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Pregnancy Intentions and Maternal and Child Health: An Analysis of Longitudinal Data in Oklahoma

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Abstract

Better understanding of the impact of unintended childbearing on infant and early childhood health is needed for public health practice and policy. Data from the 2004–2008 Oklahoma Pregnancy Risk Assessment Monitoring System survey and The Oklahoma Toddler Survey 2006–2010 were used to examine associations between a four category measure of pregnancy intentions (intended, mistimed <2 years, mistimed ≥2 years, unwanted) and maternal behaviors and child health outcomes up to age two. Propensity score methods were used to control for confounding. Births mistimed by two or more years (OR .58) and unwanted births (OR .33) had significantly lower odds than intended births of having a mother who recognized the pregnancy within the first 8 weeks; they were also about half as likely as intended births to receive early prenatal care, and had significantly higher likelihoods of exposure to cigarette smoke during pregnancy. Breastfeeding was significantly less likely among unwanted births (OR .68); breastfeeding for at least 6 months was significantly less likely among seriously mistimed births (OR .70). We find little association between intention status and early childhood measures. Measured associations of intention status on health behaviors and outcomes were most evident in the prenatal period, limited in the immediate prenatal period, and mostly insignificant by age two. In addition, most of the negative associations between intention status and health outcomes were concentrated among women with births mistimed by two or more years or unwanted births. Surveys should incorporate questions on the extent of mistiming when measuring pregnancy intentions.

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Notes

  1. Oklahoma is one of only four states with data available from follow-up interviews of PRAMS mothers; the others are Alaska, Rhode Island, and Oregon.

  2. Only one other state (Utah) included such a question in the PRAMS survey during the same period.

  3. Response categories were less than 1 year, 1 year to less than 2 years, 2 years to less than 3 years, 3 years to less than 4 years, 4 years or more.

  4. Mothers slightly overestimate early entry into prenatal care on the PRAMS survey (Oklahoma State Department of Health, PRAMSGRAM Initiation of Prenatal Care Among Women Having a Live Birth in Oklahoma, 1995, 5(2) http://www.ok.gov/health2/documents/PRAMS_Initiation%20of%20PNC_95.pdf.pdf, accessed 11/21/13); however, these small overestimates are unlikely to affect our final estimates substantially.

  5. This measure was drawn from the linked birth certificate.

  6. Defined as diarrhea lasting at least 3 days, an ear infection, or a cold or runny nose with a fever or cough.

  7. Paired comparisons of differences in the size of the proportions for intention status groups for individual attributes were tested for statistical significance using t tests. Only statistically significant differences are mentioned in the text (p < .05).

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Acknowledgments

This study was supported by Grant R40 MC 25692 from the Maternal and Child Health Research Program, Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD068433. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Health and Human Services.

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Authors and Affiliations

  1. Guttmacher Institute, New York, NY, USA

    Laura Lindberg, Isaac Maddow-Zimet & Kathryn Kost

  2. Maternal and Child Health Service, Oklahoma Department of Health, Oklahoma City, OK, USA

    Alicia Lincoln

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Correspondence to Laura Lindberg.

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Lindberg, L., Maddow-Zimet, I., Kost, K. et al. Pregnancy Intentions and Maternal and Child Health: An Analysis of Longitudinal Data in Oklahoma. Matern Child Health J 19, 1087–1096 (2015). https://doi.org/10.1007/s10995-014-1609-6

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