Factors Associated with Unplanned Pregnancy Among Cancer Survivors

Shandley, Lisa M.; Kipling, Lauren M.; Spencer, Jessica B.; Morof, Diane; Mertens, Ann C.; Howards, Penelope P.

doi:10.1089/jwh.2021.0176

Cited by 3 publications

(5 citation statements)

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“…Previous research ( 52 ) proved that the need for equal status as the husband in family relationships is one of the most influential factors causing mental disorders in pregnant women. Several lines of evidence ( 53 – 55 ) suggest that pregnant women may not be prepared to cope with the changes in social environments. Pregnant women are more likely to live in unstable social environments, lack security and support from their partners, and experience more marital conflict.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the mental health status of pregnant women in China: A latent class analysis

Pei

Chen

Zhang

et al. 2023

Front. Public Health

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BackgroundPrenatal mental health is a neglected public health issue that places pregnant women at a higher risk for mental disorders. The purpose of this study was to investigate the influencing factors of prenatal mental disorders and provide a scientific basis to guide and promote the mental health of pregnant women.MethodsThe study sample comprised 973 women in their first pregnancy, who were in their second trimester and third trimester, who underwent obstetric outpatient checkups at the Maternal and Child Health Hospital in Huai'an, who were recruited in the survey that was conducted from July to December 2017. The Chinese mental health scale (CMHS) was used to assess the mental health of pregnant women. The present study uses the chi-square test to compare the rates of class with different demographic variables, a latent class analysis to identify psychological symptoms, and multiple logistic regression analysis to examine whether the demographics predicted class membership.ResultsThe chi-square test results showed that participants who reported feeling different in the perinatal period (χ2 = 6.35, P = 0.04), having marital satisfaction (χ2 = 15.8, P < 0.001), with an in-law relationship (χ2 = 29.43, P < 0.001), with a friend relationship (χ2 = 24.81, P < 0.001), with basic diseases (χ2 = 8.04, P = 0.02), and taking birth control pills (χ2 = 8.97, P = 0.01) have different probabilities of being classified. Three latent classes were identified: the high symptoms group (6.89%), the moderate symptoms group (20.56%), and the low symptoms group (72.56%). Pregnant women in the third trimester [odds ratio (OR) = 1.83, 95% confidence interval (CI): 1.04–3.25, P = 0.04], with a poor in-law relationship (OR = 2.82, 95% CI:1.45–5.51, P = 0.002), with a bad friend relationship (OR = 3.17, 95% CI: 1.31–7.71, P = 0.01), and who had basic diseases (OR = 1.70, 95% CI: 1.00–2.90, P = 0.04) tended to be classified under the high symptoms group than under the low symptoms group. Pregnant women with a bad friend relationship (OR = 2.15, 95% CI: 1.08–4.28, P = 0.03) and taking birth control pills (OR = 1.51, 95% CI: 1.08–2.11, P = 0.02) were more likely to be placed under the moderate symptoms group than under the low symptoms group.ConclusionsA pregnant woman's mental health status factors include feeling different in the perinatal period, those with marital satisfaction, those with an in-law relationship, those with a friend relationship, those with basic diseases, and those taking birth control pills. To ensure a smooth progress of pregnancy and promote the physical and mental health of pregnant women, psychological screening and psychological intervention measures should be strengthened.

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Section: Discussionmentioning

confidence: 99%

Factors associated with the mental health status of pregnant women in China: A latent class analysis

Pei

Chen

Zhang

et al. 2023

Front. Public Health

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“…Survivors of AYA cancer experience more infertility and fewer live births compared with siblings without cancer and survivors of childhood cancer . Although many AYA cancer survivors retain the potential to have children after cancer, infertility concerns cause substantial psychological distress, and misperceptions about fertility potential can lead to unplanned pregnancies and/or misinformed reproductive decisions …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…2,3 Although many AYA cancer survivors retain the potential to have children after cancer, infertility concerns cause substantial psychological distress, and misperceptions about fertility potential can lead to unplanned pregnancies and/or misinformed reproductive decisions. [4][5][6][7][8][9] Data on fertility perceptions of AYA cancer survivors and their alignment with objective infertility risk are scant. Prior studies, largely in childhood cancer survivors, report that survivors often overestimate or underestimate their infertility risk.…”

