Pregnancy Intention Research Articles

Effect of pregnancy intention on the timing and sustained use of antenatal care services in Rwanda.

We investigated the relationship between intended pregnancy and utilization of antenatal care services in Rwanda. Using Demographic and Health Survey 2014/2015, secondary data was obtained on maternal health services utilization. We performed stepwise logistic regression analysis to examine the effect of independent variables on women's early and late utilization, as well as their sustained use of antenatal services. Dependent and main independent variables included: first trimester visits, completed antenatal visits and intended pregnancy respectively. Of 5,944 women sampled; 56.6% had made early antenatal visits and 44% had completed 4 visits. Unintended pregnancies were less likely to make early antenatal visits and complete 4 antenatal visits. Religion and being in union had positive association with standard antenatal visits; while age (>24 years), grand multiparty, and poor economic status had negative association. Our results call for deeper sensitization on utilization of antenatal services and more use of contraception to reduce unintended pregnancies.

The importance of pregnancy planning in lupus pregnancies.

In seeking new approaches to improve lupus pregnancy outcomes, we study the association between pregnancy planning, behaviors recommended by American College of Rheumatology's Reproductive Health Guideline 2020, and pregnancy and infant outcomes. Lupus pregnancies in a prospective registry (1/1/2018 to 4/1/2020) were classified as planned or not-planned using the patient-reported London Measure of Unplanned Pregnancy. These groups were compared for demographics, pre-pregnancy disease activity, pregnancy planning behaviors, and delivery outcomes. Among 43 women with 43 singleton pregnancies the average age was 29.4 years and 42% were Black. Overall, 60% were planned pregnancies and 40% were not-planned (16 ambivalent, 1 unplanned). Women with not-planned pregnancies had lower age, income, and education, and more required Medicaid. Women with not-planned pregnancies were more likely to conceive when lupus activity was higher (p = 0.001), less likely to receive pre-pregnancy counseling with a rheumatologist (p = 0.02), and less likely to continue pregnancy-compatible medications (p = 0.03). Severe PROMISSE adverse pregnancy outcomes (APOs) and severe neonatal outcomes were higher among women with not-planned than planned pregnancies (43% vs 0% p = 0.003; 70% vs 30% p = 0.06). This study identifies pregnancy intention as a potentially modifiable risk factor for poor outcomes in women with lupus. It highlights a unique population of women with lupus at high risk for pregnancy and infant complications: those ambivalent about pregnancy. These women may not be effectively engaging in health behaviors that prevent pregnancy nor those that will prepare for a safe pregnancy. With effective pregnancy planning and contraception guidance, we may decrease their risk for maternal-fetal morbidity and mortality.

Risk factors and knowledge associated with high unintended pregnancy rates and low family planning use among pregnant women in Papua New Guinea

Unintended pregnancy is a major driver of poor maternal and child health in resource-limited settings. Data on pregnancy intention and use of family planning (FP) is scarce in Papua New Guinea (PNG), but are needed to inform public health strategies to improve FP accessibility and uptake. Data from a facility-based cross-sectional sample of 699 pregnant women assessed prevalence and predictors of unintended pregnancy and modern FP use among pregnant women in East New Britain Province, PNG. More than half (55%) the women reported their pregnancy as unintended. Few (18%) reported ever having used a modern FP method, and knowledge of different methods was low. Being single, separated or divorced (AOR 9.66; 95% CI 3.27–28.54), educated to a tertiary or vocational level (AOR 1.78 CI 1.15–2.73), and gravidity > 1 (AOR 1.43 for each additional pregnancy CI 1.29–1.59) were associated with unintended pregnancy; being accompanied by a male partner to ANC was associated with a reduced unintended pregnancy (0.46 CI 0.30–0.73). Factors associated with modern FP use included male partner involvement (AOR 2.26 CI 1.39–3.67) and gravidity > 1 (AOR 1.54 for each additional pregnancy CI 1.36–1.74). FP use also varied by the facility women attended. Findings highlight an urgent need for targeted interventions to improve FP knowledge, uptake and access, and male partner involvement, to reduce unintended pregnancies and their complications.

