[The prenatal maternal representations in primiparous women with unplanned pregnancies]. / Representaciones prenatales de la maternidad en mujeres primíparas con embarazos imprevistos.

This paper analyses the prenatal representations on motherhood of 15 Spanish primiparous women who were in the dilemma of whether or not to continue with their pregnancies. Based on a qualitative methodological approach, semi-structured interviews were carried out which included in their design theoretical approaches of the so-called Maternal Constellation of Daniel Stern (1997). Through a content analysis of the interviews, an absence of mental representations of the baby in terms of both physical and characterological appearance was found in the sample, possibly due to the emotional impact generated by the news of the pregnancy. This absence of representations of the baby would reveal the importance of support and/or accompaniment by social and health care providers. It would also reveal the importance of the law in force maintaining the time for reflection, which, implemented with personalised, face-to-face and verbal counselling, would allow women who find themselves in this situation to choose freely, by providing them with all the information on alternatives for continuing their pregnancy with support and accompaniment.

Contraceptive behavior of women in India after induced abortion.

Putting an end to the silent pandemic of unsafe abortion is a major public health concern globally. Adoption of post-abortion contraception is documented as a significant contributor to reduce the number of unintended pregnancies and number of induced abortions. This study aimed at investigating the post abortion contraceptive behavior of Indian women exploring the determinants of post-abortion contraceptive uptake. Retrospective calendar data for 6,862 women aged 15-49 years from fifth round of National Family Health Survey (2019-2021) was used for the study. Multinomial logistic regression method was used to model the determinant factors to post-abortion contraceptive uptake. 72.6% women reported adopting no method of contraception after the abortion procedure. A total of 27.4% women adopted some method of contraception after abortion. 14% women preferred adopting short term modern methods. Women in early reproductive age group which is the most vulnerable group in experiencing unintended pregnancies are less likely to adopt any contraceptive method after abortion. Uptake of post abortion contraception is quite low in India. Effort should be taken in the direction of bringing awareness through provision of targeted contraceptive counselling after abortion.

Prenatal depression among pregnant women attending public health facilities in Babile district, Eastern Ethiopia: a cross-sectional study.

BACKGROUND: Depression during pregnancy is a significant health concern that can lead to a variety of short and long-term complications for mothers. Unfortunately, there is a lack of information available on the prevalence and predictors of prenatal depression in rural eastern Ethiopia. This study assessed prenatal depression and associated factors among pregnant women attending public health facilities in the Babile district, Eastern Ethiopia. METHOD: An institution-based cross-sectional study was conducted among 329 pregnant women attending Babile District Public Health Facilities from November 1 to December 30, 2021. Bivariable and multivariable logistic regression were used to identify factors associated with prenatal depression. The adjusted odds ratio (AOR) with a 95% confidence interval was used to report the association, and the significance was declared at a p-value < 0.05. RESULTS: The prevalence of prenatal depression was 33.1% (95% CI = 28.0%, 38.2%). A lower income (AOR = 3.85, 95% CI = 2.08, 7.13), contraceptive use (AOR = 0.53, 95% CI = 0.28, 0.98), unintended pregnancy (AOR = 2.24, 95% CI = 1.27, 3.98), history of depression (AOR = 5.09, 95% CI = 2.77, 9.35), poor social support (AOR = 5.08, 95% CI = 2.15, 11.99), and dissatisfied marriage (AOR = 2.37, 95% CI = 1.30, 4.33) were the factors associated with increased prenatal depression among pregnant women. CONCLUSIONS: One in every three pregnant women in rural eastern Ethiopia had prenatal depression. Monthly income, contraceptive use, pregnancy intention, history of depression, social support, and marriage satisfaction status were the determinants of prenatal depression. Preventing unintended pregnancies by encouraging women to utilize modern contraceptive methods is essential for mitigating and controlling the risks and burdens of prenatal depression and its negative consequences.

[Decision-making concerning unintended pregnancies: experiences of women and men, and insights from healthcare providers]. / Besluitvorming bij onbedoelde zwangerschappen.

