Examining the Relationship between Pregnancy Intention and Adverse Maternal Outcomes
Introduction: To investigate an association between pregnancy intention and maternal adverse outcomes, specifically postpartum depression.
Methods: Retrospective cohort study of 1105 pregnant patients between January 2015 to December 2017 who presented for prenatal care at optimus clinic (federally qualified health center). Inclusion criteria included singleton pregnancies and documented prenatal visit. Multifetal gestations, elective terminations and anyone with history of cervical insufficiency, pre-term delivery and/or premature rupture of membranes were excluded. The primary outcome is postpartum depression determined by Edinburgh postnatal depression scale at the six week postpartum visit. Secondary outcomes include incidence of development of hypertensive disorders in pregnancy, diabetes in pregnancy, contraception initiation postpartum and neonatal outcomes measured by Apgar scores and Neonatal Intensive Care Unit (NICU) admission.
Results: 56.6% of patients classified their pregnancy as unintended and 43.4% classified their pregnancy as intended. There was no significant difference found between the groups related to incidence of postpartum depression (p=0.07). No significant differences were found for secondary objectives studied including neonatal outcomes such as NICU admission or Apgar scores. Initiation of postpartum contraception was found to be significant, with the intended pregnancy cohort more likely to use postpartum contraception (89.2%, p=0.04).
Conclusion: More patients with unintended pregnancy screened positive for postpartum depression (68.6%) compared to those with intended pregnancies (31.2%, p=0.07). This can be considered clinically significant given present rates of unintended pregnancies in the United States and increasing focus on mental health issues such as postpartum depression. Pregnancy intention may an additional indicator for healthcare professionals to highlight interventions, tailor access to supportive services throughout pregnancy and postpartum to reduce postpartum depression.