Prevalence of unintended pregnancy and associated factors among pregnant women attending antenatal clinics

Objective: Unintended pregnancy is an important worldwide public health problem and one of the important factors contributing to high level of maternal and child morbidity and mortality. The study was aimed to assess the prevalence and associated factors of unintended pregnancy among pregnant women attending antenatal clinics.Methods: The study followed a descriptive cross-sectional design on 1,254 pregnant women who were chosen by convenient sample technique. The study was done at governmental hospitals in EL-Mansoura City, Egypt including: The antenatal clinics of Obstetric and Gynecological specialty Center at EL-Mansoura University Hospitals, Old General Hospital and Mansoura International Hospital. Two tools were utilized for data collection (The Urdu version of pregnancy intention scale (LMUP) and structured Interviewing Questionnaire.Results: The prevalence of unintended pregnancy among studied women was (29.1%), of which 229 (18.3%) were mistimed and 136 (10.8%) were unwanted. Age, higher family size, lower family income, gravidity, parity, increased number of children and birth spacing were significantly associated with unintended pregnancy.Conclusions: The study concluded that the prevalence of unintended pregnancy was high in El-Mansoura city. It is recommended to develop educational programs and campaigns especially for rural areas to improve awareness regarding family planning and other co-factors associated with unintended pregnancy.

Well-Being Before and After Pregnancy Termination: The Consequences of Abortion and Miscarriage on Satisfaction With Various Domains of Life

The consequences of pregnancy outcomes other than live birth on subjective well-being have rarely been analysed in research to date. This study examines pre-event determinants as well as the temporary and long-term effects of induced abortion and miscarriage (spontaneous abortion) on satisfaction with various domains of life. The data were derived from the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam). The longitudinal sample consists of 5331 women of reproductive age, of whom 214 women had an induced abortion, 331 women had a miscarriage, and 1156 women had a live birth during the observation period. First, pre-event measures of women who had an induced abortion and women who had a miscarriage were compared with the pre-event measures of those women who gave birth. Second, fixed effects models were used to examine whether overall or domain-specific life satisfaction changed following a pregnancy termination. The results show that pregnancies resulting in abortion or miscarriage were less frequently preceded by pregnancy intentions compared to those resulting in live birth, and that induced abortion—but not miscarriage—was furthermore accompanied by lower pre-event satisfaction than live birth. Following both miscarriage and induced abortion, women experienced temporary declines in overall life satisfaction and showed persistently lower satisfaction in several domains of life. With regard to induced abortion, pre-event measures were a better predictor of overall well-being than the consequences of the event itself. Low life satisfaction might therefore be a risk factor for having an abortion rather than a result.

Pregnancy intention and gestational age at first antenatal care visit in Lesotho

Background/aims With coverage of antenatal care in sub-Saharan Africa approaching a universal level, attention is now turning to maximising the life-saving potential of antenatal care. This study assessed the gestational age at which pregnant mothers make their first antenatal visit in the context of high antenatal coverage in Lesotho. Methods For the purposes of this study, secondary data from the Demographic and Health Survey of 2014 was analysed. These data were collected in 2014, via an interviewer administered questionnaire. Survival analysis was applied to the data, using Stata SE 15 to compute time ratios that estimate time to first antenatal visit in Lesotho. Results Despite near universal coverage, only 24% of mothers start antenatal care before 12 weeks of gestation, as recommended by the World Health Organization. In addition, mothers with unwanted pregnancies are most likely to delay antenatal care until later in gestation, followed by mothers with mistimed pregnancies. Education, but not wealth, correlates with the start of antenatal care. Conclusions Having achieved near universal coverage, emphasising a prompt start and adherence to recommended visits could optimise the life-saving potential of antenatal care in Lesotho.

Intentions and Childbearing in a Cross-Domain Life Course Approach: The Case of Australia

In Australia and other affluent societies people tend to report a number of desired children which is clearly higher than the number of children they eventually bear. In the effort to explain such an inconsistency, demographers have studied the correlates of the link between pregnancy intentions and births. Drawing on data from the “Household Income and Labour Dynamics in Australia” (HILDA) survey, we situate, for the first time, intentions and events in a unified and multidimensional life course framework. We examine the intention-outcome fertility link across a plurality of life course domains and in a genuine couple approach. Education, work, and residence are selected as domains closely related to the family formation process. Results show that pregnancy intentions are often part of a multidimensional life course plan and that the cross-domain effects are gendered and parity specific. Moreover, cross-domain events have stronger influence than cross-domain intentions. A change of residence is directly correlated with a childbirth if it is the outcome of a previous plan and the couple has already made the transition to parenthood. Resumption of studies is inversely correlated with the birth of a child irrespective of whether the event was planned or not by either one of the partners. Finally, a change of job decreases the chance of having a first child but only if experienced by the female partner while it decreases the chance of an additional child only if previously planned or experienced by both partners. Such results confirm the relevance of work-family conflict as one of the drivers of low fertility and outline the usefulness of a holistic life course approach in the analysis of reproductive decision-making.

