Pregnancy preferences, reproductive autonomy, and maternal health: A novel prospective study

项目总结 将意外怀孕与孕产妇和儿童健康结果不良风险增加联系起来的研究是 充满了重大的概念和科学限制，包括横截面设计，残留物 对怀孕意向进行令人困惑且过于简单化的回顾评估。我们的科学研究中的一个重大差距 因此，知识仍然存在：不良的孕产妇健康后果是否与意外怀孕有关 由于意外怀孕本身，或者更确切地说，与以下相关的背景因素导致的生育 意外怀孕风险增加？这项拟议的研究是第一次应用最先进的方法 以及测量怀孕意向的理论，以严格解决这一长期存在的科学差距。 这项前瞻性研究跟踪调查了2200名非怀孕妇女一年多来的喜好。 使用一种新的、强大的工具：避免怀孕的愿望(DAP)量表。这 验证式心理测量学 量表捕捉了认知、情感和实际考虑的连续体 怀孕和生育，超越了概念上限制的“打算”和“不打算”的标签。 经历意外怀孕的参与者--以及与之相匹配的一组具有类似 怀孕偏好--然后再跟踪三年，以测量心理和身体健康 怀孕期间和出生后的结局。这一创新的设计使我们能够实现三个目标。在AIM 1，我们将确定女性生活中时变和不变的背景因素，这些因素塑造了她们的 怀孕前的偏好，如关系因素和财务稳定性，并测试如何 偏好可以预测意外怀孕。在目标2中，在经历新怀孕的女性中，我们将 检查前瞻性评估的怀孕偏好与产妇健康之间的关系 结果，说明了暂时重要的混杂因素(来自目标1)。在目标3中，我们将调查 怀孕和不良健康结果之间的关系如何因怀孕偏好而不同。 具体地说，通过我们的配对设计，我们将比较孕妇和 最能代表她们的反事实的女性：有相似怀孕偏好的女性 而不是经历怀孕。因此，我们效仿一个假设的试验，在这个试验中，妇女有条件 混杂因素，被随机分配到怀孕，使我们能够检查是否对健康的负面影响 在那些最希望避免怀孕的人中，怀孕的风险被放大了。实现这些目标将 为意外怀孕对女性的健康影响提供新的见解，并阐明 不良后果在多大程度上源于怀孕的意向状态或潜在的社会和 背景因素。这些见解对于制定适当关注的孕产妇发病率至关重要。 预防工作。关于达到理想妊娠结局的健康后果的可靠数据是 还需要向有关获得避孕药具和生殖自主的干预措施提供信息。

PROJECT SUMMARY Research linking unintended pregnancy with increased risk of adverse maternal and child health outcomes is fraught with significant conceptual and scientific limitations, including cross-sectional designs, residual confounding, and simplistic, retrospective assessment of pregnancy intentions. A critical gap in our scientific knowledge thus remains: Are the adverse maternal health outcomes associated with unintended pregnancy and childbearing due to unintended pregnancy itself or rather contextual factors that are associated with increased risk of unintended pregnancy? The proposed research is the first to apply state-of-the-art methods and theory to the measurement of pregnancy intentions to rigorously address this long-standing scientific gap. This prospective study follows a cohort of 2,200 non-pregnant women over one year, measuring preferences about a possible pregnancy using a new, robust instrument: the Desire to Avoid Pregnancy (DAP) scale. This validated psychometric scale captures a continuum of cognitive, affective, and practical considerations about pregnancy and childbearing, moving beyond conceptually limited “intending” and “not intending” labels. Participants experiencing incident pregnancies – and a matched subset of non-pregnant women with similar pregnancy preferences – are then followed for an additional three years to measure mental and physical health outcomes during pregnancy and after birth. This innovative design positions us to address three aims. In Aim 1, we will identify the time-varying and invariant contextual factors in women’s lives that shape their preconception pregnancy preferences, such as relationship factors and financial stability, and test how preferences predict incident pregnancy. In Aim 2, among women who experience a new pregnancy, we will examine the relationship between prospectively assessed pregnancy preferences and maternal health outcomes, accounting for temporally important confounding factors (from Aim 1). In Aim 3, we will investigate how the relationship between pregnancy and adverse health outcomes differs by pregnancy preferences. Specifically, with our matched design, we will compare health outcomes among pregnant women to those of women who best represent their counterfactual: women who had similar pregnancy preferences yet who did not experience pregnancy. Thereby, we emulate a hypothetic trial in which women, conditional on confounders, are randomly assigned to pregnancy, allowing us to examine whether the negative health effects of pregnancy are amplified among those who most desire to avoid pregnancy. Achieving these aims will contribute new insights into the health repercussions of unintended pregnancy for women and elucidate the degree to which adverse outcomes stem from the intention status of pregnancies or underlying social and contextual factors. These insights are critical to developing appropriately focused maternal morbidity prevention efforts. Robust data on health consequences of attaining one’s preferred pregnancy outcomes are also needed to inform interventions around contraceptive access and reproductive autonomy.