OBJECTIVE: To gain insight into experiences of women and men who have experienced an unintended pregnancy, along with the perspectives of healthcare providers offering decision-making counseling/consultations concerning an unintended pregnancy or abortion. DESIGN: Semi-structured interviews and focus groups. METHODS: Twenty-five interviews were held with women and men whom experienced an unintended pregnancy, while nineteen healthcare providers participated in four focus groups (May-July 2021). RESULTS: In addition to partners or other family members, healthcare providers also play a significant role in supporting decision-making. Awareness of decision-making counseling was limited among interviewees, a view shared by the participating providers. Both groups highlighted deficiencies in follow-up care post-abortion or unintended pregnancy, as well as the perceived taboo surrounding unintended pregnancies and abortion. CONCLUSION: Decision-making counseling deserves more awareness among the public and healthcare providers. There is also room for improvement regarding follow-up care. Sustained attention to unintended pregnancies and abortions is necessary to reduce the prevailing taboo.

Reproductive Planning: Unintended Pregnancy.

Unintended pregnancy is seen commonly in the family medicine setting. It is defined as a pregnancy that is mistimed (occurring sooner than wanted) or unwanted (not desired at that time or any time in the future). Approximately 45% of all US pregnancies are unintended. Childbirth resulting from an undesired pregnancy has been associated with adverse maternal and child health outcomes. Clinicians should be prepared to manage unplanned pregnancies, including dating pregnancies and discussing pregnancy options. Pregnancy options counseling entails discussing the options to parent, make an adoption plan, or undergo an abortion. Because of the complexity around pregnancy intentions, a framework that places patients at the center of their reproductive decisions and engages them in collaborative decision-making during options counseling is paramount. Patients commonly seek abortion, which is considered essential health care. Because of the current legal climate surrounding abortion in many states, patients may opt to use abortion drugs without licensed clinician oversight, called self-managed medication abortion, which has been shown to be safe and effective. No states require clinicians to report known or suspected self-managed medication abortion.

The Relationship Between Childhood Abuse and Unintended Pregnancy Among Married Women of Reproductive Age in Bangladesh.

Childhood abuse has been associated with adverse medical, psychological, behavioral, and socioeconomic outcomes in adulthood. Despite this, limited research explores the connection between childhood abuse and unintended pregnancy during adulthood. Notably, existing studies have predominantly focused on high-income countries, leaving a significant gap regarding low- and middle-income nations. This study aims to investigate the impact of childhood physical, sexual, and psychological abuse on the prevalence of unintended pregnancies and explore the interaction effects of childhood abuse on unintended pregnancy occurrences. The cross-sectional survey study was conducted between October 2015 and January 2016 in the Chandpur District of Bangladesh. Data were collected from 426 married women aged 15-49 years who had at least one child of six months or younger. The assessment of child abuse pertains to the mother's own experiences of childhood abuse and not abuse inflicted on her child. The prevalence of childhood physical, psychological, and sexual abuse was 37%, 26%, and 15%, respectively. About 25.1% of their most recent pregnancies were unintended. Notably, women with a history of childhood sexual abuse were twice as likely to experience unintended pregnancy compared to those without such a history. Furthermore, a dose-response connection was observed between the combined exposure of all categories of childhood abuse and a higher risk of unintended pregnancy. These findings highlight the need for targeted interventions, such as comprehensive sex education, accessible mental health support, and improved child protection frameworks, to address the potential repercussions of maternal childhood abuse and reduce the incidence of unintended pregnancies.

A Qualitative Study Exploring Reproductive Desires and Parenting Attitudes among Ethnically Diverse Teens at Risk of Unintended Pregnancy.

OBJECTIVES: There is minimal research eliciting teen reproductive desires and parenting attitudes. Behavioral, educational, and public health interventions to prevent teen pregnancy often highlight the negative consequences of teen pregnancy or benefits of delaying parenting. However, limited empirical information is available regarding what factors teens perceive to influence the desire to delay pregnancy. In this study, we sought to identify teen perspectives regarding factors that influence their desire to delay parenting. STUDY DESIGN: A consensual qualitative research approach was used to identify reproductive desires, parenting attitudes, and any factors that influence the desire to delay parenting expressed by at risk teens. Forty participants were randomly selected from a larger clinical trial testing the efficacy of a brief, motivational interviewing-based intervention. During the brief intervention, participants were asked about their parenting attitudes and reproductive desires and factors that influence decisions to avoid teen pregnancy. These recorded segments were extracted, transcribed, and thematically analyzed. RESULTS: The study collected qualitative data on overarching key themes regarding teen parenting attitudes and reproductive desires, as well as factors that influence the desire to delay pregnancy, including education, financial stability, partnership, maturity/responsibility, friendships, and family. Many participants indicated that they wanted to delay parenting due to wanting to pursue future goals and/or not feeling ready for the responsibility of children. CONCLUSION: Overall, teens have a variety of reasons for delaying parenting that may not be explicitly captured by the general gain/loss messaging of current interventions. Allowing teens to explore their own beliefs and values around factors that they perceive to influence their desire to delay parenting creates autonomy and places the focus on the teens themselves and not perceived future losses or gains. IMPLICATIONS: This study analyzed the parenting attitudes and reproductive desires of teens undergoing a parenting prevention motivational interviewing intervention. Through a qualitative assessment, this article identifies themes of teen perspectives regarding factors that influence their desire to delay parenting.

Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study.

BACKGROUND: Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce. OBJECTIVE: To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum. DESIGN: This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum. METHODS: Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks. RESULTS: Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions. CONCLUSION: Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.

Carrying an unintended pregnancy to term and maternal psychological distress over timeEvery unintended pregnancy is different, like every person is different. Nevertheless, carrying an unintended pregnancy to term might be stressful, that might impact mental health (e.g. depression or anxiety) of people carrying an unintended pregnancy to term. Research into long-term effects of carrying an unintended pregnancy to term on maternal mental health is scarce. In this study, we investigated effects of carrying an unintended pregnancy to term on maternal mental health up to 12 years postpartum. We used data from 7784 pregnant people living in Amsterdam, who participated in the Amsterdam Born Children and their Development (ABCD) study in 2003. Participants were followed up to 12 years postpartum. During pregnancy, participants answered questions about pregnancy mistiming (did the pregnancy happen at the right time), unwantedness (did they want to become pregnant) and unhappiness (how did they feel when they found out they were pregnant). We investigated these 'dimensions' of unintended pregnancy separately, to grasp to complexity of unintended pregnancy. Furthermore, participants answered multiple questions about experienced symptoms of depressions and anxiety around 3 months, 5 years and 12 years postpartum. People, who reported that their pregnancy was more mistimed, reported more mental health problems up to 5 years postpartum. Furthermore, people who reported more unhappiness with their pregnancy, reported more mental health problems around 3 months postpartum. People with an unintended pregnancy reported no longer more mental health problems around 12 years after birth, compared to people with more intended pregnancy. Strikingly, the mental health of people during pregnancy was more important for their mental health later in life, compared to their unintended pregnancy. Thus, the (emotional) circumstances around the pregnancy might be more influential for mental health later in life, compared to their pregnancy intentions. People carrying an unintended pregnancy to term may benefit from extra support, tailored to their individual needs and circumstances. Nevertheless, our results also showed that people are also resilient to deal with the many events and challenges faced during the periods after birth, since the effect of unintended pregnancy on maternal mental health disappeared over time.

Patient perspectives of using reproductive autonomy to measure quality of care: a qualitative study.

BACKGROUND: Current measures of reproductive health care quality, such as rates of "unintended" pregnancies, neglect to incorporate patients' desires and center their reproductive autonomy. This study explores patients' perspectives on and receptivity to alternative metrics for measuring quality of such care. METHODS: An online research recruitment firm identified eligible participants living in New York, ages 18-45, self-identifying as women, and having visited a primary care provider in the last year. We conducted five virtual focus groups and eight in-depth interviews with participants (N = 30) in 2021. Semi-structured guides queried on ideal clinic interactions when preventing or attempting pregnancy and their perspectives on how to measure the quality of such encounters, including receptivity to using our definition of reproductive autonomy to develop one such metric: "whether the patient got the reproductive health service or counseling that they wanted to get, while having all the information about and access to their options, and not feeling forced into anything." We employed an inductive thematic analysis. RESULTS: Participants wanted care that was non-judgmental, respectful, and responsive to their needs and preferences. For pregnancy prevention, many preferred unbiased information about contraceptive options to help make their own decisions. For pregnancy, many desired comprehensive information and more provider support. There was considerable support for using reproductive autonomy to measure quality of care. CONCLUSIONS: Patients had distinct desires in their preferred approach to discussions about preventing versus attempting pregnancy. Quality of reproductive health care should be measured from the patient's perspective. Given participants' demonstrated support, future research is needed to develop and test a new metric that assesses patients' perceptions of reproductive autonomy during clinical encounters.

