preferred mode of responding (online vs. telephone). A total of 123 women participated in cognitive interviews (N = 13), mode testing (N = 10), or survey data collection (N = 114). ResultsInstructions, three screening questions, and 156 items were tested in one round of 17 cognitive interviews; 25 items were deleted, 94 were revised, and 37 items were retained without changes. The final version of the survey included six sub-sections: the experience of making a decision; information about pregnancy and disability; things affecting a decision; knowing what is important; support for making a decision; and working with health care providers. ConclusionsThe overall performance of the survey supported its content validity and utility as a useful way to gather information about the pregnancy decision-making experience and informational needs of women with physical disabilities.

Women’s experiences of living with albinism in Taiwan and perspectives on reproductive decision making: A qualitative study

People with Albinism tend to face multiple adverse physical, psychological and social consequences. Very little is known about experiences of women with Albinism and their deliberations whilst making reproductive decisions. This study aimed to explore lived experiences of women with Albinism and to understand their perspectives on reproductive decision making. Qualitative in-depth semi-structured interviews were conducted with ten women with Albinism in Taiwan. Five key themes emerged from the accounts which were centred around the sense of discrimination that they felt whilst growing up, their strive for normality, making difficult choices in their reproductive decisions, desire to protect children from harm and reflections of parenting struggles from own experiences and the experiences of their parents. We call for global and national policy makers and practitioners to introduce explicit measures to challenge the myths, stereotypes and prejudices associated with Albinism including specific interventions towards supporting women in pregnancy decision making. Points of interest Very little is known about the lived experiences of women with Albinism and their deliberations whilst making reproductive decisions. The research found that a key element of the overall experience is the sense of discrimination that the women had to face due to their physical appearance and visual impairment. Most women actively attempted to fight off notions of abnormality and to keep their identity close to what they perceived as normal. The women with and without children viewed pregnancy decisions as making difficult choices. Having a child who would not inherit Albinism was a key influence in pregnancy decisions. They strongly desired to protect the children from the difficult experiences that they have had. The research recommended that global and national policy makers and practitioners should introduce explicit measures to challenge the myths, stereotypes and prejudices associated with the condition including specific interventions towards supporting women in pregnancy decision making.

Developing and validating the Psychosocial Burden among people Seeking Abortion Scale (PB-SAS).

While there is a large body of research demonstrating that having an abortion is not associated with adverse mental health outcomes, less research has examined which factors may contribute to elevated levels of mental health symptoms at the time of abortion seeking. This study aims to develop and validate a new tool to measure dimensions of psychosocial burden experienced by people seeking abortion in the United States. To develop scale items, we reviewed the literature including existing measures of stress and anxiety and conducted interviews with experts in abortion care and with patients seeking abortion. Thirty-five items were administered to 784 people seeking abortion at four facilities located in three U.S. states. We used exploratory factor analysis (EFA) to reduce items and identify key domains of psychosocial burden. We assessed the predictive validity of the overall scale and each sub-scale, by assessing their associations with validated measures of perceived stress, anxiety, and depression using multivariable linear regression models. Factor analyses revealed a 12-item factor solution measuring psychosocial burden seeking abortion, with four subdomains: structural challenges, pregnancy decision-making, lack of autonomy, and others’ reactions to the pregnancy. The alpha reliability coefficients were acceptable for the overall scale (α = 0.83) and each subscale (ranging from α = 0.82–0.85). In adjusted analyses, the overall scale was significantly associated with stress, anxiety and depression; each subscale was also significantly associated with each mental health outcome. This new scale offers a practical tool for providers and researchers to empirically document the factors associated with people’s psychological well-being at the time of seeking an abortion. Findings suggest that the same restrictions that claim to protect people from mental health harm may be increasing people’s psychosocial burden and contributing to adverse psychological outcomes at the time of seeking abortion.

Pregnancy outcomes in women with Multiple Sclerosis

Women represent two-thirds of the MS population and are usually diagnosed during childbearing age. Collection of local information about pregnancy outcomes is fundamental to support individual decision-making. To explore the trends in pregnancy decision making and pregnancy outcomes before (PreMS) and after (PostMS) MS diagnosis. We developed a questionnaire for retrospective assessment of pregnancy outcomes in PreMS and PostMS patients under regular care at the Programa de Esclerosis Multiple UC in Chile. From the 218 women who responded to the questionnaire, 67 women did not have pregnancies. The total number of pregnancies registered was 299, 223 were PreMS (97 women, mean 2.5 ± 1.3 per/woman), and 76 PostMS (59 women, mean 1.9 ± 1.1 per/woman, p=0.003). Mean age at first pregnancy was 27.6 ± 6.2 in PreMS, and 32.6 ± 4.6 years in PostMS women (p < 0.001). Significant differences between PreMS and PostMS pregnancy outcomes were cesarean section (37% vs. 66%; OR 2.74 95%CI(1.5-52), p=0.002), suspected relapse during 6 months after birth (7% vs. 18%, p<0.001), and breastfeeding (83% vs 67%, p=0.005). Gestational age, weight/size at birth, were not different between groups. Major malformations were observed similarly in both groups. Changes in pregnancy decision-making after MS diagnosis occur, having fewer children and at an older age. It also changes obstetrician decisions for cesarean sections, with a 3 fold increase. Regarding newborn outcomes, there were no differences between groups.