Intentions and Childbearing

The adult life of women and men is characterised by a plurality of choices and eventspertaining to different life domains. In the literature pregnancy intentions are usuallystudied in isolation from intentions pertaining to other spheres of life. In this research,we investigate the correspondence of birth intentions and birth outcome in a life courseframework, encompassing several life domains such as partnership, education, workand residence. Using longitudinal data from the Generations and Gender Surveys in fiveEuropean countries (Austria, Bulgaria, France, Hungary, and Lithuania), we examine thematching processes of individuals’ childbearing intentions and subsequent outcomespaying attention to the mediating and moderating role of intentions other thanchildbearing. We find empirical support for the hypothesis that adults’ plans aremultidimensional and that the more simultaneous intentions individuals have, the lesslikely they are to achieve their fertility goals. Some intentions, like moving to a newdwelling, facilitate the realization of birth intentions; others, like changing a job, tend tohinder the realisation of birth intentions. Finally, individuals are more successful inachieving their fertility targets in contexts that promote a reconciliation of work andfamily life.

Prevalence & Factors Associated With Anxiety Among Pregnant Women Attending Antenatal Clinic of a Hospital

Introduction: Anxiety during pregnancy is an important predictor of postpartum anxiety. Pregnancy is a time of increased vulnerability for the development of anxiety. Maternal anxiety may also have an impact on the developing fetus. The current study aims to estimate the prevalence and associated factors of anxiety during pregnancy.
 Material and Method: A descriptive cross-sectional study was conducted among 95 pregnant women during the antenatal period. A purposive sampling technique was used and data collection was done from November 15, 2019, to December 14, 2019. Ethical permission was obtained from the concerned authority. All pregnant women were interviewed during their antenatal visit and a semi-structured questionnaire was used to collect the data. Descriptive and inferential statistics were used to analyze and interpretation of the findings.
 Results: The prevalence of anxiety was 32.6%. Among them, 18.9% had borderline anxiety and 13.7% had abnormal anxiety. More than one-fifth (21.1%) of pregnant women were worried about the sex of the baby. Although, 68.4% of them had occasionally felt tense, and 75.8% had worried thoughts from time to time. Anxiety during pregnancy was significantly associated with gravida, history of abortion, maternal desire regarding the pregnancy and worry about the sex of a fetus (p<0.05).
 Conclusion: The status of anxiety was quite common during pregnancy and its occurrence is associated with the pregnant woman's gravida, history of abortion, intention of pregnancy and worried about the sex of a fetus. Antenatal screening for anxiety should be carried out early from the antenatal clinics for improving the psychological well-being of women.

Associations between Fathers’ Prebirth Pregnancy Intentions and Involvement with Their Child 15 Months Later: A Propensity Score Analysis

Objective: This study examined whether fathers’ prebirth pregnancy intentions were associated with fathers’ involvement with his child 15 months later. Method: Propensity score matching was used to assess the effects of fathers’ pregnancy intentions (self-reported before the birth of the child) on three measures of father involvement (residency with child, engagement in caregiving activities, and engagement in social cognitive play) in a large sample of young, diverse, and low-income fathers ( N = 2,008). Results: In this sample matched on sociodemographic and interpersonal factors, fathers reporting an intended pregnancy had significantly higher levels of social and cognitive play with their child, compared to fathers reporting an unintended pregnancy. However, intentions were not significantly associated with fathers’ residency with child or caregiving activities. Conclusion: Results suggest that fathers’ pregnancy intentions are predictive of certain types of father involvement and emphasize the importance of controlling for factors associated with both fathers’ intentions and involvement.

Evaluation of Contraception Access within the Indianapolis Metropolitan Area

Background: Access to family planning care and the full-spectrum of contraception, including same-day access to long acting reversible contraception (LARC) is critical to reduce unintended pregnancy and maternal/infant mortality. However, access remains variable for many women in Indiana. We sought to examine access to various contraceptive practices within the Indianapolis metropolitan area. 
 
