-
Demography Feb 2022The prevention of unplanned or unintended pregnancies continues to be a cornerstone of U.S. reproductive health policy, but the evidence that such pregnancies cause...
The prevention of unplanned or unintended pregnancies continues to be a cornerstone of U.S. reproductive health policy, but the evidence that such pregnancies cause adverse maternal and child outcomes is limited. In this research note, we examine these relationships using recent large-scale data and inverse propensity weights estimated from generalized boosted models. We find that pregnancy timing is related to maternal experience during pregnancy, but not to infant outcomes at birth-both of which are consistent with prior research. In an addition to the literature, we show that pregnancy timing is relevant for a number of maternal outcomes, such as the onset of depression and intimate partner violence, changes in smoking behavior, and receipt of medical care. These findings suggest that policy intended to improve infant welfare by preventing unintended pregnancies has little empirical support, but that policy focused on increasing reproductive autonomy and maternal well-being has the potential to improve outcomes.
Topics: Child; Family; Female; Humans; Infant; Infant, Newborn; Intention; Intimate Partner Violence; Parturition; Pregnancy; Pregnancy, Unplanned
PubMed: 35040479
DOI: 10.1215/00703370-9710311 -
Reproductive Biomedicine Online Mar 2020Does fetal reduction of triplet pregnancies to singleton result in superior obstetric and neonatal outcomes compared with triplets reduced to twins?
RESEARCH QUESTION
Does fetal reduction of triplet pregnancies to singleton result in superior obstetric and neonatal outcomes compared with triplets reduced to twins?
DESIGN
A historical cohort study including 285 trichorionic and dichorionic triplet pregnancies that underwent abdominal fetal reduction at 11-14 weeks in a single tertiary referral centre. The study population comprised two groups: reduction to twins (n = 223) and singletons (n = 62). Main outcome measures were rates of pregnancy complications, preterm delivery and neonatal outcomes. Non-parametric statistical methods were employed.
RESULTS
Triplet pregnancies reduced to twins delivered earlier (36 versus 39 weeks, P < 0.001) with higher prevalence of Caesarean section (71.1% versus 32.2%, P < 0.001) compared with triplets reduced to singletons. Preterm delivery rates were significantly higher in twins compared with singletons prior to 37 weeks (56.9% versus 13.6%, P < 0.001), 34 weeks (20.2% versus 3.4%, P = 0.002) and 32 weeks (9.6% versus 0%, P = 0.01). No significant difference was found in the rate of pregnancy loss before 24 weeks (1.3% in twins versus 4.8% in singletons, P = 0.12) or in the rate of intrauterine fetal death after 24 weeks (0.4% versus 0%, P = 1.0). Both groups had comparable obstetrical complications and neonatal outcomes, except for higher rates of neonatal intensive care unit admission in twins (31.9% versus 6.8%, P < 0.001).
CONCLUSIONS
Reduction of triplets to singletons rather than twins resulted in superior obstetric outcomes without increasing the procedure-related complications. However, because the rate of extreme prematurity in pregnancies reduced to twins was low, the overall outcome of those pregnancies was favourable. Therefore, the option of reduction to singletons should be considered in cases where the risk of prematurity seems exceptionally high.
Topics: Birth Weight; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Triplet; Pregnancy, Twin
PubMed: 32067870
DOI: 10.1016/j.rbmo.2019.12.014 -
Journal of Midwifery & Women's Health Jan 2018Seventeen percent of women in the United States experience more than one unintended pregnancy in their lifetimes. However, few studies examine how the resolution of...
INTRODUCTION
Seventeen percent of women in the United States experience more than one unintended pregnancy in their lifetimes. However, few studies examine how the resolution of unintended pregnancy, whether in birth or abortion, affects the likelihood of a subsequent unintended pregnancy. Our objective was to determine whether receiving or being denied a wanted abortion is associated with subsequent unintended pregnancy.
METHODS
The Turnaway Study, a 5-year, prospective cohort study, followed women who sought an abortion at one of 30 abortion facilities across the United States between 2008 and 2010. Secondary analysis of the Turnaway data analyzed the effects of various factors on time to subsequent unintended pregnancy.
