Is Reproductive Orientation Associated with Sexual Satisfaction Among Partnered U.S. Women?

Little is known about how "reproductive orientation" (i.e., trying to get pregnant, ambivalent about pregnancy, trying to avoid pregnancy, or having had a sterilization surgery) is associated with sexual satisfaction among women of childbearing age. Using data from the National Survey of Fertility Barriers (N = 2811), we examined the association of reproductive orientation with sexual satisfaction, adjusting for relationship characteristics including union type (cohabitation versus marriage), quality, and length; infertility history; and demographic characteristics including age, parity, and race/ethnicity. Results indicated that women who were ambivalent or trying to get pregnant reported significantly higher levels of sexual satisfaction than women who were sterile in the unadjusted model, but not in the models that included relationship quality. The association of reproductive orientation and sexual satisfaction depended upon relationship quality; among women with lower relationship quality, "trying" was associated with higher, and among those with higher relationship quality, with lower sexual satisfaction.

Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization.

OBJECTIVE: To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance. METHODS: A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-reported on their adverse childhood experiences (ACEs), negative health risks (overweight/obesity, smoking, and alcohol use), adverse infant outcomes, NICU admittance, and maternal perinatal complications across three pregnancy assessments and one post-birth assessment. Logistic binomial regression analyses were used to examine associations between maternal ACEs and adverse infant outcomes, NICU admittance, and maternal perinatal complications, controlling for pregnancy-related health risks. RESULTS: Findings showed that women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome (odds ratio [OR] = 4.33, 95% CI: 1.02-18.39), almost 9 times the odds of reporting a NICU admission (OR = 8.70, 95% CI: 1.34-56.65), and 4 times the odds of reporting at least one maternal perinatal outcome (OR = 4.37, 95% CI: 1.43-13.39). CONCLUSIONS: The findings demonstrate the extraordinary risk that mothers' ACEs pose for infant and maternal health outcomes over and above the associations with known maternal health risks during pregnancy, including overweight/obesity, smoking, and alcohol use. These results support a biological intergenerational transmission framework, which suggests that risk from maternal adversity is perpetuated in the next generation through biophysical and behavioral mechanisms during pregnancy that negatively affect infant health outcomes.

Pregnancy intendedness, maternal-fetal bonding, and postnatal maternal-infant bonding.

This study models associations between pregnancy intendedness and prenatal maternal-fetal bonding with postnatal maternal-infant bonding. Unintended pregnancies are associated with disruptions in maternal-infant bonding, which has long-term adverse implications for maternal and child well-being. Given the high proportion of births that are unintended in the United States, identifying protective factors is critical. Pregnant women (ages 16-38) were recruited from two prenatal clinics in a metropolitan city in the South Central United States at their first prenatal visit and followed throughout pregnancy and postbirth. Multiple regression analyses examined associations, mediation, and moderation. Results indicate that the more unintended/unwanted women reported their pregnancies to be, the lower they reported their maternal-infant bonding postbirth, and higher maternal-fetal bonding scores are associated with higher postnatal maternal-infant bonding. An interaction revealed that a higher level of prenatal bonding is protective for postnatal bonding among those with unintended/unwanted pregnancies. Because prenatal bonding can be enhanced through intervention, it is a promising target to reduce the risks associated with unintended pregnancy.

Este estudio modela asociaciones entre la intencionalidad de quedarse embarazada y la vinculación materno-fetal prenatal con la vinculación postnatal entre madre e infante. Los embarazos no intencionales se asocian con una vinculación entre madre e infante desorganizada, lo cual tiene implicaciones adversas a largo plazo para el bienestar materno y del niño. Dada la alta proporción de embarazos no intencionales en los Estados Unidos, es esencial identificar factores de protección. Se reclutaron mujeres embarazadas (edades de 16 a 38 años) de dos clínicas prenatales en una ciudad metropolitana en el centro sur de Estados Unidos, en su primera visita prenatal y con seguimiento a lo largo del embarazo y posterior al nacimiento. Los análisis de regresión múltiple examinaron las asociaciones, la mediación y la moderación. Los resultados indican que mientras menos intencional o deseado es el embarazo según lo reportado por las mujeres, más baja es la vinculación posterior al nacimiento tal como lo reportaron ellas, y más altos puntajes de vinculación materno-fetal se asocian con una más alta vinculación postnatal entre madre e infante. Una interacción reveló que un más alto nivel de vinculación prenatal es un factor de protección para la vinculación postnatal entre aquellas con embarazos no intencionales/deseados. Debido a que la vinculación prenatal puede mejorarse a través de la intervención, reducir los riesgos asociados con el embarazo no intencional es una meta prometedora.

