Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Dev Behav Pediatr. 2021 Dec 1;42(9):e15-e23. doi: 10.1097/DBP.0000000000000951.
This study aims to characterize the association between maternal pregnancy intention and socioemotional developmental outcomes in a Brazilian sample of preschool-aged children.
Data from children aged 4 to 5 years and their primary caregivers in Embu das Artes, a Brazilian municipality in the state of São Paulo, were collected in 2016. Maternal pregnancy intention was defined as intended or unintended, which was then further stratified as mistimed or unwanted. Outcomes included socioemotional developmental delay, internalizing and externalizing behaviors, and school readiness. We estimated risk ratios (RRs) for unadjusted and inverse-probability-weighted regression adjustment (IPWRA) analyses using 2-level (intended vs unintended) and 3-level (intended vs mistimed vs unwanted) exposure definitions.
Of 1,034 total mothers, 40.7% reported their pregnancy as intended, 46.0% as mistimed, and 13.4% as unwanted. In both unadjusted and IPWRA analyses comparing intended and unintended pregnancies, all associations failed to reach statistical significance. In the IPWRA analysis using the 3-level exposure definition, unwanted pregnancies were associated with higher risk of socioemotional developmental delay (RR = 1.14; 95% confidence interval [CI], 1.01-1.28) and co-occurring internalizing and externalizing behaviors (RR = 1.11, 95% CI, 1.00-1.22), compared with intended pregnancies.
There was higher risk of poor child outcomes among unwanted compared with intended pregnancies, whereas mistimed pregnancies were not associated with poor outcomes. Further research using standardized definitions of pregnancy intention along with targeted interventions that increase access to family planning services and counseling for parents of children born after unintended pregnancies is needed.
本研究旨在描述巴西学龄前儿童样本中，母亲妊娠意图与社会情感发育结果之间的关系。
本研究于 2016 年在巴西圣保罗州埃姆布达斯阿尔特斯市收集了 4 至 5 岁儿童及其主要照顾者的数据。母亲妊娠意图定义为有意或无意，进一步分为时机不当或不想要。结果包括社会情感发育迟缓、内化和外化行为以及入学准备情况。我们使用 2 级（有意与无意）和 3 级（有意与时机不当与不想要）暴露定义，在未调整和逆概率加权回归调整（IPWRA）分析中估计风险比（RR）。
在总共 1034 名母亲中，40.7%报告其妊娠为有意，46.0%为时机不当，13.4%为不想要。在未调整和 IPWRA 分析中，将有意和无意妊娠进行比较时，所有关联均未达到统计学意义。在使用 3 级暴露定义的 IPWRA 分析中，与有意妊娠相比，不想要的妊娠与社会情感发育迟缓的风险增加相关（RR=1.14；95%置信区间[CI]，1.01-1.28）和并发的内化和外化行为（RR=1.11，95% CI，1.00-1.22）。
与有意妊娠相比，不想要的妊娠与较差的儿童结局风险更高，而时机不当的妊娠与不良结局无关。需要使用妊娠意图的标准化定义以及增加计划生育服务和对意外怀孕后儿童父母的咨询的针对性干预措施进行进一步研究。
