Pregnancy planning, smoking behaviour during pregnancy, and neonatal outcome: UK millennium cohort study

Flower, Anika; Shawe, Jill; Stephenson, Judith; Doyle, Pat

doi:10.1186/1471-2393-13-238

Cited by 54 publications

(64 citation statements)

References 22 publications

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“…Target all women contacting primary care for SSRI prescriptions, not just those identifying themselves as planning pregnancy, since ~43% UK pregnancies are unplanned[147]. …”

Section: Discussionmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants in Pregnancy and Congenital Anomalies: Analysis of Linked Databases in Wales, Norway and Funen, Denmark

et al. 2016

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BackgroundHypothesised associations between in utero exposure to selective serotonin reuptake inhibitors (SSRIs) and congenital anomalies, particularly congenital heart defects (CHD), remain controversial. We investigated the putative teratogenicity of SSRI prescription in the 91 days either side of first day of last menstrual period (LMP).Methods and FindingsThree population-based EUROCAT congenital anomaly registries- Norway (2004–2010), Wales (2000–2010) and Funen, Denmark (2000–2010)—were linked to the electronic healthcare databases holding prospectively collected prescription information for all pregnancies in the timeframes available. We included 519,117 deliveries, including foetuses terminated for congenital anomalies, with data covering pregnancy and the preceding quarter, including 462,641 with data covering pregnancy and one year either side. For SSRI exposures 91 days either side of LMP, separately and together, odds ratios with 95% confidence intervals (ORs, 95%CI) for all major anomalies were estimated. We also explored: pausing or discontinuing SSRIs preconception, confounding, high dose regimens, and, in Wales, diagnosis of depression. Results were combined in meta-analyses. SSRI prescription 91 days either side of LMP was associated with increased prevalence of severe congenital heart defects (CHD) (as defined by EUROCAT guide 1.3, 2005) (34/12,962 [0.26%] vs. 865/506,155 [0.17%] OR 1.50, 1.06–2.11), and the composite adverse outcome of 'anomaly or stillbirth' (473/12962, 3.65% vs. 15829/506,155, 3.13%, OR 1.13, 1.03–1.24). The increased prevalence of all major anomalies combined did not reach statistical significance (3.09% [400/12,962] vs. 2.67% [13,536/506,155] OR 1.09, 0.99–1.21). Adjusting for socio-economic status left ORs largely unchanged. The prevalence of anomalies and severe CHD was reduced when SSRI prescriptions were stopped or paused preconception, and increased when >1 prescription was recorded, but differences were not statistically significant. The dose-response relationship between severe CHD and SSRI dose (meta-regression OR 1.49, 1.12–1.97) was consistent with SSRI-exposure related risk. Analyses in Wales suggested no associations between anomalies and diagnosed depression.ConclusionThe additional absolute risk of teratogenesis associated with SSRIs, if causal, is small. However, the high prevalence of SSRI use augments its public health importance, justifying modifications to preconception care.

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“…Target all women contacting primary care for SSRI prescriptions, not just those identifying themselves as planning pregnancy, since ~43% UK pregnancies are unplanned[147]. …”

Section: Discussionmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants in Pregnancy and Congenital Anomalies: Analysis of Linked Databases in Wales, Norway and Funen, Denmark

et al. 2016

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“…Previous studies demonstrating a significant increase in preterm (10-15,16,17) or SGA births (3,10,11,13,14,17-22) among unplanned pregnancies have multiple methodological limitations. Most studies showing a positive association relied on retrospective assessment of pregnancy intention,(3,10-15,17-22) which may be subject to recall and reporting bias (2,52).…”

Section: Discussionmentioning

confidence: 99%

“…Most studies showing a positive association relied on retrospective assessment of pregnancy intention,(3,10-15,17-22) which may be subject to recall and reporting bias (2,52). Prospective longitudinal analyses of pregnancy planning and timing demonstrate that women’s answers change over time, especially after childbirth and women are more likely to report a pregnancy as planned, possibly due to rationalization (2,52).…”

Section: Discussionmentioning

confidence: 99%

“…Women giving birth to infants with health problems due to prematurity or SGA may also be more likely to report a pregnancy as unplanned (53). In addition to limitations in exposure assessment, many studies employed methods to ascertain birth outcomes that are less reliable than review of individual medical charts, including retrospective parental surveys and use of birth certificate data (10,12-15, 17, 19, 20, 22). Studies reporting an increased risk of preterm or SGA births among women with unplanned pregnancies are also hampered by lack of control for potential confounding variables (11,15,18).…”

Section: Discussionmentioning

confidence: 99%

“…While there is support for an association between unplanned pregnancy and either preterm birth (7-17), SGA, or low birth weight (3,10,11,13,14,17-22), not all studies agree (15,23-27). More clearly understanding risk factors for preterm and SGA births is a public health priority.…”

Section: Introductionmentioning

confidence: 99%

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Are pregnancy planning and timing associated with preterm or small for gestational age births?