RESULTS
By 5 years, the rate of unintended pregnancy was 42 per 100 women with no difference between those who received and those who were denied a wanted abortion. Women aged 35 to 46 years (vs those aged 20-24 years), women with a college degree (vs women who had completed high school or obtained a general education diploma), and foreign-born (vs native-born) women had a reduced rate of a subsequent unplanned pregnancy (adjusted hazard ratio [AHR], 0.30; 95% confidence interval [CI], 0.16-0.57; AHR, 0.54, 95% CI, 0.30-0.97; AHR, 0.44; 95% CI, 0.25-0.77, respectively). Higher parity and a history of depression were positively associated with a higher rate of subsequent unintended pregnancy. There was no difference in the outcomes of these unintended pregnancies by study group; approximately one-sixth ended in miscarriage and one-quarter of subsequent unintended pregnancies ended in abortion.
DISCUSSION
Neither receiving nor being denied abortion is associated with subsequent unintended pregnancy risk. Other factors such as nativity, parity, age, and mental health history are associated with multiple unintended pregnancies. Ensuring access to abortion services will not increase the likelihood that women will experience subsequent unintended pregnancies.
Topics: Abortion, Induced; Adolescent; Adult; Depression; Female; Health Services Accessibility; Humans; Mental Health; Middle Aged; Parity; Patient Acceptance of Health Care; Pregnancy; Pregnancy, Unplanned; Pregnancy, Unwanted; Prospective Studies; Socioeconomic Factors; United States; Young Adult
PubMed: 29377521
DOI: 10.1111/jmwh.12723 -
American Journal of Obstetrics and... Apr 2013The Centers for Disease Control and Prevention last estimated a national ectopic pregnancy rate in 1992, when it was 1.97% of all reported pregnancies. Since then rates...
OBJECTIVE
The Centers for Disease Control and Prevention last estimated a national ectopic pregnancy rate in 1992, when it was 1.97% of all reported pregnancies. Since then rates have been reported among privately insured women and regional health care provider populations, ranging from 1.6-2.45%. This study assessed the rate of ectopic pregnancy among Medicaid beneficiaries (New York, California, and Illinois, 2000-03), a previously unstudied population.
STUDY DESIGN
We identified Medicaid administrative claims records for inpatient and outpatient encounters with a principal International Classification of Diseases 9th Revision diagnosis code for ectopic pregnancy. We calculated the ectopic pregnancy rate among female beneficiaries aged 15-44 as the number of ectopic pregnancies divided by the number of total pregnancies, which included spontaneous abortions, induced abortions, ectopic pregnancies, and all births. We used Poisson regression to assess the risk of ectopic pregnancy by age and race.
RESULTS
Four-year Medicaid ectopic pregnancy rates were 2.38% of pregnancies in New York, 2.07% in California, and 2.43% in Illinois. Risk was higher among black women compared with whites in all states (relative risk, 1.26; 95% confidence interval, 1.25-1.28; P < .0001), and among older women compared with younger women (trend for age, P < .001).
CONCLUSION
Medicaid beneficiaries in these 3 states experienced higher rates of ectopic pregnancy than reported for privately insured women nationwide in the same years. Relying on private insurance databases may underestimate ectopic pregnancy's burden in the United States population. Furthermore, within this low-income population racial disparities exist.
Topics: Adolescent; Adult; Female; Humans; Medicaid; Pregnancy; Pregnancy Rate; Pregnancy, Ectopic; United States; Young Adult
PubMed: 23313717
DOI: 10.1016/j.ajog.2012.12.038 -
Obstetrical & Gynecological Survey Aug 2005Over the past 20 years, the number and rate of multiple births have dramatically increased in the United States. The rise in multiple births is mainly attributable to... (Review)
Review
UNLABELLED
Over the past 20 years, the number and rate of multiple births have dramatically increased in the United States. The rise in multiple births is mainly attributable to the increased use of ovulation-inducing drugs and the newly developed assisted reproductive technologies such as in vitro fertilization. Multifetal gestation is associated with an increased risk of perinatal morbidity and mortality. Multiple births account for an increasing percentage of low-birth-weight infants, preterm births, and infant mortality. In this section, we address the management of the multifetal pregnancy, focusing on the maternal physiology, the diagnosis, the pregnancy outcomes, and the antenatal management of multiple gestation.
TARGET AUDIENCE
Obstetricians & Gynecologists, Family Physicians
LEARNING OBJECTIVES
After completion of this article, the reader should be able to describe the effects of the rising rate of multiple pregnancies on perinatal morbidity and mortality, to recall the complications of diagnosing and treating abnormalities of multiple pregnancies, and to list the many changes that occur in both the mother and the fetuses in multiple pregnancies.