Pregnancy intentions and its associated factors among married women in resunga, Gulmi, Nepal.

Pregnancy intention refers to a women's thinking at the time she became aware that she was pregnant. It can be categorized as intended and unintended. Identifying pregnancy intentions during prenatal periods help to employ careful monitoring of pregnancy that is at high risk for mother and children's health outcomes. Unintended pregnancy is a contributing factor for maternal and infant mortality, which is still high in Nepal. Reproductive and family planning program should incorporate pregnancy intention domains in health education and counseling with priority to design program to address and reduce unintended pregnancy. This brief research examines the pregnancy intentions and its associated factors among married women so that it could identify the intentions of pregnancy and factors influencing unintended pregnancy and could be useful to improve and maintain the health and well-being of women, family, community, and nation.

The effect of counseling on women's coping with unplanned pregnancy.

INTRODUCTION: The responses to a life-changing event can be different. The study aimed to determine the effect of counseling on coping strategies among women facing unplanned pregnancy. METHODS: This quasi-experimental study was conducted on 70 unplanned pregnant women with a gestational age <10 weeks, who scored ≥ 15 in the avoidance pattern of Revised Prenatal Coping Inventory (NU-PCI). The participants were randomly assigned into the intervention and control groups. Three counseling sessions were held for the intervention group. Data were gathered using questionnaires of the women's perceptions of unplanned pregnancy, decision-making style and strategies, NU-PCI, and the checklist for the type of decision. Independent t-tests, ANCOVA, and Chi-square were used. RESULTS: After intervention, the mean score of the avoidance pattern in the intervention group was significantly lower than that in the control group [AMD: - 4.35, 95% CI: -8.7 to -0.13, P=0.03]. In addition, the continuation rate of pregnancy in the intervention group, 28 subjects (80%), was significantly higher than that in the control group, 21 (60%) (P = 0.03). CONCLUSION: The counseling leads to a decrease in the use of avoidance strategies among women facing unplanned pregnancies. Development of supportive interventions for women experiencing unplanned pregnancies is recommended specially in societies with induced abortion restrictions.

Opportunities for Increasing Access to Effective Contraception in Australia.

Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.

Clustering of characteristics associated with unplanned pregnancies: the generation R study.

BACKGROUND: Unplanned or unintended pregnancies form a major public health concern because they are associated with unfavorable birth outcomes as well as social adversity, stress and depression among parents-to-be. Several risk factors for unplanned pregnancies in women have previously been identified, but studies usually take a unidimensional approach by focusing on only one or few factors, disregarding the possibility that predictors might cluster. Furthermore, data on predictors in men are largely overlooked. The purpose of this study is to determine predictors of unplanned versus planned pregnancy, to determine predictors of ambivalent feelings regarding pregnancy, and to investigate how characteristics of men and women with an unplanned pregnancy cluster together. METHODS: This study was embedded in Generation R, a multiethnic population-based prospective cohort from fetal life onwards. Pregnancy intention was reported by 7702 women and 5367 partners. Information on demographic, mental, physical, social, and sexual characteristics was obtained. Logistic regression, multinomial regression and cluster analyses were performed to determine characteristics that were associated with an unplanned pregnancy, with ambivalent feelings regarding the unplanned pregnancy and the co-occurrence of characteristics in women and men with unplanned pregnancy. RESULTS: Twenty nine percent of the pregnancies were unplanned. Logistic regression analyses showed that 42 of 44 studied predictors were significantly associated with unplanned pregnancy. The most important predictors were young age, migration background, lower educational level, lower household income, financial difficulties, being single, lower cognitive ability, drug use prior to pregnancy, having multiple sexual partners in the year prior to the pregnancy, younger age of first sexual contact and a history of abortion. Multinomial regression analyses showed that a Turkish or Moroccan background, Islamic religion, little financial opportunities, being married, having ≥3 children, high educational level, more mental health and social problems and older age of first sexual contact were associated with prolonged ambivalent feelings regarding pregnancy. Different combinations of characteristics were observed in the four clusters of women and men with unplanned pregnancy. CONCLUSIONS: Many predictors are related with unplanned pregnancies, ambivalent feelings toward the pregnancy, and we identified very heterogeneous groups of women and men with unplanned pregnancies. This calls for heterogeneous measures to prevent unplanned pregnancies.

