Context: The planning status of a pregnancy may affect a woman's prenatal behaviors and the health of her newborn. However, whether this effect is independent or is attributable to socioeconomic and demographic factors has not been explored using nationally representative data.
Methods: Data were obtained on 9,122 births reported in the 1988 National Maternal and Infant Health Survey and 2,548 births reported in the 1988 National Survey of Family Growth. Multiple logistic regression analyses were employed to examine the effects of planning status on the odds of a negative birth outcome (premature delivery, low-birth-weight infant or infant who is small for gestational age), early well-baby care and breastfeeding.
Results: The proportion of infants born with a health disadvantage is significantly lower if the pregnancy was intended than if it was mistimed or not wanted; the proportions who receive well-baby care by age three months and who are ever breastfed are highest if the pregnancy was intended. In analyses controlling for the mother's background characteristics, however, a mistimed pregnancy has no significant effect on any of these outcomes. An unwanted pregnancy increases the likelihood that the infant's health will be compromised (odds ratio, 1.3), but the association is no longer significant when the mother's prenatal behaviors are also taken into account. Unwanted pregnancy has no independent effect on the likelihood of well-baby care, but it reduces the odds of breastfeeding (0.6).
Conclusions: Knowing the planning status of a pregnancy can help identify women who may need support to engage in prenatal behaviors that are associated with healthy outcomes and appropriate infant care.
PIP: The planning status of a pregnancy has been shown to influence maternal behaviors during pregnancy (e.g., smoking and weight gain) as well as pregnancy outcomes such as prematurity and low birth weight. It is possible, however, that the apparent effects of planning status actually reflect demographic and socioeconomic differences between women who plan their pregnancies and those who did not intend to conceive. This issue was explored through use of data on 9122 births reported in the 1988 US National Maternal and Infant Health Survey and 2548 births reported in the 1988 National Survey of Family Growth. In the first survey, 16% of intended births, compared with 20% of mistimed and 26% of unwanted births, had at least one negative outcome. Similarly, the proportions of infants who received well-baby care by 3 months and were breast-fed were highest when the pregnancy was intended. However, when the mother's physical and socioeconomic characteristics and the infant's health status at birth were controlled, a mistimed pregnancy had no significant effect on any of these outcomes. An unwanted birth was significantly more likely than an intended one to be associated with negative infant health outcomes when a woman's prior pregnancy experiences, physical characteristics, and socioeconomic status were controlled (odds ratio, 1.3), but the association lost significance when the mother's prenatal behaviors were considered. Unwanted pregnancy had no independent effect on the likelihood of well-baby care, but significantly reduced the likelihood of breast feeding (odds ratio, 0.6). These associations should be reassessed with more sophisticated measures and study design. However, intention status at conception does appear to represent a useful gross indicator for identifying women in need of special services and support during pregnancy.