Risk Factors Associated with Unintended Pregnancies

描述(申请人提供)：这项前瞻性研究的目的是确定育龄妇女重复意外怀孕的预测因素。在美国，几乎一半的怀孕都是意外怀孕，17%的女性意外怀孕不止一次。意外怀孕，特别是意外怀孕，与不良的孕产妇和儿童健康结果有关。再次意外怀孕更有可能是意外的，并可能与妇女和儿童最糟糕的结局有关。现有发表的文献表明，既往堕胎、吸毒和/或酗酒，以及应激性生活事件(如童年虐待、亲密伴侣暴力)与再次意外怀孕的风险之间存在关联。然而，这些早期研究在许多方面都受到限制，包括使用重复选择性终止作为重复意外怀孕的替代指标，回溯性研究设计，以及排除老年、有生育能力的女性的样本。这项研究的目的是：1)评估意外怀孕的发生率，并描述在两年的随访期内要求终止妊娠的妇女中重复意外怀孕的分布；2)验证重复意外怀孕与社会人口学变量(如种族/民族、社会经济地位)之间的关系；3)确定重复意外怀孕与生育史(如既往怀孕意图、产次、选择性终止妊娠史)、应激性生活事件(如虐待儿童、亲密伴侣暴力、创伤)和选择行为(如吸毒和/或酗酒)之间的关系。这些数据来自一项正在进行的前瞻性全国研究(Turnaway Study)中收集的为期两年的每半年一次的跟踪数据，该研究对956名有再次意外怀孕风险的女性进行了调查。结果将使用伦敦意外怀孕测量方法进行有序Logistic回归。这项研究将有助于确定在这一未被研究但具有临床重要性的妇女亚群中管理预防的机会和优先次序，这些妇女是孕产妇和儿童健康结果不佳的高危人群。

DESCRIPTION (provided by applicant): The purpose of this prospective study is to identify factors predictive for repeat unintended pregnancy among reproductive-aged women. In the United States (US), almost half of all pregnancies are unintended and 17% of women have more than one unintended pregnancy. Unintended pregnancies, particularly those that are unwanted, are associated with poor maternal and child health outcomes. Repeat unintended pregnancies are more likely to be unwanted and may be associated with the poorest outcomes for women and children. The extant published literature suggests associations between previous abortion, drug and/or alcohol use, and stressful life events (e.g. childhood abuse, intimate partner violence) with the risk of repeat unintended pregnancy. However, these earlier studies were limited in a number of ways including the use of repeat elective termination as a proxy for repeat unintended pregnancy, retrospective study designs, and samples that excluded older, reproductively-capable women. This study aims to 1) estimate the incidence and characterize the distribution of repeat unintended pregnancy among women recruited while presenting for pregnancy termination during a two-year follow-up period 2) validate the relationship between repeat unintended pregnancy and sociodemographic variables (e.g. race/ethnicity, socioeconomic status) and 3) identify the association between repeat unintended pregnancy and reproductive history (e.g. intent of previous pregnancies, parity, elective termination history), stressful life events (e.g. child abuse, intimate partner violence, trauma), and select behavior (drug and/or alcohol use). The data are to be derived from two years of semiannual, follow-up data being collected in an ongoing prospective national study (Turnaway Study) of 956 women at risk for a repeat unintended pregnancy. Ordinal logistic regression will be utilized as the outcome is measured with the London Measure of Unplanned Pregnancy. This study will help to identify and prioritize opportunities to manage prevention in this understudied, but clinically important, subgroup of women at high risk for poor maternal and child health outcomes.