Unintended conceptions leading to wanted pregnancies - an integral perspective on pregnancy acceptance from a mixed-methods study in Germany.

OBJECTIVE: The study examines the differences within unintended first pregnancies in the life course of 20-44 year old women. Special attention is paid to response and pregnancy acceptance. Exploring determinants and dynamics, this study will contribute to a better understanding of 'happiness with an unintended pregnancy', as this is assumed to be indicative of fewer social problems and health risks. METHODS: Retrospective survey data on first unintended pregnancies carried to term (n = 2,306) were analysed using bivariate analysis. Qualitative analysis of the narrations of such pregnancies (n = 59) used the technique of comparing cases. Standardised and qualitative data are available for first intended or aborted pregnancies as comparison groups. All data were collected from the cross-sectional mixed-methods study of 'Women's Lives: Family Planning in the Life Course' (2012-2018, Federal Centre of Health Education, Germany). RESULTS: Two-fifth of the unintended pregnancies carried to term were '(very) welcome'. Pregnancy intention, contraceptive use, living conditions, and attitudes had a significant impact. Five pathways of acceptance - sooner or later, more easy or hard to achieve - were identified in the qualitative data. CONCLUSION: Unintended pregnancies form a continuum ranging from readily accepted 'happy' pregnancies to pregnancies hard to accept. A new measure should also include postconception acceptance, besides preconception desire.

Smoking during pregnancy in association with maternal emotional well-being.

OBJECTIVE: The aim of the study was to investigate psychosocial predictors of smoking during pregnancy. MATERIALS AND METHODS: It was a cross-sectional analysis of a prospective birth-cohort study. The participants were 514 mothers of full-term infants. Women completed questionnaires during hospital stay after delivery. Questionnaire included items on sociodemographic characteristics, planning and emotional acceptance of pregnancy, reproductive history, health-related behavior, emotional well-being, and relationships with a partner. RESULTS: Smoking during pregnancy was reported by 14.8% of the participants. Prenatal smoking was associated with secondary or lower education, maternal age less than 20 years, childbirth outside of marriage, history of elective abortion, unplanned pregnancy, lack of positive emotional acceptance of pregnancy by mother and father, emotional distress and alcohol consumption during pregnancy. Smoking during pregnancy remained significantly associated with prenatal alcohol consumption, previous elective abortion, and lack of positive emotional acceptance of pregnancy by mother even after adjustment for maternal age, education, and family structure. CONCLUSIONS: Results support an idea of complexity of the relationships among smoking, alcohol use, and emotional well-being. Lack of positive emotional acceptance of pregnancy by mother and history of elective abortions can be considered as possible associates of smoking during pregnancy and suggest that strengthening of positive attitudes toward motherhood could add to lower smoking rates among pregnant women.

A não aceitação da gravidez e o desenvolvimento de crianças com quatro anos de idade no bairro Vila Jardim, Porto Alegre, Rio Grande do Sul, Brasil / Unwanted pregnancy and children development at four years of age in Vila Jardim, Porto Alegre, Rio Grande do Sul, Brazil / No aceptación del embarazo y el desarrollo infantil a los cuatro años de edad en Vila Jardim, Porto Alegre, Rio Grande do Sul, Brasil