 Methods: A telephone survey of clinic managers was conducted between June-July 2020 of all identified IU Health, Eskenazi, and HealthNet primary care and OB/GYN providers in the Indianapolis metropolitan area. The 27-question survey gathered information regarding contraceptive practices (e.g. contraceptive method availability, same-day LARC insertion/removal, pregnancy intention screening, educational materials, and parental consent policies). The data was compared based on type of medical provider (OB/GYN, Family Medicine, and Pediatrics). 
 
 Results: In total, 82 sites were identified, 58 surveys (70.7%) were completed. Oral contraception is the most commonly offered contraception (91.4%), followed by depot medroxyprogesterone acetate (DMPA) injection (84.5%), and the contraceptive patch (81.0%). LARC placement is available in 51.7% of all clinics, but only 34.5% offer same-day placements. Routine pregnancy intention screening is offered in 43.1% and educational materials in 74.1% of practices. OB/GYN clinics provide the most comprehensive access, 69.2% provide same-day LARC insertion (84.6% LARC removals). Family medicine practices are variable regarding contraceptive choices: over 91% offer oral contraception and DMPA injections, but only 20.8% place LARCs and 41.7% remove LARCs. Half (50%) of pediatric clinics provide oral contraception, while 50% do not provide any contraceptives. Parental consent for minors to obtain contraception provision is highly variable. 
 
 Conclusion: Contraceptive practices vary among primary care and OB/GYN providers in the Indianapolis area. This variability in access leads to barriers for use, particularly for young women. Efforts to ensure comprehensive, same-day access to all forms of contraception (including LARCs), pregnancy intention screening, and contraceptive educational materials are needed.

Fit to conceive? Representations of preconception health in the UK press

The period before conception is increasingly claimed to be of critical importance for pregnancy and birth outcomes, prompting calls for public health advice and interventions to be targeted at women before rather than during pregnancy. Drawing on Foucault’s concepts of governmentality and technologies of the self, this article explores the implications of preconception health messages for women of reproductive age. Following a critical discursive analysis of 57 UK newspaper articles, three dominant representations of preconception health were identified: preconception health as optimizing fertility, as determining infant health, and as point of intervention. I suggest that these representations reflect neoliberal health agendas, positioning women as in control of and responsible for their fertility, the health of their future children, future generations, and of the wider population, all through careful self-policing of their lifestyles. In this way, “good” preconception health is emphasized as an increasingly important form of health citizenship. Furthermore, the analysis highlights the gendered nature of these expectations, with a disproportionate focus on the potential impact of women’s preconception health. Few challenges to these dominant messages were identified, and concerns are raised about the potential impacts on the autonomy and subjectivities of women of reproductive age, regardless of pregnancy intentions.

Factors influencing pregnancy planning of multi-ethnic Asian women with diabetes: A qualitative study.

IntroductionPregnancy planning varies among women with diabetes. Observing that the literature examining the factors affecting diabetic women’s pregnancy intentions in multi-ethnic Asian populations is limited, we sought to explore these factors to give a better perspective on these women’s pregnancy planning.MethodsThis qualitative study used individual in-depth interviews to capture the views and experiences of non-pregnant diabetic women of reproductive age in four public health clinics in a southwestern state of peninsular Malaysia from May 2016 to February 2017. The participants were purposively sampled according to ethnicity and were interviewed using a semi-structured topic guide. Interviews were audio-recorded, and transcripts were analysed using thematic analysis.ResultsFrom the 33 interviews that were analysed, four important factors influencing participants’ decisions regarding pregnancy planning were identified. Participants’ perception of poor pregnancy outcomes due to advanced age and medical condition was found to have an impact. However, despite these fears and negative relationships with doctors, personal, family and cultural influences supported by religious ‘up to God’ beliefs took centre stage in the pregnancy intention of some participants. Participants demonstrated a variety of understandings of pregnancy planning. They outlined some activities for pregnancy preparation, although many also reported limited engagement with pre-pregnancy care.ConclusionsThis study emphasised the known dilemma experienced by diabetic women considering their desire for an ideal family structure against their perceived pregnancy risks, heterogeneous religious beliefs and the impact of cultural demands on pregnancy intention. This study urges healthcare providers to increase their engagement with the women in pregnancy planning in a more personalised approach.