Topics: Adult; Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Multiple; Prenatal Care; Risk Factors; Ultrasonography, Prenatal
PubMed: 16056011
DOI: 10.1097/01.ogx.0000172088.29348.e4 -
The Journal of International Medical... Feb 2022Monozygotic triplet pregnancies are very rare in assisted reproductive technology, and the relationship between monozygotic multiple pregnancies and several assisted...
Monozygotic triplet pregnancies are very rare in assisted reproductive technology, and the relationship between monozygotic multiple pregnancies and several assisted reproductive techniques, including blastocyst transfer, remains unclear. Here, the case of a 28-year-old female patient with dichorionic quadruplet pregnancy following intracytoplasmic sperm injection and transfer of two day-3 fresh embryos, without assisted hatching, is reported. At 7 weeks following embryo transfer, the dichorionic quadruplet pregnancy, comprising monozygotic monochorionic triamniotic (MCTA) triplets plus a singleton, was detected by a transabdominal ultrasound scan. After counselling, the patient underwent selective reduction of the MCTA triplet pregnancy at 7 weeks after embryo transfer. The remaining singleton pregnancy was uneventful, resulting in a live birth at 38 weeks. As the predictors of monozygotic multiple gestations remain poorly characterized, clinicians and patients should give great consideration to the risks associated with monozygotic multiple pregnancies, even if the patient has not undergone blastocyst transfer.
Topics: Adult; Embryo Transfer; Female; Humans; Pregnancy; Pregnancy, Multiple; Pregnancy, Quadruplet; Sperm Injections, Intracytoplasmic; Triplets
PubMed: 35118888
DOI: 10.1177/03000605221075506 -
BMC Pregnancy and Childbirth Apr 2022It is generally beneficial for triplet gestation or high-order multiple pregnancies to operate multifetal pregnancy reduction (MFPR) after assisted reproductive...
BACKGROUND
It is generally beneficial for triplet gestation or high-order multiple pregnancies to operate multifetal pregnancy reduction (MFPR) after assisted reproductive techniques. However, data on pregnancy outcomes is lacking regarding dichorionic triamniotic (DCTA) and trichorionic triplets (TCTA) pregnancy.
METHOD
This research analyzes the difference between 128 DCTA and 179 TCTA pregnancies with or without MFPR after in vitro fertilization/intracytoplasmic sperm injection cycles between January 2015 and June 2020. The subdivided subgroups of the two groups are reduction to singleton, reduction to dichorionic twins, and expectant management groups. We also compare the pregnancy and obstetric outcomes between 2104 dichorionic twins and 122 monochorionic twins.
RESULT
The research subgroups were DCTA to monochorionic singleton pregnancies (n = 76), DCTA to dichorionic twin pregnancies (n = 18), DCTA-expectant management (n = 34), TCTA to monochorionic singleton pregnancies (n = 31), TCTA to dichorionic twin pregnancies (n = 130), and TCTA-expectant management (n = 18). In DCTA-expectant management group, the complete miscarriage rate is dramatically higher, and the survival rate and the rate of take-home babies are lower. However, there was no difference between the rates of complete miscarriages, survival rates, and take-home babies in TCTA-expectant management group. But the complete miscarriage rate of DCTA-expectant management was obviously higher than that of TCTA-expectant management group (29.41 vs. 5.56%, p = 0.044). For obstetric outcomes, MFPR to singleton group had higher gestational week and average birth weight, but lower premature delivery, gestational hypertension rates and low birth weight in both DCTA and TCTA pregnancy groups (all p < 0.05). DCTA to monochorionic singleton had the lowest incidence of gestational diabetes, whereas The subdivided subgroups of TCTA had no significant difference in the incidence of gestational diabetes. Monochorionic twins have higher rates of complete, early, and late miscarriage, premature delivery, and late premature delivery, and lower survival rate (p < 0.05).
CONCLUSION
MFPR could improve gestational week and average birth weight, reducing premature delivery, LBW, and gestational hypertension rates in DCTA and TCTA pregnancies. Monochorionic twins have worse pregnancy and obstetric outcomes. MFPR to singleton is preferable recommended in the pregnancy and obstetric management of complex triplets with monochorionic pair.