Objetivo: investigar como a gravidez não planejada e não aceita pode afetar o desenvolvimento da criança e quais os fatores sociodemográficos, das relações familiares e da rede social que podem interagir nessa relação. Método: participaram 82 mulheres que não planejaram a gestação, parte de um estudo longitudinal que incluiu todas as famílias do Bairro Vila Jardim de Porto Alegre, que tiveram filhos em hospital público entre novembro de 1998 e dezembro de 1999. Estas foram divididas em dois grupos: 73 mulheres que aceitaram a gestação até o quarto mês e nove delas que não a aceitaram. As participantes foram entrevistadas sobre: a gravidez e o parto, o relacionamento do casal e o impacto do nascimento da criança tanto para as suas vidas como para a dos pais da criança e famílias de origem. O desenvolvimento das crianças aos quatro anos foi avaliado pelo Teste de Denver II. Resultados: encontrou-se uma diferença significativa entre os grupos, demonstrando que os filhos de mães que não aceitaram a gestação apresentam maiores dificuldades de desenvolvimento da linguagem e da coordenação motora fina em relação às crianças cujas gestações foram aceitas até o quarto mês. Destaca-se que o grupo de mães que não aceitou a gestação apresentou problemas conjugais de moderados a graves e maior número de filhos. Conclusões: as crianças cuja gestação não foi aceita têm maiores riscos de apresentarem problemas de desenvolvimento, quando comparadas com aquelas fruto de gestações não planejadas, mas aceitas até o quarto mês. Esse achado salienta a importância de os profissionais de saúde identificarem durante o pré-natal a aceitação ou não da gestação, visto que este fator, assim como a qualidade da relação conjugal e o número de filhos, está associado com as dificuldades de desenvolvimento da criança, sendo sensível a intervenções terapêuticas e/ou programas de prevenção.

Objective: To investigate how the unplanned and unaccepted pregnancy may affect children's development and associated demographic and relational factors. Method: 82 women who did not plan their pregnancies participated. They are part of a larger study that follows all children born in public hospitals, from November 1998 to December 1999 in a Porto Alegre neighborhood, in South of Brazil. They were divided in two groups: 73 accepted the pregnancy after the fourth month and nine did not accept it. Participants were interviewed on: the pregnancy and birth; the couple's relationship; the impact of the child's birth for their lives and to the child's fathers, as well as to the family of origin. Children were evaluated at age four using Denver II test. Results: There was a statistically significant difference between the groups: children of mothers that did not accept the pregnancy had developmental difficulties in language and fine motor coordination. These mothers had significantly more couple relationship problems and more children. Conclusions: children of unaccepted pregnancies showed evidences of more developmental problems in language and fine motor coordination than children of mothers who did not plan but accepted their pregnancies by the fourth month. This finding emphasizes the importance of health professionals to look for acceptance or not of pregnancy during prenatal care - as well as the quality of the couple's relationship and the number of children - since these factors are associated with difficulties of child development, which may be sensitive to therapeutic intervention and/or prevention programs.

Objetivo: investigar como la gestación que no ha sido ni planeada, ni aceptada hasta los cuatro meses, puede afectar el desarrollo del niño y cuales son los factores sociodemográficos, de las relaciones familiares y de la red social que pueden interactuar en esta asociación. Método: se han estudiado 82 mujeres que no planearon la gestación, parte de un estudio longitudinal que incluyó a todas las familias de un barrio de Porto Alegre que tuvieron hijos en un hospital público entre noviembre de 1998 y diciembre de 1999. Fueron divididas en dos grupos: 73 que aceptaron la gestación hasta el cuarto mes y nueve que no la aceptaron. Las participantes fueron entrevistadas acerca de: el embarazo y el parto, la relación de pareja y el impacto de nacimiento del niño, tanto para sus vidas como para los padres de los niños y las familias de origen. El desarrollo de los niños a los cuatro años fue evaluado con el Test de Denver II. Resultados: se encontró una diferencia significativa entre los grupos, indicando que los hijos de madres que no aceptaron la gestación presentan mayores dificultades de desarrollo del lenguaje y de la coordinación motora fina comparados con los niños nacidos de gestaciones que fueron aceptadas hasta el cuarto mes. Se destaca que el grupo de madres que no aceptó la gestación presentó más problemas de pareja de moderados a graves y mayor número de hijos. Conclusiones: Los niños y niñas nacidos de gestaciones no aceptadas tienen mayor riesgo de presentar problemas en el desarrollo que los de gestaciones no planeadas, pero aceptadas al cuarto mes. Este hallazgo refuerza la importancia de los profesionales sanitarios identificar durante prenatal la aceptación o no del embarazo, así como la calidad de la relación marital y el número de niños, visto que estos factores se relacionan con las dificultades de desarrollo del niño, siendo sensibles a la intervención terapéutica y/o programas de prevención.