Fertility treatment and oral contraceptive discontinuation for identification of pregnancy planning in routinely collected health data \u2013 an application to analgesic and antibiotic utilisation

BackgroundWomen with unplanned pregnancies use folic acid less frequently, and more often use potentially teratogenic medications in the first trimester. Yet most studies based on routinely collected data lack information on pregnancy planning. Further, only pregnancies proceeding beyond a certain gestational age appear in routinely collected data, creating the possibility for collider-stratification bias. If pregnancy intention could be identified, pregnancies could be ascertained earlier. This study aimed to investigate fertility treatment and discontinuation of oral contraception (OC) as proxies for pregnancy planning by describing variations in patterns of prescription fills for antibiotics and analgesics during the peri-pregnancy period by these proxies of pregnancy intention.MethodsFertility treatment with clomiphene and discontinuation of OC were identified in the Norwegian Prescription Database (NorPD) and linked with data from the Medical Birth Registry of Norway for the years 2006 to 2017. Filled prescriptions for antibiotics and analgesics from NorPD were displayed for women on fertility treatment, women who discontinued OC before pregnancy, and women who discontinued during pregnancy.ResultsOf 172,585 included pregnancies, fertility treatment was identified in 19,449, and OC discontinuation before or during pregnancy in 153,136. Women who discontinued OC during pregnancy were less likely to use preconception folic acid (25.4%) than women who discontinued before pregnancy (32.9%), and women on fertility treatment (51.0%). Proportions of first trimester prescription fills were 4.9% (analgesics) and 12.8% (antibiotics) for women who discontinued OC during pregnancy, compared to 4.0 and 11.4% in women who discontinued OC before pregnancy, and 4.7 and 11.0% in women on fertility treatment.ConclusionsThere were no substantial differences in patterns of prescription fills for analgesics and antibiotics before or during pregnancy by fertility treatment and OC discontinuation. This suggests that there were few differences in medication use between women with planned and unplanned pregnancies, or that fertility treatment and timing of OC discontinuation from routinely collected health data cannot stand alone in the identification of unplanned pregnancies. A narrower definition of OC discontinuation during pregnancy seemed to be a better proxy, but this should be confirmed in other studies.

Mother-child separation among women living with HIV and their children in the first four years postpartum in South Africa.

Mother-child pairs may separate during early life, yet the health impacts thereof are unclear. We explored the patterns and impact of separation among women living with HIV (WLHIV) and their children in South Africa. WLHIV who had initiated antiretroviral therapy (ART) during pregnancy received HIV viral load (VL) testing and completed a timeline questionnaire of mother-child separation since delivery at 3-5years post-partum. Health care usage was abstracted from routine medical records. We examined associations between separation and (a) maternal health outcomes (engagement in HIV care and HIV viral suppression, [VS]) and (b) child health outcomes (post-breastfeeding HIV testing and immunisation completion), using logistic regression. Of 346 mother-child pairs (median maternal age at antenatal ART initiation, 28years), 24% were ever separated (median time to first separation 20months, interquartile range [IQR] 9, 31). Most separated children were living with their grandmothers (65/83, 78%). Mothers who ever separated were younger, and more likely to be employed, and to reside in informal housing than those who never separated. Any separation reduced the odds of VS≤50 copies/mL at four years post-partum (odds ratio 0.57; 95% CI 0.34-0.93); associations were similar for VL≤1000 copies/mL and maternal engagement in care. No association was found between separation and child confirmatory HIV testing or immunisation completion. In this setting, mother-child separation is common in the first four years of life and appears associated with suboptimal maternal outcomes. Further research is required to understand the drivers and implications of mother-child separation.

Low utilisation of postnatal care among women with unwanted pregnancy: A challenge for Bangladesh to achieve Sustainable Development Goal targets to reduce maternal and newborn deaths.

