Pregnancy preferences, reproductive autonomy, and maternal health: A novel prospective study

怀孕偏好、生殖自主权和孕产妇健康：一项新颖的前瞻性研究

• 批准号: 10420659
• 负责人: Corinne H. Rocca
• 金额: $ 53.92万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10420659
• 关键词: Accounting; Address; Affect; Affective; Attitude; Birth; Characteristics; Child; Childbirth; Cognitive; Communities; Conceptions; Contraceptive Agents; Couples; Data; Development; Enrollment; Ethnic Origin; Fruit; Funding; Health; Health Status; Human Rights; Individual; Intention; Intervention; Investigation; Knowledge; Label; Link; Longitudinal observational study; Maternal Health; Maternal Mortality; Maternal and Child Health; Measurement; Measures; Mental Health; Methods; Morbidity - disease rate; Outcome; Parents; Participant; Persons; Positioning Attribute; Pregnancy; Pregnancy Outcome; Pregnancy Tests; Pregnant Women; Prevention; Prospective Studies; Prospective cohort study; Psychometrics; Randomized; Research; Research Project Summaries; Residual state; Risk; Sampling; Shapes; Social Desirability; Socioeconomic Status; Testing; Time; Uncertainty; United States; Woman; adverse outcome; child bearing; cohort; comparison group; contextual factors; design; experience; follow-up; improved; innovation; insight; instrument; longitudinal analysis; maternal morbidity; maternal outcome; mortality; novel; physical conditioning; preference; pregnant; prospective; racial disparity; recruit; reproductive; social factors; stability testing; stem; theories; trial comparing; unintended pregnancy

PROJECT SUMMARY Research linking unintended pregnancy with increased risk of adverse maternal and child health outcomes is fraught with significant conceptual and scientific limitations, including cross-sectional designs, residual confounding, and simplistic, retrospective assessment of pregnancy intentions. A critical gap in our scientific knowledge thus remains: Are the adverse maternal health outcomes associated with unintended pregnancy and childbearing due to unintended pregnancy itself or rather contextual factors that are associated with increased risk of unintended pregnancy? The proposed research is the first to apply state-of-the-art methods and theory to the measurement of pregnancy intentions to rigorously address this long-standing scientific gap. This prospective study follows a cohort of 2,200 non-pregnant women over one year, measuring preferences about a possible pregnancy using a new, robust instrument: the Desire to Avoid Pregnancy (DAP) scale. This validated psychometric scale captures a continuum of cognitive, affective, and practical considerations about pregnancy and childbearing, moving beyond conceptually limited “intending” and “not intending” labels. Participants experiencing incident pregnancies – and a matched subset of non-pregnant women with similar pregnancy preferences – are then followed for an additional three years to measure mental and physical health outcomes during pregnancy and after birth. This innovative design positions us to address three aims. In Aim 1, we will identify the time-varying and invariant contextual factors in women’s lives that shape their preconception pregnancy preferences, such as relationship factors and financial stability, and test how preferences predict incident pregnancy. In Aim 2, among women who experience a new pregnancy, we will examine the relationship between prospectively assessed pregnancy preferences and maternal health outcomes, accounting for temporally important confounding factors (from Aim 1). In Aim 3, we will investigate how the relationship between pregnancy and adverse health outcomes differs by pregnancy preferences. Specifically, with our matched design, we will compare health outcomes among pregnant women to those of women who best represent their counterfactual: women who had similar pregnancy preferences yet who did not experience pregnancy. Thereby, we emulate a hypothetic trial in which women, conditional on confounders, are randomly assigned to pregnancy, allowing us to examine whether the negative health effects of pregnancy are amplified among those who most desire to avoid pregnancy. Achieving these aims will contribute new insights into the health repercussions of unintended pregnancy for women and elucidate the degree to which adverse outcomes stem from the intention status of pregnancies or underlying social and contextual factors. These insights are critical to developing appropriately focused maternal morbidity prevention efforts. Robust data on health consequences of attaining one’s preferred pregnancy outcomes are also needed to inform interventions around contraceptive access and reproductive autonomy.

项目概要 研究将意外怀孕与不良孕产妇和儿童健康结果风险增加联系起来 充满了重大的概念和科学限制，包括横截面设计、残差 对怀孕意图的混杂且简单化的回顾性评估是我们科学上的一个关键差距。 因此，知识仍然存在：不良孕产妇健康结果是否与意外怀孕有关 以及由于意外怀孕本身或与之相关的背景因素而导致的生育 意外怀孕的风险增加？拟议的研究是第一个应用最先进方法的研究 和测量怀孕意图的理论，严格解决这一长期存在的科学差距。 这项前瞻性研究对 2,200 名非怀孕女性进行了为期一年的跟踪调查，测量偏好 使用一种新的、强大的工具来了解可能的怀孕：避免怀孕的欲望（DAP）量表。 经过验证的心理测量学 规模捕捉了认知、情感和实际考虑的连续体 怀孕和生育，超越概念上有限的“有意”和“无意”标签。 经历意外怀孕的参与者——以及具有类似情况的匹配的非怀孕女性子集 怀孕偏好——然后再跟踪三年以衡量心理和身体健康 这一创新设计使我们能够实现三个目标。 1，我们将确定女性生活中塑造她们的时变和不变的背景因素 孕前怀孕偏好，例如关系因素和财务稳定性，并测试如何 在目标 2 中，我们将在经历新怀孕的女性中进行偏好预测。 检查前瞻性评估的怀孕偏好与孕产妇健康之间的关系 结果，考虑暂时重要的混杂因素（来自目标 1），我们将进行调查。 怀孕与不良健康结果之间的关系如何因怀孕偏好而异。 具体来说，通过我们的匹配设计，我们将比较孕妇和正常人的健康结果 最能代表她们的反事实的女性：具有相似怀孕偏好但未怀孕的女性 因此，我们模拟了一项假设的试验，其中女性的条件是 混杂因素被随机分配到怀孕，使我们能够检查是否会对健康产生负面影响 在那些最希望避免怀孕的人中，怀孕的几率会更大。 为女性意外怀孕的健康影响提供新的见解，并阐明 不良结果在多大程度上源于怀孕的意图状态或潜在的社会和 这些见解对于制定适当关注的孕产妇发病率至关重要。 关于实现首选妊娠结局对健康造成的影响的可靠数据努力是 还需要为围绕避孕药具获取和生殖自主权的干预措施提供信息。