Pregnancy Wantedness and Adverse Pregnancy Outcomes: Differences by Race and Medicaid Status

Abstract

The relationship between pregnancy wantedness and adverse pregnancy outcomes was studied using data from 2,828 mothers who participated in the Missouri Maternal and Infant Health Survey. The wantedness of a pregnancy was measured using traditional classifications of mistimed and unwanted, as well as additional measures gauging how the woman felt about the pregnancy while she was pregnant. Fifty-eight percent of the very low birth weight infants and 59% of the moderately low birth weight infants resulted from unintended pregnancies, as did 62% of the normal-birth-weight infants. Logistic regression showed that mothers of very low birth weight infants were significantly more likely than those who had a normal-weight baby to report that they had felt unhappy about the pregnancy (odds ratio of 1.53). Very low birth weight was also associated with early denial of the pregnancy (1.54). Odds ratios associating these two unwantedness categories with low-birth-weight babies were higher among Medicaid recipients than among women not receiving Medicaid. Associations between very low birth weight and the denial variable were also significant among white women when very low birth weight outcomes were compared with normal outcomes, but there was no significant association among black women. There were no significant associations between low birth weight and the traditional unwantedness variables.

Parental Attitudes About a Pregnancy Predict Birth Weight in a Low-Income Population

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]30 Sociodemographic variables obtained with the NSFG included place of birth, educational attainment, relationship, dominant language, age, education, and race/ ethnicity. Insurance status was obtained from the clinic database.…”

“…2 We chose to study a low-risk subgroup because, although known risk factors are sometimes strongly predictive of poor birth outcomes, most low-birth-weight infants are born to women without these traditional risk factors. 12,20 Maternal intendedness 9,18,19 and attitude toward a pregnancy 14,19,21,22 may predict low birth weight and birth weight. ness and all attitude studies are based upon retrospective assessments, however, and their clinical relevance is uncertain.…”

“…Section 16-10a of Healthy People 2010 recommends decreasing the rate of low birth weight to 5.0% by 2010. 4 A variety of socioeconomic, medical, and psychosocial factors are known to increase the risk of low birth weight, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] but prevention programs aimed at primarily high-risk subgroups have been largely ineffective. 2 We chose to study a low-risk subgroup because, although known risk factors are sometimes strongly predictive of poor birth outcomes, most low-birth-weight infants are born to women without these traditional risk factors.…”

“…ness and all attitude studies are based upon retrospective assessments, however, and their clinical relevance is uncertain. 14,19,[22][23][24] Maternal perceptions of partner intendedness and happiness toward the pregnancy may also represent modifi able predictors of pregnancy outcomes. 13,14,19,21,25 Our study goals were to test whether the mother's reports of her own and the father's happiness about a pregnancy measured before 21 weeks' estimated gestational age predict birth weight and the risk of low birth weight.…”

An implicit ambivalence-indifference dimension of childbearing desires in the National Survey of Family Growth

“…This approach is well represented by Miller's (1974Miller's ( , 1994a series of questions about a pregnancy's intendedness and wantedness, where intendedness reflects the amount of intention that went into the respondent getting pregnant and wantedness reflects the degree of motivational and emotional acceptance or rejection of being pregnant. Numerous other researchers have adopted the postconception approach as well (for example, Adler 1992; Sable and Herman 1997;Blake et al 2007;East, Chen, and Barber 2012). While in many cases there is little or no difference in the assessment of pregnancy wantedness between the two approaches, in others, especially when preconception desires are weak, conflicted, and/or largely unconscious but the pregnancy is welcomed, the difference may be appreciable.…”