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Impact of Psychosocial Health on Pregnancy Intention
Pamela J. Maxson, Ph.D. Christina Gibson-Davis, Ph.D., Geeta Swamy, M.D., Redford Williams, M.D., Marie Lynn Miranda, Ph.D. 11/5/07
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Children’s Environmental Health Initiative
A research, education, and outreach program committed to fostering environments where all children can prosper.
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Relationships among SCEDDBO Projects
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Study Design Prospective cohort study of pregnant women in Durham, NC Psychosocial assessment through surveys Maternal blood draws at 28 weeks (genetics) and at birth (environmental exposures) Delivery samples: placental tissue, cord segment, cord blood Pregnancy outcomes including: Birth weight Gestation Maternal medical complications
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Study Participants Over 18 years of age Speak/read English Must live in Durham County (neighborhood assessment component) Singleton gestation, no known congenital abnormalities Between weeks gestation at recruitment Recruitment (current=748; target=1500) Duke OB clinic (409, 121 NHW, 249 NHB, 26 H) Lincoln Community Health Center-Durham County Health Department (339, 20 NHW, 272 NHB, 33 H)
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Demographics of Participants
Income (%) 30 25 20 15 10 5 130 159 113 134 <$5000 $5-20,000 $20-40,000 >$40,000 Education (%) 10 20 30 40 50 Some HS HS Some college College Racial Distribution (%) 10 20 30 40 50 60 70 80 NHB NHW Hispanic 74 250 147 144 521 141 59
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Pregnancy Intention Survey Question
Think back to just before you were pregnant with this child. How did you feel about becoming pregnant? I wanted to be pregnant at that time. I wanted to be pregnant sooner. I wanted to be pregnant later. I didn’t want to be pregnant at that time or at any time in the future. Now Never Later
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Pregnancy Intention Status
Now N=240 39% of participants Later N=260 42% of participants Never N=113 19% of participants 61% of the pregnancies are mistimed or unwanted
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Psychosocial Instruments
CES-D John Henryism ISEL Paternal Support Self-Efficacy Perceived Stress NEO Significant differences across intention status
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Lowest depressive symptoms Highest depressive symptoms
Depression (CES-D) Lowest depressive symptoms Highest depressive symptoms Now Later Never p=<.08 p<.0001 p<.0001
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ISEL- Interpersonal Support
Most support Least support Now Later Never p<.08 p<.07 p<.01
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Paternal Support Most support Least support Now Later Never p<.01
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Highest Self-efficacy
Lowest Self-efficacy Now Later Never p<.05 p<.05
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Least perceived stress
Most perceived stress Now Later Never p<.09 p<.0001 p<.0001
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Extraversion- NEO Most extraverted Least extraverted Now Later Never
p<.08 p<.07 p<.01
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Neuroticism- NEO Least neurotic Now Later Never Most neurotic
p<.001 p<.001 p<.001
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-Openness to Experience -Agreeableness -Conscientiousness
Personality- NEO -Openness to Experience -Agreeableness -Conscientiousness Highest Lowest Now Later Never Significant Significant
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Maternal Behaviors No differences in tobacco usage between intention statuses. No differences in alcohol usage between intention statuses.
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Gestational age at delivery
Pregnancy Outcomes Birth weight Gestational age at delivery Prevalence of gestational diabetes Pregnancy related hypertension Gestational Intention Age Never* weeks Later weeks Now weeks among intention statuses. (Never significantly lower than Later and Now). BW- no significant differences GA- Never significantly lower than Later and Now. No significant differences in gestational diabetes or pregnancy related hypertension
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Closing points Psychosocial indices differ by intention status with “Now” having a healthier psychosocial profile and “Never” having a less healthy psychosocial profile Depression (CES-D) Self-efficacy Interpersonal Support Paternal Support Perceived Stress Personality Pregnancy intention is a multifaceted construct.
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Acknowledgements National Institutes of Health U.S. Environmental Protection Agency Duke University and Medical Center Study participants Duke University Office of Research Support
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Pregnancy Intention and Maternal Age
20 40 60 80 100 120 140 160 180 Never Later Now under 25 26-30 31-35 over 36 Chi-square 69.33, p<.0001
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Race by Maternal Age Non-Hispanic Blacks Non-Hispanic Whites
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Pregnancy Intention by Race
70 60 50 % 40 NHB NHW 30 Hispanics 20 10 Never Later Now 113 255 220
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Pregnancy Intention and Income
% Of those who are in the lowest income category, 47% of them report wanting to be pregnant later. Similarly, of those in the middle income range, 47% of them report wanting to be pregnant later. Of those in the highest income category, 72% report wanting to be pregnant now.
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Pregnancy Intention and Income
Non-Hispanic Blacks versus Non-Hispanic Whites 10 20 30 40 50 60 70 80 90 Never Later Now <$20,000 $20-40,000 >$40,000 10 20 30 40 50 60 70 80 90 Never Later Now Non-Hispanic Blacks Non-Hispanic Whites
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Pregnancy Intention and Insurance
10 20 30 40 50 60 70 Never Later Now No Insure Medicaid Private Intention differs as expected with insurance. Those privately insured are more likely to want the pregnancy now. Those on Medicaid are more likely to want to be pregnant later. Those with no insurance (32) are split relatively equally, with fewer saying ‘never.’
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Paternal Relationship
While the distribution is somewhat as expected, it is interesting to note how the percentage of women in non-marital relationships who say that wanted to be pregnant now.
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