Evaluation of the Amharic version of the London measure of unplanned pregnancy in Ethiopia.

BACKGROUND: Unplanned pregnancy is an important public health problem in both the developing and developed world, as it may cause adverse social and health outcomes for mothers, children, and families as a whole. London Measure of Unplanned Pregnancy (LMUP) has been formally and informally validated in multiple and diverse settings. However, there is a dearth of literature on the validation of LMUP in Ethiopia either in the Amharic version or other languages. OBJECTIVE: The general objective of this study was to translate the LMUP into Amharic and evaluate its psychometric properties in a sample of Amharic-speaking women receiving antenatal care (ANC) service at public health facilities in Arbaminch and Birbir towns. METHODS: A cross-sectional study design was used for the study. Forward and backward translation of original English LMUP to Amharic was done. A cognitive interview using a pretested structured questionnaire was used to collect the data from respondents. The collected data was analyzed using SPSS version 25. Reliability was assessed using Cronbach's alpha, inter-item correlations, and corrected item-total correlations while construct validity was assessed using principal components analysis and hypothesis testing. RESULTS: Data was collected from 320 women attending antennal care services at selected public health care facilities. LMUP range of 1to 11 was captured. The prevalence of unplanned pregnancies was 19(5.9%), while 136(42.5 were ambivalent and 165(51.6%) were planned pregnancies. The reliability testing demonstrated acceptable internal consistency (Cronbach's alpha = 0.799) and the validity testing confirmed the unidimensional structure of the scale. In addition, all hypotheses were confirmed. CONCLUSIONS: Amharic version of LMUP is a valid and reliable tool to measure pregnancy intention so that it can be used by Amharic speaking population in Ethiopia. It can also be used in research studies among Amharic-speaking women to measure unplanned pregnancy.

Pregnancy planning and acceptance and maternal psychological distress during pregnancy: results from the National Perinatal Survey, France, 2016.

BACKGROUND: Studies report heightened risks of mental health problems among women who experience an unintended pregnancy, but few consider the complexity of pregnancy intentions. In this study, we evaluate how different dimensions of pregnancy intentions (pregnancy planning and pregnancy acceptance) relate to two maternal depressive symptoms and perceived psychological distress. METHODS: This study draws from a cross-sectional national survey conducted in all maternities in France over a one-week period in 2016. All mothers 18 years and older who had a live birth during the study period were invited to participate. After excluding women who underwent infertility treatment, our analytical sample included 10,339 women. We first described levels and correlates of pregnancy planning and acceptance, defined in four categories; planned/welcomed, unplanned/welcomed, planned/unwelcomed, unplanned/unwelcomed. We then assessed the bivariate and multivariate associations between pregnancy planning and acceptance and two outcomes: women's self-perceived psychological health and the presence of two depressive symptoms during pregnancy. We used multivariate logistic regressions to evaluate these associations, after adjusting for socio-demographic and medical factors. RESULTS: Altogether 7.5 to 24.1% of mothers perceived their psychological health during pregnancy was poor, according to pregnancy planning and acceptance categories and 10.3 to 22.4% indicated feelings of sadness and loss of interest during pregnancy, according to pregnancy planning and acceptance categories. As compared to women with planned/welcomed pregnancies, the odds of perceived poor psychological health and depressive symptoms were 2.55 times (CI 2.20-2.95) and 1.75 times higher (CI 1.51-2.02), respectively, among unplanned/unwelcomed pregnancies and 2.02 (CI 1.61-2.53) and 2.07 (CI 1.7-2.5) higher, among planned/unwelcomed pregnancies. Among women with unplanned pregnancies, we also found higher odds of perceived poor psychological health among women whose pregnancy was unwelcomed while the odds of depressive symptoms were not different by pregnancy planning status among women with unwelcomed pregnancies. CONCLUSIONS: These findings consolidate previous reports of the association between pregnancy intentions and maternal psychological distress, while further specifying the relationship, which mostly depends on the acceptance of pregnancy timing rather than on pregnancy planning. Identifying women with low pregnancy acceptance can potentially enhance current medical practice by improving early detection of maternal depression.

Desire, acceptability, and expected resolution: A latent class analysis of current pregnancy orientation in the United States.

