Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study

Abstract

Background: Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce. Objective: To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum. Design: This study is based on the population-based birth cohort study ‘Amsterdam Born Children and their Development’ study, which included pregnant people in 2003 ( n = 7784) and followed them up until 12 years postpartum. Methods: Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks. Results: Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions. Conclusion: Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.

‘I was an accident’. Long-term effects of unintended pregnancy on children: Findings from the Dutch prospective birth-cohort Amsterdam Born Children and their Development study

“…The first peaking, but then disappearing effect of unintended pregnancy on children is in line with trends found in other studies examining over-time effects of unintended pregnancy (34). Further, this is in line with previous results showing disappearing risks of unintended pregnancy on maternal mental health over time (11).…”

“…People who carried an unintended pregnancy to term reported poorer bonding and mental health, which in turn was associated to psychosocial problems of the child . This is in line with previous studies, which found that people carrying an unintended pregnancy to term reported poorer maternal bonding (14) and more mental health problems in the first years postpartum (11). Thus, current results stress the importance of maternal mental health for children, which appeared to be a stronger factor contributing to children’s psychosocial problems than pregnancy unintendedness.…”

“…Participants who were lost to follow up were compared to those who responded to each measurement. Detailed results are reported in an earlier published manuscript (11). In short, compared to responders, dropouts reported more antepartum mental health problems and more unintended pregnancies.…”

“…Besides inconsistent results, previous research into potential indirect effects explaining impact of unintended pregnancy on children is lacking. People who carried an unintended pregnancy to term, reported more mental health problems later in life (11, 12). Concurrently, maternal mental health has been found to affect children’s psychosocial problems (13).…”

Comparison of maternal-fetal attachment, anxiety, depression, and prevalence of intimate partner violence in Iranian women with intended and unintended pregnancy: a cross-sectional study

“…Unintended pregnancy is associated with decreased maternal-fetal attachment [ 10 ] and can lead to inadequate prenatal care and nutrition, resulting in adverse outcomes for both the mother and the child [ 11 ]. The type of unintended pregnancy, whether it is mistimed or unwanted, has a significant relationship with maternal-fetal attachment, with mistimed pregnancies showing higher levels of attachment compared to unwanted pregnancies [ 12 ].…”