Advancing Innovative Measurement of Pregnancy Preferences with Longitudinal Data

项目摘要 研究有效战略，减少意外怀孕和短间隔生育， 相关的不利孕产妇和新生儿健康结果，一直受到概念化差的阻碍 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， 可用于前瞻性地捕捉许多女性对怀孕的感觉的范围和复杂性， 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， 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 和短解释间隔（IPI）。学者们表示迫切需要改进措施， 纵向研究设计，引用其重要性，严格调查的作用，怀孕的意图 关于意外怀孕、短期IPIs和不良健康结果的因果途径。这项建议 利用基于人口的纵向数据解决这些关键的科学和测量差距 调查，超过12,000名妇女，年龄在18-44岁，在美国九个州。这些调查包括欲望 避免怀孕（DAP）量表，这是我们团队使用尖端，严格的 心理测量方法该文书将“意图”重新概念化为“偏好”， 女性对未来可能怀孕的各种考虑和感受。用三年的时间 数据，我们将研究DAP评分，避孕药使用，意外怀孕， 出生结果。我们将使用结构方程模型来研究DAP得分 调解妇女生活的个人和社会背景与怀孕和生育之间的关系 结果，解决阻碍先前调查的混淆问题。关键是，分析将首先 应用前瞻性孕期偏好资料调查阴性产妇的风险是否升高 短期IPIs的出生结果是由生理机制或这些机制的背景造成的， 经常发生意外怀孕。然后，我们将利用民主行动党的优势， 测量工具，扩大其效用。首先，我们将使用项目反应理论（IRT）开发一个简短的 DAP版本保持结构效度，促进严格的，以人为本的措施的整合 用于未来的研究、监测和临床护理。然后，我们将使用IRT建立基于证据的 量表上的阈值，定义怀孕前偏好的标准化分组（例如，“不希望的”或 “不太受欢迎”），并解决迫切需要采取“意外怀孕”的替代措施， 如果女性实现了她们的生殖偏好。更好地了解怀孕偏好 以及意外怀孕如何导致不良的孕产妇和新生儿结局-以及 作为我们的新仪器对未来科学的贡献-可以引导该领域的干预， 可以更成功地促进生殖自主，改善孕产妇和儿童健康。

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.