Topics: Abortion, Spontaneous; Female; Humans; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Triplet; Pregnancy, Twin; Retrospective Studies
PubMed: 35382798
DOI: 10.1186/s12884-022-04617-y -
Midwifery Jan 2023Complications during pregnancy and birth are known risk factors for negative birth experience. Women value the opportunity to review their birth experiences, but limited...
BACKGROUND
Complications during pregnancy and birth are known risk factors for negative birth experience. Women value the opportunity to review their birth experiences, but limited knowledge exists about appropriate interventions and the feasibility of providing this care for women following high-risk pregnancies.
OBJECTIVE
To describe the construction and evaluate the feasibility and acceptability of a postpartum midwifery counselling intervention for women following high-risk pregnancies.
DESIGN
A mixed-method study.
SETTING
A high-risk antenatal outpatient clinic at Landspítali University Hospital in Reykjavík, Iceland.
SAMPLE, RECRUITMENT AND DATA COLLECTION
Thirty women who experienced high-risk pregnancies were invited to write about and review their birth experience with a known midwife 4-6 weeks postpartum. Eight midwives working in a high-risk antenatal clinic provided the intervention after a special training. Data including birth outcomes, birth experience and experience of the intervention were collected by questionnaires from women at two time points before and after the counselling intervention. Midwives providing the intervention completed diaries and participated in focus group interview to explore their experiences of the process.
DATA ANALYSIS
Descriptive and content analysis.
FINDINGS
Women and midwives perceived the intervention positively and feasible in this context. Midwives evaluated the pre-training program as helpful. Most women would like to review their birth experience with a midwife they know, 4-6 weeks postpartum. Almost half of the women wrote about their birth experiences.
KEY CONCLUSIONS
The findings indicate that women experiencing high-risk pregnancies might benefit from a follow up by a midwife they know. Women and midwives perceived the counselling intervention as an acceptable and feasible option in maternity care. The training program sufficiently prepared the midwives to provide the counselling intervention.
IMPLICATIONS FOR PRACTICE
The findings provide an opportunity to offer the intervention on a larger scale to explore the effects further and subsequently implement into routine care after birth for high-risk women.
Topics: Female; Pregnancy; Humans; Pregnancy, High-Risk; Feasibility Studies; Maternal Health Services; Parturition; Midwifery
PubMed: 36223663
DOI: 10.1016/j.midw.2022.103508 -
The International Journal of... Sep 2004An increasing body of literature confirms anecdotal reports that cognitive changes occur during pregnancy. This article assessed whether prior pregnancy, which alters a...
An increasing body of literature confirms anecdotal reports that cognitive changes occur during pregnancy. This article assessed whether prior pregnancy, which alters a woman's subsequent hormonal environment, is associated with a specific cognitive profile during and after pregnancy. Seven primigravids and nine multigravids were compared, equivalent for age and education. No differences between groups were found during pregnancy. After delivery, multigravids performed better than primigravids on verbal memory tasks. After controlling for mood, a significant difference in verbal memory remained. A neuroadaptive mechanism may develop after first pregnancy that increases the ability to recover from some cognitive deficits after later pregnancies.
Topics: Adult; Cognition; Female; Humans; Neuropsychological Tests; Postpartum Period; Pregnancy; Verbal Learning
PubMed: 15370176
DOI: 10.1080/00207450490475544 -
The Journal of Heart and Lung... Aug 2002The purpose of this study was to report a single center's experience of 5 new pregnancies following heart-lung transplantation. These 5 pregnancies gave rise to 4 live...
The purpose of this study was to report a single center's experience of 5 new pregnancies following heart-lung transplantation. These 5 pregnancies gave rise to 4 live births. Vaginal delivery occurred at a mean of 38 +/- 1 weeks of amenorrhea (range, 37-39 weeks) and the mean birth weight was 3,143 +/- 757 grams (range, 2,270-3,990 grams). Mean maternal forced expiratory volume in 1 second (%) before, during (sixth month), and after (1 year) pregnancy was 87 +/- 18, 87 +/- 22, and 88 +/- 17, respectively (p = NS). In conclusion, pregnancy after heart-lung transplantation can be associated with a good prognosis for mother and child.
Topics: Adult; Female; Heart-Lung Transplantation; Humans; Postoperative Period; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk
PubMed: 12163094
DOI: 10.1016/s1053-2498(02)00388-1