From Journal of the American Medical Association (JAMA):

Tracking Unintended Pregnancy and Adverse Health Outcomes

New study led by KPSOM professor shows higher risks compared to intended pregnancy

November 01, 2022

KPSOM Professor Heidi D. Nelson, MD, MPH

KPSOM Professor Heidi D. Nelson, MD, MPH

Unintended pregnancy is significantly associated with higher odds of adverse maternal and infant health outcomes, such as maternal depression during pregnancy and postpartum and maternal experience of interpersonal violence, preterm birth, and infant low birth weight, compared to intended pregnancy. A new research study published November 1, 2022, by JAMA and led by Heidi D. Nelson, MD, MPH, Kaiser Permanente Bernard J. Tyson School of Medicine Professor of Health Systems Science shared these findings.

In Associations of Unintended Pregnancy with Maternal and Infant Health Outcomes: A Systematic Review and Meta-analysis, Dr. Nelson and the study’s co-authors note that in the United States, 45% of pregnancies from 2008 to 2011 and 38% of births from 2017 to 2019 were unintended, and even as unintended pregnancies have declined across previous decades, rates are highest among those with low incomes, at younger ages, and among racial or ethnic minority groups. 

And although unintended pregnancy is associated with poorer health and welfare for parents, infants, and children, data about the association between unintended pregnancy and health – and how it affects certain populations in the U.S. – is lacking. The study thus aimed to evaluate associations between unintended pregnancy and maternal and infant health outcomes, during pregnancy and postpartum, using data relevant to current clinical practice and public health in the U.S.

“It is important to understand the health consequences of unintended pregnancy in order to improve them,” said Dr. Nelson. “Pregnancy is a health condition affecting immediate and lifetime maternal and infant health.”

The researchers surveyed 36 previous studies with 524,522 participants comparable to U.S. populations. The studies (published from January 1, 2000, to June 15, 2022) compared key maternal and infant health outcomes for unintended versus intended pregnancies. Combined statistics from these studies showed that, compared with intended pregnancy, unintended pregnancy was significantly associated with higher rates of depression during pregnancy (23.3% vs 13.9%); postpartum depression (15.7% vs 9.6%); interpersonal violence (14.6% vs 5.5%); preterm birth (9.4% vs 7.7%); and infant low birth weight (7.3% vs 5.2%).

The study authors note that multiple factors contribute to unintended pregnancies. While the safety and effectiveness of contraception is well-established, and clinical recommendations from medical and public health organizations provide guidance on contraceptive methods to patients and clinicians, access to and health insurance coverage for contraceptive services have faced ongoing obstacles. In addition, many states are moving to restrict or prohibit access to abortion following the U.S. Supreme Court’s recent ruling overturning Roe v. Wade. 

“Improving health by reducing unintended pregnancy is a Healthy People 2030 public health priority,” Dr. Nelson said, referring to the Center for Disease Control and Prevention’s initiative to promote health and prevent disease on a national scale. “However, achieving this goal is increasingly difficult as restrictions on contraceptive services and abortion limit delivery of these types of health care in the United States. Americans should understand how their health is affected by these restrictions.”

Nelson served as the study’s principal investigator and lead author. Co-authors of the study are Blair G. Darney, PhD; Katherine Ahrens, PhD; Amanda Burgess, MPPM; Rebecca M. Jungbauer, DrPH; Amy Cantor, MD, MPH; Chandler Atchison, MPH; Karen B. Eden, PhD; Rose Goueth, PhD, MS; and Rongwei Fu, PhD.

Read the article here .