Pregnancy complications are the major cause of maternal and newborn deaths in low- and middle-income countries that are more frequently associated with unintended pregnancy. The World Health Organization (WHO) recommends postnatal care (PNC) for women and their newborns within 24hr of birth to prevent pregnancy complications and associated adverse outcomes. We, therefore, examined the relationship between unintended pregnancy and PNC use in Bangladesh. Data from 4,493 women and newborn dyads were extracted from the 2014 Bangladesh Demographic and Health Survey and analysed. PNC was classified as: no PNC; some level of PNC (either the woman or her newborn missed PNC within 24hr of birth but had at least one PNC visit within 42days of birth); and WHO's recommended level of PNC (at least one PNC use for both the woman and her child within 24hr of birth). Pregnancy intention at conception for the last live birth was categorised as wanted, mistimed or unwanted. Multilevel multinomial logistic regression modelling was used to assess the association between pregnancy intention and PNC use, adjusting for possible confounders. We found around 27% of participants had adhered to WHO's PNC use recommendations. Around 26% of pregnancies that resulted in live births were unintended at conception, including 15% of which were classified as mistimed and 11% as unwanted. Following adjustment of confounders, a 37% (OR=0.63, 95% CI: 0.47-0.85) lower odds of using WHO's recommended level of PNC and a 33% (OR, 95% CI, 0.49-0.93) lower odds of some level of PNC were found for pregnancies that were unwanted relative to those that were wanted. No association was found between mistimed pregnancy and PNC use. Strengthening healthcare facilities and improving the linkage between women and existing healthcare facilities are important to ensure WHO's PNC recommendations are met for women experiencing an unwanted pregnancy.

Assessing the effect of pregnancy intention at conception on the continuum of care in maternal healthcare services use in Bangladesh: Evidence from a nationally representative cross-sectional survey.

The Continuum of Care (CoC; defined as accessing the recommended healthcare services during pregnancy and the early postpartum period) is low in lower-middle-income countries (LMICs). This may be a major contributor to the high rates of pregnancy-related complications and deaths in LMICs, particularly among women who had an unintended pregnancy. With a lack of research on the subject in Bangladesh, we aimed to examine the effect of unintended pregnancy on CoC. Data from 4,493 mother-newborn dyads who participated in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Women's level of CoC was generated from responses to questions on the use and non-use of three recommended services during the course of pregnancy: four or more antenatal care (ANC) visits, skilled birth attendance (SBA) during delivery, and at least one postnatal care (PNC) visit within 24 hours of giving birth. Global recommendations of service use were used to classify CoC as high (used each of the recommended services), moderate (used at least two of the three recommended services), and low/none (no PNC, no SBA, and ≤3 ANC visits). Women's pregnancy intention at the time of conception of their last pregnancy (ending with a live birth) was the major exposure variable, classified as wanted, mistimed, and unwanted. Unadjusted and adjusted (with individual-, household-, and community-level factors) multilevel multinomial logistic regression models were used to assess the association between unintended pregnancy and level of CoC. In Bangladesh, the highest level of CoC occurred in only 12% of pregnancies that ended with live births. This figure was reduced to 5.6% if the pregnancy was unwanted at conception. The antenatal period saw the greatest drop in CoC, with 65.13% of women receiving at least one ANC visit and 26.32% having four or more ANC visits. Following the adjustment of confounders, an unwanted pregnancy was found to be associated with 39% and 62% reduced odds of women receiving moderate and high levels of CoC, respectively, than those with a wanted pregnancy. Having a mistimed pregnancy was found to be associated with a 31% reduction in odds of women achieving a high CoC than women with a wanted pregnancy. Almost nine in ten women did not achieve CoC in their last pregnancy, which was even higher when the pregnancy was unintended. Given that the ANC period has been identified as a critical time for intervention for these women, it is necessary for policies to scale up current maternal healthcare services that provide in-home maternal healthcare services and to monitor the continuity of ANC, with a particular focus on women who have an unintended pregnancy. Integration of maternal healthcare services with family planning services is also required to ensure CoC.

Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey

Background: Transgender, nonbinary, and gender-expansive (TGE) people experience pregnancy. Quantitative data about pregnancy intentions and outcomes of TGE people are needed to identify patterns in pregnancy intentions and outcomes and to inform clinicians how best to provide gender-affirming and competent pregnancy care. Aims: We sought to collect data on pregnancy intentions and outcomes among TGE people assigned female or intersex at birth in the United States. Methods: Collaboratively with a study-specific community advisory team, we designed a customizable, online survey to measure sexual and reproductive health experiences among TGE people. Eligible participants included survey respondents who identified as a man or within the umbrella of transgender, nonbinary, or gender-expansive identities; were 18 years or older; able to complete an electronic survey in English; lived in the United States; and were assigned female or intersex at birth. Participants were recruited through The PRIDE Study – a national, online, longitudinal cohort study of sexual and gender minority people – and externally via online social media postings, TGE community e-mail distribution lists, in-person TGE community events, and academic and community conferences. We conducted descriptive analyses of pregnancy-related outcomes and report frequencies overall and by racial and ethnic identity, pregnancy intention, or testosterone use. Results: Out of 1,694 eligible TGE respondents who provided reproductive history data, 210 (12%) had been pregnant. Of these, 115 (55%) had one prior pregnancy, 47 (22%) had two prior pregnancies, and 48 (23%) had three or more prior pregnancies. Of the 433 pregnancies, 169 (39%) resulted in live birth, 142 (33%) miscarried, 92 (21%) ended in abortion, two (0.5%) ended in stillbirth, two (0.5%) had an ectopic pregnancy, and seven (2%) were still pregnant; nineteen pregnancies (4%) had an unknown outcome. Among live births, 39 (23%) were delivered via cesarean section. Across all pregnancies, 233 (54%) were unintended. Fifteen pregnancies occurred after initiation of testosterone, and four pregnancies occurred while taking testosterone. Among all participants, 186 (11%) wanted a future pregnancy, and 275 (16%) were unsure; 182 (11%) felt “at risk” for an unintended pregnancy. Discussion: TGE people in the United States plan for pregnancy, experience pregnancy (intended and unintended) and all pregnancy outcomes, and are engaged in family building. Sexual and reproductive health clinicians and counselors should avoid assumptions about pregnancy capacity or intentions based on a patient’s presumed or stated gender or engagement with gender-affirming hormone therapy.

Certainty and intention in pregnancy decision-making: An exploratory study

ObjectiveAbortion is often characterized as an inherently difficult decision, despite research demonstrating high decision certainty among abortion patients. Minimal research has examined decision certainty among people planning to continue a pregnancy. We examined whether women seeking abortion experience lower decision certainty than those planning to continue pregnancies and whether certainty differs by pregnancy intendedness. Study designWe administered the decisional conflict scale (DCS) to pregnant women (n = 149) at 8 U.S. primary and reproductive health clinics. Using Poisson regression models adjusted for sociodemographic and pregnancy characteristics, we evaluated differences in DCS scores (<25/100 vs ≥25/100) by pregnancy decision and whether pregnancy intention modified the effect of pregnancy decision on certainty. ResultsOver one-half (58%) of respondents planned to have an abortion, 32% to continue the pregnancy, and 10% were unsure. DCS scores were low overall (median 9.4/100; IQR: 1.6, 25.0), indicative of high certainty, and the percentage scoring ≥25/100, reflecting any uncertainty, did not differ by pregnancy decision (23% abortion vs 19% continuing, p = 0.55). In a multivariable model, there was no statistically significant interaction between pregnancy decision (abortion vs continuing pregnancy) and intention. However, the predicted percentage reporting any uncertainty among respondents with intended pregnancies was comparable among those decided on abortion (13%) and continuing the pregnancy (16%). Among those with unintended pregnancies, these figures were 25% among those decided on abortion vs 36% among those continuing. ConclusionLevels of certainty about a pregnancy decision were high and appeared to depend more on whether the pregnancy was intended or unintended than on the pregnancy decision itself. ImplicationsSimilar levels of uncertainty among individuals who decided to have an abortion versus continue a pregnancy challenge the narrative that abortion is a particularly difficult medical and personal decision. The prevalence of some uncertainty among respondents continuing pregnancies suggests voluntary options counseling may be useful for some patients in prenatal care settings.

Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception.

The period before pregnancy is critically important for the health of a woman and her infant, yet not all women have access to health insurance during this time. We evaluated whether increased access to health insurance under the Affordable Care Act Medicaid expansions affected ten preconception health indicators, including the prevalence of chronic conditions and health behaviors, birth control use and pregnancy intention, and receipt of preconception health services. By comparing changes in outcomes for low-income women in expansion and nonexpansion states, we document greater preconception health counseling, prepregnancy folic acid intake, and postpartum use of effective birth control methods among low-income women associated with Medicaid expansion. We do not find evidence of changes on the other preconception health indicators examined. Our findings indicate that expanding Medicaid led to detectable improvements on a subset of preconception health measures.