Gariepy

Lundsberg

Stolar

et al. 2015

Fertility and Sterility

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Objective Investigate whether unplanned or poorly timed pregnancies (self-reported at enrollment) are associated with preterm or small for gestational age births. Design Prospective cohort of 2,654 pregnant women with individual assessments. Setting Offices (n=137) providing prenatal care in Connecticut and Western Massachusetts March 2005 to May 2009. Patient(s) Women less than 18 weeks estimated gestational age with a singleton pregnancy. Intervention(s) None. Main Outcome Measure(s) Preterm and small for gestational age births. Results In adjusted analyses, pregnancy planning was not significantly associated with preterm (Odds Ratio 1.18, 95%CI 0.85-1.65) nor small for gestational age birth (Odds Ratio 1.17, 95%CI 0.69-1.97). Similarly, poorly timed pregnancies were not significantly associated with preterm (Odds Ratio 0.85, 95%CI 0.53-1.38) nor small for gestational age birth (Odds Ratio 0.92, 95%CI 0.65-1.29). Combining pregnancy planning (yes/no) and timing (yes/no) into a 4-level category showed no significant association with preterm birth or small for gestational age. Conclusion(s) In a large cohort with antenatally assessed pregnancy planning and timing, outcome data collected from medical record abstraction, and robust analysis adjusting for multiple confounding factors including maternal demographics, medical conditions, and other risk factors, neither pregnancy planning nor pregnancy timing showed a significant association with preterm or small for gestational age infants. This study improves upon previous analyses that lack adjustment for confounding, and use retrospective self-reporting to assess pregnancy planning and timing, and preterm and small for gestational age birth. Findings may differ in higher risk populations with higher prevalence of preterm or small for gestational age births. Capsule Neither pregnancy planning nor timing showed a significant association with preterm or small for gestational age births in this large prospective cohort controlling for confounders.

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Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes

Nelson

Darney

Ahrens

et al. 2022

JAMA

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ImportanceUnintended pregnancy is common in the US and is associated with adverse maternal and infant health outcomes; however, estimates of these associations specific to current US populations are lacking.ObjectiveTo evaluate associations of unintended pregnancy with maternal and infant health outcomes during pregnancy and post partum with studies relevant to current clinical practice and public health in the US.Data SourcesCochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE databases (January 1, 2000, to June 15, 2022) and manual review of reference lists.Study SelectionEpidemiologic studies relevant to US populations that compared key maternal and infant health outcomes for unintended vs intended pregnancies and met prespecified eligibility criteria were included after investigators’ independent dual review of abstracts and full-text articles.Data Extraction and SynthesisInvestigators abstracted data from publications on study methods, participant characteristics, settings, pregnancy intention, comparators, confounders, and outcomes; data were validated by a second investigator. Risk of bias was independently dual rated by investigators using criteria developed by the US Preventive Services Task Force. Results of studies controlling for confounders were combined by using a profile likelihood random-effects model.Main Outcomes and MeasuresPrenatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth, and infant low birth weight.ResultsThirty-six studies (N = 524 522 participants) were included (14 cohort studies rated good or fair quality; 22 cross-sectional studies); 12 studies used large population-based data sources. Compared with intended pregnancy, unintended pregnancy was significantly associated with higher odds of depression during pregnancy (23.3% vs 13.9%; adjusted odds ratio [aOR], 1.59 [95% CI, 1.35-1.92]; I2 = 85.0%; 15 studies [n = 41 054]) and post partum (15.7% vs 9.6%; aOR, 1.51 [95% CI, 1.40-1.70]; I2 = 7.1%; 10 studies [n = 82 673]), interpersonal violence (14.6% vs 5.5%; aOR, 2.22 [95% CI, 1.41-2.91]; I2 = 64.1%; 5 studies [n = 42 306]), preterm birth (9.4% vs 7.7%; aOR, 1.21 [95% CI, 1.12-1.31]; I2 = 1.7%; 10 studies [n = 94 351]), and infant low birth weight (7.3% vs 5.2%; aOR, 1.09 [95% CI, 1.02-1.21]; I2 = 0.0%; 8 studies [n = 87 547]). Results were similar in sensitivity analyses based on controlling for history of depression for prenatal and postpartum depression and on study design and definition of unintended pregnancy for relevant outcomes. Studies provided limited sociodemographic data and measurement of confounders and outcomes varied.Conclusions and RelevanceIn this systematic review and meta-analysis of epidemiologic observational studies relevant to US populations, unintended pregnancy, compared with intended pregnancy, was significantly associated with adverse maternal and infant outcomes.Trial RegistrationPROSPERO Identifier: CRD42020192981

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Pregnancy planning, smoking behaviour during pregnancy, and neonatal outcome: UK millennium cohort study

Cited by 54 publications

References 22 publications

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants in Pregnancy and Congenital Anomalies: Analysis of Linked Databases in Wales, Norway and Funen, Denmark

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants in Pregnancy and Congenital Anomalies: Analysis of Linked Databases in Wales, Norway and Funen, Denmark

Are pregnancy planning and timing associated with preterm or small for gestational age births?

Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes

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