Cette étude modèle les liens entre l'intention de la grossesse et le lien prénatal maternel-fœtal avec le lien maternel-nourrisson postnatal. Les grossesses indésirées sont liées à des perturbations du lien maternel-nourrisson, ce qui a des implications défavorables à long terme pour le bien-être maternel et de l'enfant. Etant donnée la grande proportion de naissances indésirables aux Etats-Unis, l'identification de facteurs protecteurs est critique. Des femmes enceintes (âgées de 16 à 38 ans) ont été recrutées dans deux cliniques prénatales d'une ville urbaine de la région Sud-Centrale des Etats-Unis à leur première prénatale et ont été suivies au travers de leur grossesse et après la naissance. Des analyses de régression multiple ont examiné les liens, la médiation et la modération. Les résultats indiquent que plus les femmes faisaient état de grossesses indésirées/non voulues, le moins elles faisaient état de leur lien maternel-nourrisson après la naissance. Les liens maternel-fœtal élevés étaient liés à un lien maternel-nourrisson postnatal plus élevé. Une interaction a révélé qu'un niveau de lien prénatal plus élevé est protecteur pour le lien postnatal chez celles avec des grossesses indésirées/non voulues. Parce que le lien prénatal peut être amélioré au travers de l'intervention cela en fait une cible prometteuse afin de réduire les risques liés à une grossesse indésirée.

Trauma exposure and adolescent attitudes toward having a baby: An exploratory survey.

OBJECTIVES: To examine the association between childhood trauma exposure (i.e., extent of interpersonal trauma experienced in childhood) and attitudes toward teen parenthood. STUDY DESIGN: We used a cross-sectional sample of 416 urban middle and high school male and female students from Tulsa, OK recruited through a local public school district mailing list. Multinomial logistic regression analyses were used to examine odds of reporting having a baby would make life worse, better, or cause no change according to childhood trauma score. RESULTS: Approximately 8% of students and their guardians responded to the mailed survey invitation. Among the students, 67% reported having a baby would make their lives worse; 17% reported it would not change their lives much, and 16% reported having a baby would make their lives better. Each increase in trauma score was associated with a 9% increase in reporting an indifferent attitude (p < 0.001) and a 15% increase in reporting a positive attitude toward having a baby (p < 0.01). After controlling for a wide range of sociodemographic, attitudinal, and sexual history variables, childhood trauma remained associated with a positive attitude toward having a baby (p<.01), but not an indifferent attitude toward having a baby. CONCLUSIONS: Greater childhood trauma exposure is associated with indifferent and positive attitudes toward having a baby during adolescence. IMPLICATIONS: Screening for childhood trauma and utilizing interventions designed to reduce the harmful effects of trauma exposure in childhood may offer a more targeted approach to adolescent pregnancy prevention strategies.

Childhood Adversity and Perceived Distress from the COVID-19 Pandemic.

Childhood exposure to adversity may increase an individual's reactivity to subsequent stressors. In this paper, we examine how adverse childhood experiences (ACEs) are associated with experiencing greater perceived distress during the pandemic. In this volunteer clinical cohort study, 177 pregnant women (ages 16-38) were recruited from two university-affiliated perinatal clinics located in a small metropolitan city between October 2017 and May 2018. Longitudinal data collection is ongoing. The current study includes the 101 women who participated through the eighth and most recent survey conducted in mid-April 2020. OLS regression analyses were used to examine the association between childhood adversity and pandemic-related distress. We found that ACE scores were associated with higher levels of distress (b = .08; se = .03; p < .01) when controlling for demographic characteristics. The addition of loneliness to the model fully mediates the association between ACEs score and distress. Findings suggest that adverse childhood experiences influence COVID-19-related distress due to greater social isolation. Those who had greater adversity during childhood may be less likely to have the social connectedness needed to reduce distress due to the pandemic.

Is a dyadic stressor experienced as equally distressing by both partners? The case of perceived fertility problems.

