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: 10709484
• 负责人: Corinne H. Rocca
• 金额: $ 26.9万
• 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/10709484
• 关键词: Accounting; Address; Adopted; Adoption; Adverse effects; Affect; Affective; Behavior; Birth; Birth Intervals; Birth Order; Child; Childbirth; Clinical; Code; Cognitive; Communities; Contraceptive Usage; Couples; Data; Development; Equation; Ethnic Origin; Feeling; Future; 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; US State; Uncertainty; United States; Woman; Women' s Group; adverse maternal outcomes; aged; avoid pregnancy; child bearing; clinical care; contextual factors; 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.

项目概要 研究减少意外怀孕和短间隔分娩的有效策略，并减轻 相关的不良孕产妇和新生儿健康结果受到不良概念化的阻碍 和怀孕意愿的测量。直到最近，还没有经过验证的心理测量方法 可以前瞻性地捕捉许多女性对怀孕的感受的范围和复杂性， 包括矛盾心理和不确定性。对简单化措施和回顾性数据的依赖已经消失 我们对意外怀孕的原因和健康后果的理解存在严重的科学差距 和短的妊娠间隔（IPI）。学者们表示迫切需要改进措施和 纵向研究设计，指出其对严格调查怀孕意图的作用的重要性 意外怀孕、短期 IPI 和不良健康结果的因果途径。这个提议 使用基于人口的纵向数据来解决这些关键的科学和测量差距 调查对象为美国九个州的 12,000 多名 18-44 岁女性。这些调查包括欲望 避免怀孕（DAP）量表，是我们团队采用尖端、严格的方法开发的一种新颖仪器 心理测量方法。该工具将“意图”重新概念化为“偏好”并捕获 女性对未来可能怀孕的考虑和感受多种多样。用了三年的时间 数据，我们将检查 DAP 评分、避孕药具使用、意外怀孕、 和出生结果。我们将使用结构方程模型来研究 DAP 得分的程度 调解妇女生活、怀孕和生育的个人和社会背景之间的关系 结果，解决阻碍先前调查的混淆问题。至关重要的是，分析将首先 是时候应用前瞻性妊娠偏好数据来调查阴性孕产妇的风险是否升高 短期 IPI 的出生结果是由生理机制或这些情况产生的背景造成的。 经常发生意外怀孕。然后，我们将利用行动党的优势来开发新颖的 扩展其实用性的测量工具。首先，我们将使用项目反应理论（IRT）来开发更短的 DAP 版本保持结构有效性，促进严格、以人为本的措施的整合 未来的研究、监测和临床护理。然后，我们将使用 IRT 来建立基于证据的 量表的阈值，定义怀孕前偏好的标准化分组（例如，“不想要的”或 “不太优选”），并解决对“意外怀孕”替代措施的迫切需要 捕捉女性是否达到她们的生育偏好。更好地了解怀孕偏好 的形成，以及意外怀孕如何导致不良的孕产妇和新生儿结局 - 以及 作为我们的新颖仪器对未来科学的贡献 - 可以引导该领域采取干预措施 可以更成功地促进生殖自主权，改善妇幼健康。