Section: Introductionmentioning

confidence: 99%

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Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer

Din,

Singh-Carlson,

Corliss

et al. 2023

JAMA Netw Open

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ImportanceFertility is important to many survivors of adolescent and young adult (AYA) cancer, yet data on this population’s fertility perceptions and their alignment with objective infertility risk are scant.ObjectiveTo assess whether estimated treatment gonadotoxicity and posttreatment menstrual pattern are associated with higher infertility risk perception.Design, Setting, and ParticipantsThis retrospective cohort study included female young adult survivors of cancer diagnosed between ages 15 and 39 years were recruited between March 25, 2015, and September 24, 2018, from 2 state cancer registries, social media, and clinician referrals to participate in a study of posttreatment ovarian function. Data analysis occurred between March 1 and September 1, 2022.ExposuresParticipants reported their menstrual pattern. Estimated treatment gonadotoxicity was ascertained through medical record review.Main Outcomes and MeasuresParticipants reported infertility risk perception and were categorized as increased risk (feeling less fertile or unable to become pregnant) or no increased risk (feeling more or as fertile) compared with female individuals their age. Objective infertility risk was determined by estimated gonadotoxicity, menstrual pattern, and ovarian reserve testing of self-collected dried blood spots. Multivariable logistic regression identified factors associated with perceived infertility and underestimation or overestimation of infertility risk.ResultsThis study included 785 female participants with a mean (SD) age of 33.2 (4.8) years at enrollment and 25.9 (5.7) years at diagnosis. Most participants self-identified their race and ethnicity as White (585 [74.5%]) and non-Hispanic (628 [78.7%]). Most participants (483 [61.5%]) perceived a higher risk of infertility compared with female participants their age. Prior exposure to moderate- or high-gonadotoxicity treatments was associated with higher odds of perceiving increased infertility risk compared with exposure to low-gonadotoxicity treatments (adjusted odds ratio [AOR], 2.73 [95% CI, 1.87-3.97] and 15.39 [95% CI, 5.52-42.96], respectively). Amenorrhea and irregular cycles were associated with higher odds of perceiving increased infertility risk (AOR, 3.98 [95% CI, 2.13-7.41] and 1.69 [95% CI, 1.19-2.40], respectively). Perceived infertility risk had minimal agreement with objective risk (κ = 0.19). Multiparity (AOR, 4.17 [95% CI, 2.61-6.64]) was associated with increased odds of underestimation, while older age (AOR, 0.94 [95% CI, 0.89-0.98]), endocrine comorbidity (AOR, 0.35 [95% CI, 0.18-0.69]), and prior infertility (AOR, 0.16 [95% CI, 0.07-0.38]) were associated with lower odds of underestimation. Multiparity (AOR, 0.48 [95% CI, 0.27-0.86]), breast cancer (AOR, 0.38 [95% CI, 0.20-0.73]), and skin cancer (AOR, 0.24 [95% CI, 0.11-0.51]) were associated with lower odds of overestimation.Conclusions and RelevanceIn this cohort study, survivors of AYA cancer had high rates of perceiving increased infertility risk but frequently overestimated or underestimated their risk. These findings suggest that counseling on infertility risk throughout survivorship may reduce misalignment between perceptions and actual risk, decrease fertility-related psychological distress, and inform family planning decisions.

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“…Intentions to become pregnant is high among cancer survivors, upwards of 60–78%, and often is high regardless of the type of cancer and treatments experienced [ 17 , 18 ]. Despite this, most studies with cancer survivors focus on factors associated with unplanned pregnancies or attempt to contextualize why survivors may or may not desire to have children after cancer [ 19 – 21 ]. Only one study evaluated the association between pregnancy intentions and preconception behaviors among female AYA survivors and found intentions during preconception were positively association with PA, but only cross-sectionally [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study

et al. 2022

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Purpose Pregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors. Methods A cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18–39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations. Results Survivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior. Conclusions Increasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA. Implications for cancer survivors Screening for immediate intentions can identify AYA survivors in need of early preconception health promotion.

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Factors Associated with Unplanned Pregnancy Among Cancer Survivors

Cited by 3 publications

References 47 publications

Factors associated with the mental health status of pregnant women in China: A latent class analysis

Factors associated with the mental health status of pregnant women in China: A latent class analysis

Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer

The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study

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