Using data from a population survey, this article explores whether perceptions of having a fertility problem among 926 U.S. couples in heterosexual relationships (women aged 25-45 and male partners) are associated with distress. Most couples did not perceive a fertility problem (58%). In almost a third (30%) of the couples, only women perceived a fertility problem; in 4%, only the men; and in nearly a fifth (19%), both perceived a problem. Adjusted for characteristics associated with fertility problems and depressive symptoms, those who perceived a problem exhibited significantly more depressive symptoms than those who did not. Fertility problems are sometimes experienced as individual because in some couples only one partner perceives a problem or has higher distress in response to their own rather than to their partners' perceived problems. For women, fertility problems are experienced as a couple phenomenon because women were more distressed when both partners perceive a problem. The perception of fertility problems is gendered in that women were more likely to perceive a problem than men. Furthermore, men are most distressed when they perceive a problem and their partner does not.

The role of pregnancy intendedness and prenatal contraceptive counseling on postpartum contraceptive use.

BACKGROUND: The study was conducted to prospectively examine how pregnancy intendedness and prenatal provider counseling about postpartum contraceptive options are associated with lack of contraception use at 6 months post-birth (e.g., increased risk for a short interpregnancy interval). METHODS: Logistic regression models were used to examine risk for no postpartum contraception use among a sample of low-income and racially/ethnically diverse women recruited from two metropolitan perinatal clinics in Tulsa, OK. RESULTS: Women who reported that they were trying to get pregnant or "okay either way" about getting pregnant had significantly lower odds of using contraception at 6 months post childbirth than those who had unintended pregnancies. Having providers who discussed postpartum contraceptive options during pregnancy significantly increased the odds of contraceptive uptake among those who were planning or ambivalent about their pregnancies. CONCLUSIONS: Intentions of a current pregnancy and provider contraceptive counseling matter for postpartum contraceptive use and the associated risk for a short interval subsequent pregnancy. Provider contraceptive counseling that accounts for the intendedness of a current pregnancy may offer a more targeted approach to prevent a short interval subsequent pregnancy.

Is infertility resolution associated with a change in women's well-being?

STUDY QUESTION: Is giving birth associated with improved subjective well-being among involuntarily childless women? SUMMARY ANSWER: Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms. WHAT IS KNOWN ALREADY: Cross-sectional data and studies of treatment-seekers show that infertility is associated with lower subjective well-being. Childless women with infertility tend to report lower subjective well-being than women who experience secondary infertility, but a prospective study using a random sample of involuntarily childless women over time has not previously been conducted. STUDY DESIGN, SIZE, DURATION: The sample for the current study includes all women without children who met medical criteria for infertility or perceived a fertility problem (N = 283) at baseline and who were interviewed in both waves (3 years apart) of the National Survey of Fertility Barriers (NSFB), in a random-digit dialing telephone survey. It is therefore possible to explore here whether there are differences in the association of infertility resolution and subjective well-being among women who do and do not perceive themselves as having a fertility problem. PARTICIPANTS/MATERIALS, SETTING, METHODS: Depressive symptoms (as measured by the Center for Epidemiologic Studies-Depression Scale), self-esteem (as measured by a modified version of the Rosenberg Self-esteem Scale) and life satisfaction (as measured by a modified version of the Satisfaction with Life Scale) were assessed for all 283 participants at both waves. For all three variables, change scores of 47 involuntarily childless women who resolved their infertility through a live birth were compared to the scores for the 236 women who remained childless. A number of variables shown to be associated with subjective well-being among infertile women were included as controls. MAIN RESULTS AND THE ROLE OF CHANCE: No relationship between infertility resolution and change in depressive symptoms was observed (b = -0.04; P > 0.05). Involuntarily childless women who resolved their infertility improved in self-esteem (b = 0.74; P < 0.01) and life satisfaction (b = 1.06; P < 0.01). LIMITATIONS, REASONS FOR CAUTION: Women were measured at only two time points. Only 47 women had a live birth between waves. While it is common practice to make causal interpretations based on panel data, such interpretations should be made with caution. In addition, the NSFB was conducted in the USA where medical expenditures are high and most fertility treatment expenses are not covered by insurance. Thus it may not be possible to generalize the findings to other modern industrialized societies. WIDER IMPLICATIONS OF THE FINDINGS: Knowing that resolution of infertility is associated with improved subjective well-being is important for infertile couples and infertility professionals alike. STUDY FUNDING/COMPETING INTEREST(S): This research was supported in part by NICHD grant R01-HD044144 and NIGMS grant P20-GM109097 from the National Institutes of Health. The authors have no competing interests.

Exploring Experiences with Sterilization among Nulliparous Women.

