Intention to Become Pregnant and Low Birth Weight and Preterm Birth: A Systematic Review (original) (raw)

Abstract

Increased stress, psychosocial problems, economic disadvantages, and lack of prenatal care are proposed to explain discrepancies in the outcome of unintended pregnancies. Studies of maternal intention and pregnancy outcomes have yielded varied results. Objective is to review studies of the risk of low birth weight (LBW)/preterm births (PTB) associated with unintended pregnancies ending in a live birth. We reviewed studies reporting on maternal intentions and outcomes from Medline, Embase, CINAHL, and bibliographies of identified articles. An unintended pregnancy was further classified as mistimed (not intended at that time) or unwanted (not desired at any time). Studies reporting an association between pregnancy intention and any of the outcomes were included. Study quality was assessed for biases in selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition. Unadjusted and adjusted data from included studies were extracted by two reviewers. There were significantly increased odds of LBW among unintended pregnancies [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.25, 1.48] ending in a live birth. Within the unintended category, mistimed (OR 1.31, 95% CI 1.13, 1.52) and unwanted (OR 1.51, 95% CI 1.29, 1.78) pregnancies were associated with LBW. There were statistically significantly increased odds of PTB among unintended (OR 1.31, 95% CI 1.09, 1.58), and unwanted (OR 1.50, 95% CI 1.41, 1.61) but not for mistimed (OR 1.36, 95% CI 0.96, 1.93) pregnancies. Unintended, unwanted, and mistimed pregnancies ending in a live birth are associated with a significantly increased risk of LBW and PTB.

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Abbreviations

LBW:

Low birth weight

PTB:

Preterm birth

SGA:

Small for gestational age

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Acknowledgments

We would sincerely like to thank Elizabeth Uleryk, Chief Librarian at the Hospital for Sick Children, Toronto, for her contribution in developing search strategy and running searches on a periodic basis. We would also like to thank Karen Wade from Toronto Public Health Department for her critical review of this manuscript. Funding: This study was supported by funding from Canadian Institute of Health Research (CIHR) Knowledge Synthesis/Translation grant # KRS 86242. CIHR has no role in analyses, writing of the report, interpretation of data or decision to submit the manuscript.

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None for any authors.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Mount Sinai Hospital, 775A-600 University Avenue, Toronto, ON, M5G 1X5, Canada
    Prakesh S. Shah, Taiba Balkhair & Arne Ohlsson
  2. Department of Paediatrics, University of Toronto, Toronto, ON, Canada
    Prakesh S. Shah, Taiba Balkhair & Arne Ohlsson
  3. Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
    Arne Ohlsson
  4. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
    Prakesh S. Shah & Arne Ohlsson
  5. Research Institute of the Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
    Joseph Beyene
  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
    Joseph Beyene & Fran Scott
  7. Toronto Public Health, Toronto, ON, Canada
    Fran Scott
  8. Alberta Perinatal Health Program, University of Calgary, Calgary, AB, Canada
    Corine Frick
  9. Faculty of Nursing, University of Calgary, Calgary, AB, Canada
    Corine Frick

Authors

  1. Prakesh S. Shah
  2. Taiba Balkhair
  3. Arne Ohlsson
  4. Joseph Beyene
  5. Fran Scott
  6. Corine Frick

Corresponding author

Correspondence toPrakesh S. Shah.

Additional information

On behalf of Knowledge Synthesis Group on LBW/preterm birth.

Members of Knowledge Synthesis Group on determinants of LBW/preterm births: Prakesh Shah, University of Toronto, Toronto, Canada; Arne Ohlsson, University of Toronto, Canada; Vibhuti Shah, University of Toronto, Toronto, Canada; Kellie E Murphy, University of Toronto, Canada; Sarah D McDonald, McMaster University, Hamilton, Canada; Eileen Hutton, McMaster University, Hamilton, Canada; Christine Newburn-Cook, University of Alberta, Edmonton, Canada; Corine Frick, University of Calgary, Calgary, Canada; Fran Scott, University of Toronto and Toronto Public Health, Toronto, Canada; Victoria Allen, Dalhousie University, Halifax, Canada; Joseph Beyene, University of Toronto, Toronto, Canada.

Appendix

Appendix

See Appendix Tables 5 and 6.

Table 5 Assessment of quality of included studies

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Table 6 Outcomes reported in individual studies

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Shah, P.S., Balkhair, T., Ohlsson, A. et al. Intention to Become Pregnant and Low Birth Weight and Preterm Birth: A Systematic Review.Matern Child Health J 15, 205–216 (2011). https://doi.org/10.1007/s10995-009-0546-2

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