BACKGROUND: Scant research has examined latent and contextual dimensions of pregnancy intentions, conventionally classifying unintended pregnancies as mistimed (wanted later) or unwanted (not wanted at all). Being at risk of mistimed pregnancy likely encompasses a broad spectrum of emotions and expectations regarding pregnancy and merits further exploration. METHOD: Using a national sample from GfK's online KnowledgePanel of women aged 15-39 considered at risk of mistimed pregnancy in 2017 (n = 1278), we conducted a latent class analysis to assess underlying patterns of current pregnancy orientation using three items: pregnancy desire, pregnancy acceptability, and expected pregnancy resolution. As class structure varied by relationship status (serious or not), we stratified analyses by relationship status. RESULTS: Among women in serious relationships, three classes emerged: "No," "Slightly okay," and "Acceptable." For those not in serious relationships, there were two classes: "Strong no" and "Ambiguous." Overall, the classes indicate varied patterns of wantedness, acceptability, and anticipated resolution to potential pregnancy. CONCLUSIONS: This analysis reinforces that the construct of mistimed pregnancy is too restrictive to reflect the inherent diversity of prospective pregnancy orientation. The combination of relationship type as a grouping variable for stratified analyses, financial hardships' impact, and the overall effect of increasing age on increasing interest in pregnancy suggest the importance of locating pregnancy intentions within the broader reproductive life course. Scholars, clinicians, and public health programs should allow for multidimensionality of pregnancy perspectives, locate them within the broader life course, and acknowledge the potential impacts of stratified relationship formation on eventual pregnancy intentions.

Psychiatric vulnerability and the risk for unintended pregnancies, a systematic review and meta-analysis.

BACKGROUND: Unintended pregnancies (UPs) are a global health problem as they contribute to adverse maternal and offspring outcomes, which underscores the need for prevention. As psychiatric vulnerability has previously been linked to sexual risk behavior, planning capacities and compliance with contraception methods, we aim to explore whether it is a risk factor for UPs. METHODS: Electronic databases were searched in November 2020. All articles in English language with data on women with age ≥ 18 with a psychiatric diagnosis at time of conception and reported pregnancy intention were included, irrespective of obstetric outcome (fetal loss, livebirth, or abortion). Studies on women with intellectual disabilities were excluded. We used the National Institutes of Health tool for assessment of bias in individual studies and the Grading of Recommendations Assessment, Development and Evaluation method for assessment of quality of the primary outcome. FINDINGS: Eleven studies reporting on psychiatric vulnerability and UPs were included. The participants of these studies were diagnosed with mood, anxiety, psychotic, substance use, conduct and eating disorders. The studies that have been conducted show that women with a psychiatric vulnerability (n = 2650) have an overall higher risk of UPs compared to women without a psychiatric vulnerability (n = 16,031) (OR 1.34, CI 1.08-1.67) and an overall weighed prevalence of UPs of 65% (CI 0.43-0.82) (n = 3881). INTERPRETATION: Studies conducted on psychiatric vulnerability and UPs are sparse and many (common) psychiatric vulnerabilities have not yet been studied in relation to UPs. The quality of the included studies was rated fair to poor due to difficulties with measuring the outcome pregnancy intention (use of various methods of assessment and use of retrospective study designs with risk of bias) and absence of a control group in most of the studies. The findings suggest an increased risk of UPs in women with psychiatric vulnerability. As UPs have important consequences for mother and child, discussing family planning in women with psychiatric vulnerabilities is of utmost importance.

Pregnancy denial: a complex symptom with life context as a trigger? A prospective case-control study.

OBJECTIVE: To identify risk factors for a woman to experience pregnancy denial. DESIGN, SETTING AND POPULATION: A French multicentric prospective case-control study with 71 mother-infant dyads having experienced a pregnancy denial versus a control group of 71 dyads. METHODS: Data were collected in the week after delivery using an observational leaflet and two psychiatric scales (MINI and QSSP). MAIN OUTCOME MEASURES: Statistically significant differences between the two groups regarding social, demographic, medical and psychiatric data. RESULTS: Not being in a stable relationship (odds ratio [OR] 17.18, 95% CI 3.37-87.60]; P < 0.0001), not having a high school diploma (OR 1.11, 95% CI 1.04-1.38]; P < 0.0001) and having a psychiatric history (OR 6.33, 95% CI 1.62-24.76; P = 0.0002) were risk factors to experience pregnancy denial, whereas being older was a protective factor (OR 0.86, 95% CI 0.79-0.93; P = 0.0054) (logistic regression, Wald 95% CI). Other risk factors included late declarations of pregnancy history and past pregnancy denials (case n = 7, 9.7% versus 0% in controls; P = 0.01), past pregnancy denials in the family (case n = 13, 18% versus control n = 4, 5.6%; P = 0.03), and use of a contraceptive method (75% for cases versus 7% in control; P < 0.0001), primarily an oral contraceptive (75%). CONCLUSION: Family or personal history of pregnancy denial should be part of the systematic anamnesis during the first visit of a patient of child-bearing age. Further, our study points out that life context (young age, single status, socio-economic precarity, pill-based contraception) could be a trigger for pregnancy denial in certain women. TWEETABLE ABSTRACT: Life context can be a trigger for pregnancy denial.

