Pregnancy Intentions and Birth Outcomes in Southern States

• Main Author: Dierschke, Nicole Adele
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2017
• Subjects: Public health
• ISBN: 0355339153; 9780355339154

Objective: Adolescents <20 years old and women 35+ years old are at increased risk for preterm birth (PTB), low birth weight (LBW), and infant mortality (IM). Unintended pregnancy (UP) is significantly associated with infants being born preterm or LBW. The geographic region most burdened by high adolescent birth rates and UP rates is in the Southern U.S. However, there is little evidence of the demographic profile of women that experienced a PTB, LBW infant or an IM among those in Southern states. Moreover, little is known about the effect of pregnancy intentions on these outcomes in highly burdened Southern states. Methods: Two studies were conducted. The aim of study 1 was to create a demographic profile of women that experienced a PTB, LBW, or IM. The aim of study 2 was to determine the association between pregnancy intentions and PTB, LBW, and IM. Both studies used the Pregnancy Risk Assessment Monitoring System data for women ages 15-44 that gave birth in Oklahoma, Arkansas, Texas, Georgia, and West Virginia during 2009-2011. Univariate, chi-square, and multivariable logistic regression were performed for both studies. Results: The prevalence of IM was similar to the national rate, while PTB and LBW were below the rates for 2011. Women with an IM were significantly more likely to be of lower socioeconomic status and from Arkansas or Texas. Women 35+ years old, blacks and Asians, and those that had a previous PTB had greater odds of PTB and LBW infants. Respondents from Oklahoma and Texas had greater odds of LBW. Young maternal age (≤19 years old) was associated with lower odds for PTB, and pregnancy morbidities were associated with greater odds for all outcomes. A total of 48.3% of participants reported an unintended pregnancy (UP). Participants that were black (66.9%) and those that were 35 + years old (65.7%) had the highest rates of UP. Minorities, younger, lower income, higher parity, and smoking during pregnancy had lower odds of an intended pregnancy. Pregnancy intention was not significant in any modeling; however, women 35+ years old with an UP had a 93% lower odds of an IM. Conclusions: Maternal age and race remain significant determinants of adverse birth outcomes; however, this study challenges prior work suggesting women of younger age have greater odds of IM, PTB, and LBW. Moreover, UP has a differential effect on IM, depending on maternal age. Study findings can help identify the demographic profile of women most at risk for all three outcomes, and results emphasize the need for a validated measure of pregnancy intentions. Future studies aimed at preventing pregnancy morbidities could help alleviate the impact on poor birth outcomes, and more research should focus on risk factors associated with term infants born LBW. Finally, studies should further investigate interactions with pregnancy intentions among older women to identify factors that contribute to IM.