Advancing Innovative Measurement of Pregnancy Preferences with Longitudinal Data

利用纵向数据推进怀孕偏好的创新测量

• 批准号: 10444819
• 负责人: Corinne H. Rocca
• 金额: $ 26.91万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444819
• 关键词: Accounting; Address; Adopted; Adoption; Adverse effects; Affect; Affective; Behavior; Birth; Birth Intervals; Birth Order; Categories; Child; Childbirth; Clinical; Code; Cognitive; Communities; Contraceptive Usage; Couples; Data; Development; Equation; Ethnic Origin; Feeling; Future; Geographic state; Goals; Grouping; Health; Intention; Intervention; Investigation; Knowledge; Lead; Left; Longitudinal Studies; Longitudinal Surveys; Low Birth Weight Infant; Maternal Health; Maternal and Child Health; Measurement; Measures; Mediating; Mediation; Methodology; Methods; Modeling; Nature; Outcome; Pathway interactions; Personal Satisfaction; Physiological; Pregnancy; Pregnancy Interval; Premature Birth; Psychometrics; Public Health; Race; Research; Research Design; Research Personnel; Research Project Summaries; Risk; Risk Factors; Role; Science; Shapes; Social Environment; Standardization; Surveys; Time; Uncertainty; United States; Woman; Women' s Group; adverse maternal outcomes; aged; base; child bearing; clinical care; effective intervention; evidence base; improved; innovation; insight; instrument; longitudinal analysis; neonatal health; neonatal outcome; novel; person centered; population based; preference; prepregnancy; preservation; prevent; prospective; public health research; reproductive; response; social factors; theories; therapy development; tool; unintended pregnancy

PROJECT SUMMARY Research into effective strategies to reduce unintended pregnancy and short interval births, and to mitigate associated adverse maternal and neonatal health outcomes, has been hampered by poor conceptualization and measurement of pregnancy intentions. Until recently, no validated psychometric measures had been available to prospectively capture the range and complexity of feelings many women have about pregnancy, including ambivalence and uncertainty. Reliance on simplistic measures and retrospective data have left serious scientific gaps in our understanding of the causes, and health consequences, of unintended pregnancy and short interpregnancy intervals (IPIs). Scholars have expressed an urgent need for improved measures and longitudinal study designs, citing their importance to rigorous investigations of the role of pregnancy intentions on the causal pathway to unintended pregnancy, short IPIs, and adverse health outcomes. This proposal addresses these critical scientific and measurement gaps using longitudinal data from population-based surveys, fielded to over 12,000 women, aged 18-44, across nine US states. These surveys include the Desire to Avoid Pregnancy (DAP) scale, a novel instrument developed by our team using cutting-edge, rigorous psychometric methods. The instrument reconceptualizes “intentions” as “preferences” and captures the diversity of considerations and feelings women have about a potential future pregnancy. Using three years of data, we will examine the predictive relationships between DAP scores, contraceptive use, incident pregnancy, and birth outcomes. We will use structural equation models to investigate the extent to which DAP scores mediate relationships between the personal and social contexts of women’s lives and pregnancy and birth outcomes, addressing confounding that has hindered prior investigations. Critically, analyses will for the first time apply prospective pregnancy preference data to investigate whether the elevated risk of negative maternal and birth outcomes from short IPIs results from physiologic mechanisms, or the contexts in which these frequently unintended pregnancies occur. We will then capitalize on the DAP’s strengths to develop novel measurement tools that expand its utility. First, we will use item response theory (IRT) to develop a shorter DAP version that maintains construct validity, facilitating the integration of rigorous, person-centered measures into future research, surveillance, and clinical care. Then, we will use IRT to establish evidence-based thresholds on the scale, defining standardized groupings of pre-pregnancy preferences (e.g., “undesired” or “less preferred”), and addressing the urgent need for alternative measures to “unintended pregnancy” that capture if women attain their reproductive preferences. A better understanding of how pregnancy preferences are formed, and how unintended pregnancy contributes to adverse maternal and neonatal outcomes – as well as the contributions of our novel instruments to future science – can guide the field toward interventions that can more successfully promote reproductive autonomy and improve maternal and child health.

项目总结