Pregnancy Intention and Pregnancy Outcome: Systematic Review and Meta-Analysis
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REVIEW PAPER
Pregnancy Intention and Pregnancy Outcome: Systematic Review and Meta-Analysis Jennifer A. Hall1 · Lorna Benton2 · Andrew Copas3 · Judith Stephenson1
© The Author(s) 2017. This article is published with open access at Springerlink.com
Abstract Introduction Previous systematic reviews concluded that rigorous research on the relationships between pregnancy intentions and pregnancy outcomes is limited. They further noted that most studies were conducted in high-income countries and had methodological limitations. We aim to assess the current evidence base for the relationship between pregnancy intention and miscarriage, stillbirth, low birthweight (LBW) and neonatal mortality. In March 2015 Embase, PubMed, Scopus and PsychInfo were searched for studies investigating the relationship between pregnancy intention and the outcomes of interest. Methods Studies published since 1975 and in English, French or Spanish were included. Two reviewers screened titles and abstracts, read the full text of identified articles and extracted data. Meta-analyses were conducted where possible. Results Thirty-seven studies assessing the relationships between pregnancy intention and LBW were identified. A meta-analysis of 17 of these studies found that unintended pregnancies are associated with 1.41 times greater odds
of having a LBW baby (95%CI 1.31, 1.51). Eight studies looking at miscarriage, stillbirth or neonatal death were found. The limited data concerning pregnancy loss and neonatal mortality precluded meta-analysis but suggest these outcomes may be more common in unintended pregnancies. Discussion While there seems to be an increased risk of adverse pregnancy outcome in unintended pregnancies, there has been little improvement in either the quantity of evidence from low-income countries or in the quality of evidence generally. Longitudinal studies of pregnancy intention and pregnancy outcome, where pregnancy intention is assessed prospectively with a validated measure and where analyses include confounding or mediating factors, are required in both high- and low-income countries. Keywords Systematic review · Meta-analysis · Pregnancy intention · Miscarriage · Stillbirth · Low birthweight · Neonatal mortality
Significance * Jennifer A. Hall [email protected] Lorna Benton [email protected] Andrew Copas [email protected] Judith Stephenson [email protected] 1
Research Department of Reproductive Health, UCL Institute for Women’s Health, London, UK
2
Department of Population Policy and Practice, UCL Institute of Child Health, London, UK
3
Department of Infection and Population Health, UCL Institute of Epidemiology and Health Care, London, UK
What is already known on this subject? Pregnancy intention may be associated with adverse pregnancy outcomes. Previous systematic reviews concluded that insufficient attention has been paid to investigating these relationships. They further noted that most studies were conducted in high-income countries and had methodological limitations that could inv
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