Advancing Innovative Measurement of Pregnancy Preferences with Longitudinal Data

项目总结 研究减少意外怀孕和短间隔出生的有效策略，并缓解 相关的不良孕产妇和新生儿健康后果，由于概念化不佳而受到阻碍 以及怀孕意向的测量。直到最近，还没有经过验证的心理测量方法 可以前瞻性地捕捉到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。对简单化衡量标准和回溯数据的依赖 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 和短口译间隔(IPIs)。学者们表示，迫切需要改进措施和 纵向研究设计，指出它们对严格调查怀孕意向的作用的重要性 关于意外怀孕、短期IPI和不良健康后果的因果途径。这项建议 使用以人口为基础的纵向数据解决这些关键的科学和测量差距 调查对象为美国九个州超过12000名年龄在18岁至44岁之间的女性。这些调查包括希望 避免怀孕(DAP)量表，由我们的团队开发的一种新工具，使用尖端的、严格的 心理测量学方法。该工具将“意图”重新定义为“偏好”，并捕捉到 女性对未来可能怀孕的各种考虑和感受。利用三年的时间 数据，我们将检验DAP评分、避孕药使用、意外怀孕、 和出生结果。我们将使用结构方程模型来调查DAP得分的程度 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，解决了阻碍先前调查的混乱问题。关键的是，分析将是第一次 《时代周刊》应用预期怀孕偏好数据来调查阴性母亲的风险是否升高 短IPI的出生结局是由生理机制造成的，或者是这些 意外怀孕的情况经常发生。然后我们将利用DAP的优势开发新的 扩展其用途的测量工具。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，促进严格的、以人为中心的措施的集成 用于未来的研究、监测和临床护理。然后，我们将使用IRT来建立基于证据的 量表上的阈值，定义怀孕前偏好的标准化分组(例如，“不想要的”或 “不太受欢迎”)，并解决对“意外怀孕”采取替代措施的迫切需要 如果女性达到了她们的生育偏好，就可以捕获。更好地理解怀孕偏好 以及意外怀孕如何导致母亲和新生儿的不良结局--以及 因为我们的新仪器对未来科学的贡献-可以引导该领域走向干预 可以更成功地促进生殖自主，改善妇幼健康。

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.