Stress and coping among unmarried pregnant university students in South Africa.

BACKGROUND: The improvement of maternal and child health (MCH) outcomes is an important part of the sustainable development goals (SDGs). MCH remains an important issue globally as the SDGs have not yet been achieved in most countries. Young women in universities are likely to experience unintended pregnancy due to risky sexual behaviors in tertiary institutions which is characterized by lack of condom and/or contraceptive use and coercion. Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. However, very little is known about the stress and coping among young people in tertiary institutions who get pregnant during the course of their studies and choose to keep the pregnancy. METHODS: Participants were purposively selected among pregnant students and those in the puerperal period at the time of the study. Semi-structured qualitative interviews were undertaken to explore the experiences of pregnancy and early motherhood, with particular focus on the various stressors experienced and possible coping strategies employed by students. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis. RESULTS: The findings show that pregnancy and early motherhood was an experience that came with a lot of stress emanating from fear of parents' reactions, academic pressure, financial constraints, relationship problems with male partners and experiences of social stigma. Participants used emotion-focused and problem-focused coping strategies to deal with the stressors confronting them during and after their pregnancy. CONCLUSION: The experiences of pregnant students are multifaceted and generally characterised by financial crisis, academic challenges, shame, strenuous relationships and transitioning into a new identity. A multipronged approach to healthcare for pregnant students that focus on comprehensive antenatal services, health education, health promotion, psychosocial interventions including academic counselling will have positive outcomes for young mothers and their children.

Magnitude and associated factors of antenatal depression among mothers attending antenatal care in Arba Minch town, Ethiopia, 2018.

BACKGROUND: Depression is a common mental disorder. The burden of antenatal depression is higher in developing countries which is 20% as compared to developed ones 10% to 15%. In Ethiopia around one-fifth of pregnant mothers are depressed. Despite the severity of the problem, only a few studies have been done in Ethiopia, and there is no study done in Arba Minch on the problem. OBJECTIVE: To assess the magnitude and associated factors of antenatal depressive symptoms among pregnant women attending Public Health facilities in Arba Minch town Southern Nations and Nationalities Peoples Region, Ethiopia 2018. METHODS: Health Institution based, cross-sectional study design was used to assess the magnitude and associated factors of antenatal depression among 323 pregnant mothers who came for antenatal care follow-up in all public health facilities in Arba Minch town. The systematic random sampling technique was applied. Interviewer administered, pretested structured Questionnaire containing Edinburgh postpartum depression scale was utilized. EPI INFO was used to enter data and then the data were analyzed by logistic regression using SPSS. Variables with P-value less than 0.2 in the bivariate logistic regression were inserted in for multivariable analysis to see their independent effect and those with P-value less than 0.05 were used to determine the significant association between dependent and independent variables. RESULT: The magnitude of antenatal depression was 35.4%. Variables that were significantly associated with antenatal depression on multivariate analysis were anxiety (AOR = 5.49, 95%CI: 2.56, 11.77), un-planned pregnancy (AOR = 2.71, 95%CI: 1.21, 6.07), and Primigravida (AOR = 2.96, 95%CI: 1.28, 6.8). Similarly, uneducated mothers and those who attend only elementary school had AOR 4.92, 95% CI 1.36,17.73 and AOR 4.04955CI 1.23, 13.39 respectively. CONCLUSION: The magnitude of antenatal depression, intimate partner violence, and threatening life event in Arba Minch town was high. Anxiety, unplanned pregnancy, educational status, and Primigravida were significantly associated factors with depression. There should be a mechanism for routine screening and management of antenatal depression and intimate partner violence during antenatal care follow-up.