Adverse life experiences and risk of unintended pregnancy in adolescence and early adulthood: Implications for toxic stress and reproductive health

Abstract

ObjectiveWe examined the effects of adverse life experiences (ALEs) on rates of unintended first pregnancy, including differential effects by race/ethnicity and socioeconomic status, among women in a national longitudinal cohort study.MethodsWe drew upon 15-years of data from 8810 adolescent and young adult females in the National Longitudinal Study of Adolescent to Adult Health. Using 40 different ALEs reported across childhood and adolescence, we created an additive ALE index, whereby higher scores indicated greater ALE exposure. We employed Cox proportional hazard models, including models stratified by racial/ethnic and socioeconomic groups, to estimate the effects of ALEs on time to first unintended pregnancy, controlling for time-varying sociodemographic, health and reproductive covariates.ResultsAmong all women, a 1-standard deviation increase in ALE scores was associated with an increased rate of unintended first pregnancy (adjusted Hazard Ratio 1.11, 95% Confidence Interval=1.04–1.17). In stratified models, associations between ALE scores and risk of unintended pregnancy varied across racial/ethnic, socioeconomic, and age groups and according to various elevated ALE thresholds. For example, the 1-standard deviation increase in ALE score indicator increased the unintended pregnancy risk for African-American (aHR=1.12, CI=1.01–1.25), Asian (aHR 1.69, CI=1.26–2.26), and White women (aHR=1.12, CI=1.03–1.22), women in the lowest ($0-$19,999; aHR=1.21, CI = 1.03–1.23) and highest (>$75,000; aHR=1.36, CI=1.12–1.66) income categories, and women aged 20–24 (aHR=1.13, CI=1.04–1.24) and >24 years (aHR 1.25, CI=1.06–1.47), but not among the other sociodemographic groups.ConclusionALEs increased the risk of unintended first pregnancy overall, and different levels of exposure impacting the risk of pregnancy differently for different sub-groups of women. Our ongoing research is further investigating the role of stress-associated adversity in shaping reproductive health outcomes and disparities in the United States.

Socio-Cultural Constraints in Protecting Child Rights in a Society in Transition: A Review and Synthesis from Oman

“…Abdominal/thoracic injuries (Kotch et al 1993) Acquire brain injuries (Buchweitz et al 2019) Bruises, welts, lacerations, and abrasions (Alexander et al 2001) Fractures (Felitti 1998) Eyes injuries (McBeth et al 1999) Sexual and reproductive ill-health Reproductive health problems (Cooperman and Merten 2001) Sexual dysfunction (Rapsey et al 2019) Sexually transmitted diseases, including HIV/AIDS (Shamu et al 2019) Unwanted pregnancy (Hall et al 2019) Cognitive, emotional and behavioral disorders Developmental delays (Croft et al 2019) Alcohol and drug abuse (Cicchetti and Handley 2019) Cognitive impairment (Aas et al 2019) Delinquent, violent and other risk-taking behaviors (Mumford et al 2019) Depression and anxiety (Rapsey et al 2019) Deliberate food restriction and body-image problem (Bahji et al 2019) Feelings of shame and guilt (Baiden et al 2019) Poor self-esteem (McDonald et al 2019) Post-traumatic stress disorder (Hartley et al 2016) Deliberate self-harm and Suicidal behavior (Shapero et al 2019) Other longer-term health consequences Cancer (Henchoz et al 2019) Respiratory diseases (Riedl et al 2019) Fibromyalgia (Varinen et al 2019) Irritable bowel syndrome (Parker et al 2019) Ischemic heart disease (Obi et al 2019) Reproductive health problems such as infertility (Panisch 2019) Child maltreatment tends to trigger a myriad of physical, sexual and reproductive problems in addition to cognitive, emotional and behavioral disorders as shown in Table 2. It might also be advisable for those working in the caregiving profession to be trained in the biopsychosocial approach.…”

Associations between Adverse Childhood Experiences and Sexual Risk among Postpartum Women

“…Research among adolescents and young women demonstrates associations between early adversity and markers of adolescent sexual risk, including earlier age of first sex [ 20 , 21 ], election of a greater number of sexual partners [ 20 , 21 , 22 ], and incidence of sexually transmitted diseases [ 20 , 22 ]. Additionally, ACEs have been linked with unintended [ 23 , 24 , 25 ] and adolescent [ 26 ] pregnancy, as well as with reproductive intentions more broadly [ 25 , 26 ]. Less is known about the association between exposure to adversity and sexual risk among the full range of women of reproductive age.…”

Pregnancy History and Associated Factors Among Hawassa University Regular Undergraduate Female Students, Southern Ethiopia

“…Consistently a study in Addis Ababa supports this finding (6). Other studies state that when parents have better income they usually follow, support and control their child's which reduces exposure of unintended pregnancy (8,10,(34)(35)(36). This might be due to those whose income is from partners might be influenced or forced by their partners due to economic dependency.…”