Research Department of Reproductive Health, UCL Institute for Women's Health, London, United Kingdom.
Department of Infection & Population Health, UCL Institute of Epidemiology and Health Care, London, United Kingdom.
PLoS One. 2018 Oct 18;13(10):e0205487. doi: 10.1371/journal.pone.0205487. eCollection 2018.
It is unclear whether unintended pregnancies are associated with adverse outcomes. Data are predominantly from high-income countries and have methodological limitations, calling the findings into question. This research was designed to overcome these limitations and assess the relationships between pregnancy intention and miscarriage, stillbirth, low birthweight, neonatal death and postnatal depression in a low-income country.
The pregnancy intention of 4,244 pregnant women in Mchinji District, Malawi, was measured using the validated Chichewa version of the London Measure of Unplanned Pregnancy (LMUP). Women were re-interviewed postnatally to assess pregnancy outcome. Postnatal depression was assessed using the WHO's Self-Reporting Questionnaire. Multivariable regressions were conducted, with the choice of confounders informed by a pre-existing conceptual epidemiological hierarchy.
Planned pregnancies are associated with a reduced risk of any (adjusted RR 0.90 [95%CI 0.86, 0.95]) or high symptoms of depression (adjusted RR 0.76 [95%CI 0.63, 0.91]) compared to unplanned pregnancies in rural Malawi. There was no relationship between pregnancy intention and the composite measure of miscarriage, stillbirth, low birthweight and neonatal death. There was some evidence that greater pregnancy intention was associated with reduced adjusted risk of stillbirth (0·93 [95%CI 0·87, 1·00]).
Our study is the first to use a psychometrically valid measure of pregnancy intention, and to do so antenatally. As pregnancy intention increases, the risk of postnatal depression and, possibly, stillbirth decreases. This suggests a new, clinical use for the LMUP; identifying women antenatally who are at risk of these adverse pregnancy outcomes.
目前尚不清楚意外怀孕是否与不良结局有关。数据主要来自高收入国家，且存在方法学上的局限性，这使得研究结果受到质疑。本研究旨在克服这些局限性，并评估在一个低收入国家中，妊娠意图与流产、死产、低出生体重、新生儿死亡和产后抑郁之间的关系。
马拉维姆钦吉区的 4244 名孕妇使用经过验证的奇契瓦语版伦敦意外妊娠测量工具（London Measure of Unplanned Pregnancy，LMUP）来测量妊娠意图。产后对这些女性进行重新访谈以评估妊娠结局。使用世界卫生组织的自我报告问卷评估产后抑郁。进行多变量回归，选择混杂因素的依据是预先存在的概念流行病学层次结构。
与无计划妊娠相比，计划妊娠与农村马拉维任何（调整后的 RR 0.90 [95%CI 0.86, 0.95]）或高症状的抑郁（调整后的 RR 0.76 [95%CI 0.63, 0.91]）风险降低有关。妊娠意图与流产、死产、低出生体重和新生儿死亡的综合指标之间没有关系。有一些证据表明，妊娠意图越高，调整后的死产风险降低（0·93 [95%CI 0·87, 1·00]）。
本研究首次使用心理测量学上有效的妊娠意图测量方法，并在产前进行。随着妊娠意图的增加，产后抑郁和可能的死产风险降低。这表明 LMUP 有一个新的临床用途；在产前识别出有这些不良妊娠结局风险的女性。
