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Healthcare Policy/Economics

Poster Session 2

(516) Association of unintended pregnancy and maternal and neonatal outcomes: Evaluation in a contemporary cohort

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Nearly half of births in the United States are unintended, a metric that may rise with increasing abortion restrictions. Prior data demonstrated an association between unintended pregnancy and adverse birth outcomes among individuals who have live births. Our objective was to evaluate this relationship in a contemporary cohort of birthing individuals.

Study Design: This was a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System (2016-2020) respondents with singleton live births. The primary exposure was unintended pregnancy including respondents who reported ambivalence, had mistimed, or had undesired pregnancies. Outcomes included adverse maternal and neonatal outcomes. Multivariable models controlled for significant (P< 0.05) sociodemographic and comorbidity differences. A subgroup analysis examined these relationships in respondents with undesired pregnancy compared to intended pregnancy. All analyses were population weighted.

Results: The weighted population included 9 million respondents, of whom 40.5% reported unintended pregnancy and 6.2% reported undesired pregnancy. On adjusted analyses, unintended pregnancy, was significantly associated with adverse maternal outcomes (Table). Respondents with unintended pregnancy had greater odds of depression, both during pregnancy (aOR 1.51, 95% CI 1.42-1.60) and postpartum (aOR 1.28, 95% CI 1.21-1.35), intimate partner violence during pregnancy (aOR 1.18, 95% CI 1.04-1.35), and lower odds of breastfeeding for more than three months (aOR 0.89, 95% CI 0.85-0.92) compared to those with intended pregnancy. Neonatal outcomes did not differ by pregnancy intendedness. On subgroup analysis of respondents with undesired pregnancy, these findings were more pronounced, and they had 18% higher odds of developing a hypertensive disorder of pregnancy.

Conclusion: Unintended pregnancy, particularly when undesired, is associated with adverse maternal outcomes in this contemporary cohort. This risk factor for maternal morbidity is particularly relevant in the current political landscape and highlights the importance of preserving abortion access.