Although nulliparous women who are sterilized appear voluntarily "childfree," the majority report non-contraceptive reasons for their surgical procedure. Using an analytical subsample of the National Survey of Fertility Barriers, we examined 105 women's closed- and open-ended responses about the reasons for their sterilization surgeries and whether their sterilization occurred before their childbearing desires were met. We found considerable heterogeneity in the experiences and attitudes of participants. We highlight important implications of women's experiences for fertility and reproductive health research and practice, particularly by drawing a distinction between voluntarily childfree and involuntarily childless women.

Pregnancy happiness: implications of prior loss and pregnancy intendedness.

Objective: This study aimed to examine the interaction between pregnancy loss and pregnancy intentions on women's happiness about a subsequent pregnancy.Background: Anxiety about prior loss persist for women, even during subsequent pregnancies. It is unclear from prior research, whether a prior pregnancy loss shapes attitudes towards and feelings about a subsequent birth.Methods: Using data from the 2002-2013 National Survey of Family Growth (NSFG), we used logistic regression analyses to explore the implications of a prior pregnancy loss for happiness about a subsequent pregnancy that ends in a live birth. We compared births classified as on-time, mistimed, unwanted, and ambivalent.Results: Births were more likely to be characterised as on-time if they occurred following a pregnancy loss, and women were less likely to report being happy about a conception if they were ambivalent about the conception and experienced a previous loss. Overall, pregnancy loss alone was not associated with lower levels of happiness about a subsequent birth.Conclusions: Pregnancy loss can be a highly distressing experience, women's happiness about a subsequent pregnancy is not reduced due to prior pregnancy loss. Future research should explore why women who were ambivalent about pregnancy reported lower levels of happiness following a loss.

Effect of a mindfulness-based pilot intervention on maternal-fetal bonding.

This pilot study explored the effects of a two-week mindfulness-based intervention designed to enhance maternal-fetal bonding among pregnant women. Participants who listened to their baby's heartbeat every day for two weeks and received four texts per week with mindfulness-based activities to do from home reported a significant increase in reported maternal-fetal attachment scores across the study period. Enhancing maternal-fetal bonding through this low-cost intervention has the potential for reducing adverse birth outcomes.

Change in Motherhood Status and Fertility Problem Identification: Implications for Changes in Life Satisfaction.

OBJECTIVE: To determine whether the association between changes in life satisfaction and becoming a mother (or not) depends on fertility problem identification status. BACKGROUND: Evidence and symbolic interactionist theory suggest that, for women who initially perceive a fertility barrier, gaining the valued identity "mother" should be associated with increases, and continuing to face a blocked goal (i.e. not becoming a mother) should be associated with decreases in life satisfaction. METHOD: This study used the nationally representative two-wave National Survey of Fertility Barriers to conduct a change-score analysis with chained multiple imputation (MICE). The focal dependent variable was change in life satisfaction. Focal independent variables were Wave 1 life satisfaction, fertility problem identification status, and birth between waves, controlling for stability and change in relationship status, talking to a doctor about how to get pregnant, religiosity, social support, importance of parenthood, importance of leisure, importance of work success, and economic hardship. RESULTS: Among women who perceived a fertility problem at both waves, becoming a mother was associated with increased life satisfaction and not becoming a mother was associated with decreased life satisfaction. Women who gained or lost a fertility problem perception between waves but did not have a live birth experienced a gain in life satisfaction between waves, suggesting the relevance of the duration of fertility problem perception for change in life satisfaction.

A New Way to Estimate the Potential Unmet Need for Infertility Services Among Women in the United States.

BACKGROUND: Fewer than 50% of women who meet the medical/behavioral criteria for infertility receive medical services. Estimating the number of women who both meet the medical/behavioral criteria for infertility and who have pro-conception attitudes will allow for better estimates of the potential need and unmet need for infertility services in the United States. METHODS: The National Survey of Fertility Barriers was administered by telephone to a probability sample of 4,712 women in the United States. The sample for this analysis was 292 women who reported an experience of infertility within 3 years of the time of the interview. Infertile women were asked if they were trying to conceive at the time of their infertility experience and if they wanted to have a child to determine who could be considered in need of services. RESULTS: Among U.S. women who have met medical criteria for infertility within the past three years, 15.9% report that they were neither trying to have a child nor wanted to have a child and can be classified as not in need of treatment. Of the 84.9% of infertile women in need of treatment, 58.1% did not even talk to a doctor about ways to become pregnant. DISCUSSION: Even after taking into account that not all infertile women are in need of treatment, there is still a large unmet need for infertility treatment in the United States. CONCLUSION: Studies of the incidence of infertility should include measures of both trying to have a child and wanting to have a child.