Risk Factors Associated with Unintended Pregnancies

描述（由申请人提供）：这项前瞻性研究的目的是确定育龄妇女再次意外怀孕的预测因素。在美国，几乎一半的怀孕是意外怀孕，17%的女性有一次以上的意外怀孕。意外怀孕，特别是意外怀孕，与孕产妇和儿童健康状况不佳有关。重复意外怀孕更有可能是不想要的，可能与妇女和儿童的最差结果有关。现有的已发表文献表明，以前的堕胎、吸毒和/或酗酒以及压力性生活事件（例如童年虐待、亲密伴侣暴力）与再次意外怀孕的风险之间存在关联。然而，这些早期的研究在许多方面受到限制，包括使用重复选择性终止作为重复意外妊娠的替代，回顾性研究设计，以及排除老年，有生育能力的女性的样本。本研究的目的是：1）在为期两年的随访期内，估计再次意外怀孕的发生率并描述再次意外怀孕在接受终止妊娠的妇女中的分布特征; 2）验证再次意外怀孕与社会人口学变量之间的关系（例如种族/民族，社会经济地位）和3）确定重复意外怀孕和生育史之间的关联（例如，以前怀孕的意图，产次，选择性终止历史），压力生活事件（例如虐待儿童，亲密伴侣暴力，创伤）和选择行为（药物和/或酒精使用）。这些数据来自一项正在进行的前瞻性国家研究（Turnaway研究）中收集的两年半年度随访数据，该研究包括956名有再次意外怀孕风险的妇女。将使用有序逻辑回归，因为结局是用计划外妊娠的伦敦指标测量的。这项研究将有助于确定和优先考虑在这一研究不足但具有临床重要性的孕产妇和儿童健康结果不佳的高风险妇女亚组中管理预防的机会。

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.