Unintended pregnancy and maternal health complications: cross-sectional analysis of data from rural Uttar Pradesh, India

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Abstract

Background

This study aims to explore the potential association between unintended pregnancy and maternal health complications. Secondarily, we test whether antenatal care (ANC) and community health worker (CHW) visits moderate the observed association between unintended pregnancy and maternal health complications.

Methods

Cross sectional data were collected using a multistage sampling design to identify women who had a live birth in the last 12 months across 25 highest risk districts of Uttar Pradesh ( N = 3659). Participants were surveyed on demographics, unintendedness of last pregnancy, receipt of ANC clinical visits and community outreach during pregnancy, and maternal complications. Regression models described the relations between unintended pregnancy and maternal complications. To determine if receipt of ANC and CHW visits in pregnancy moderated associations between unintended pregnancy and maternal complications, we used the Mantel-Haenzel risk estimation test and stratified logistic models testing interactions of unintended pregnancy and receipt of health services to predict maternal complications.

Results

Around one-fifth of the women (16.9%) reported that their previous pregnancy was unintended. Logistic regression analyses revealed that unintended pregnancy was significantly associated with maternal complications- pre-eclampsia (AOR:2.06; 95% CI:1.57–2.72), postpartum hemorrhage (AOR:1.46; 95% CI: 1.01–2.13) and postpartum pre-eclampsia (AOR:2.34; 95% CI:1.47–3.72). Results from the Mantel Haenszel test indicated that both ANC and CHW home visit in pregnancy significantly affect the association between unintended pregnancy and postpartum hemorrhage ( p < 0.001).

Conclusion

Unintended pregnancy is associated with increased risk for maternal health complications, but provision of ANC clinical visits and CHW home visits in pregnancy may be able to reduce potential effects of unintended pregnancy on maternal health.

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Most cited references 19

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How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania

Amon Exavery, Almamy Kanté, Ahmed Hingora … (2013)

Background Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation. Methods Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 3,127 women from whom 910 of reproductive age who had given birth in the past two years and sought ANC at least once during pregnancy were selected for the current analysis. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chi-square was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies relate with timing of ANC initiation. Results Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10–2.58) and 2.00 (95% CI 1.05–3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41–5.59) and 4.10 (95% CI 1.68–10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility. Conclusion Late ANC initiation is a significant maternal and child health consequence of mistimed and unwanted pregnancies in Tanzania. Women should be empowered to delay or avoid pregnancies whenever they need to do so. Appropriate counseling to women, especially those who happen to conceive unintentionally is needed to minimize the possibility of delaying ANC initiation.

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Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population.

Claudio G. Sosa, Fernando Althabe, Pierre Buekens … (2009)

To identify risk factors for immediate postpartum hemorrhage after vaginal delivery in a South American population. This was a prospective cohort study including all vaginal births (N=11,323) between October and December 2003 and October and December 2005 from 24 maternity units in two South American countries (Argentina and Uruguay). Blood loss was measured in all births using a calibrated receptacle. Moderate postpartum hemorrhage and severe postpartum hemorrhage were defined as blood loss of at least 500 mL and at least 1,000 mL, respectively. Moderate and severe postpartum hemorrhage occurred in 10.8% and 1.9% of deliveries, respectively. The risk factors more strongly associated and the incidence of moderate postpartum hemorrhage in women with each of these factors were: retained placenta (33.3%) (adjusted odds ratio [OR] 6.02, 95% confidence interval [CI] 3.50-10.36), multiple pregnancy (20.9%) (adjusted OR 4.67, CI 2.41-9.05), macrosomia (18.6%) (adjusted OR 2.36, CI 1.93-2.88), episiotomy (16.2%) (adjusted OR 1.70, CI 1.15-2.50), and need for perineal suture (15.0%) (adjusted OR 1.66, CI 1.11-2.49). Active management of the third stage of labor, multiparity, and low birth weight were found to be protective factors. Severe postpartum hemorrhage was associated with retained placenta (17.1%) (adjusted OR 16.04, CI 7.15-35.99), multiple pregnancy (4.7%) (adjusted OR 4.34, CI 1.46-12.87), macrosomia (4.9%) (adjusted OR 3.48, CI 2.27-5.36), induced labor (3.5%) (adjusted OR 2.00, CI 1.30-3.09), and need for perineal suture (2.5%) (adjusted OR 2.50, CI 1.87-3.36). Many of the risk factors for immediate postpartum hemorrhage in this South American population are related to complications of the second and third stage of labor. II.

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Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan

Muhammad Atif Habib, Camille Raynes-Greenow, Sidrah Nausheen … (2017)

Background Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP). Methods We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive history, awareness and past experience with contraceptives and unintended pregnancies using six item the LMUP. We used Univariate and multivariate analysis to explore the association between unintended pregnancies and predictor variables and presented the association as adjusted odds ratios. We also evaluated the psychometric properties of the Urdu version of the LMUP. Results Amongst 3010 pregnant women, 1150 (38.2%) pregnancies were reported as unintended. In the multivariate analysis age 2 (AOR 1.4 1.2-1.8), having no knowledge about contraceptive methods (AOR 3.0 1.7-5.4) and never use of contraceptive methods (AOR 2.3 1.4-5.1) remained significantly associated with unintended pregnancy. The Urdu version of the LMUP scale was found to be acceptable, valid and reliable with the Cronbach's alpha of 0.85. Conclusions This study explores a high prevalence of unintended pregnancies and important factors especially those related to family planning. Integrated national family program that provides contraceptive services especially the modern methods to women during pre-conception and post-partum would be beneficial in averting unintended pregnancies and their related adverse outcomes in Pakistan

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Author and article information

Contributors

Nabamallika Dehingia:

ORCID: http://orcid.org/0000-0003-1787-9050

nabamallika.dehingia@sambodhi.co.in , ndehingi@ucsd.edu

Anvita Dixit: a2dixit@ucsd.edu

Yamini Atmavilas: Yamini.Atmavilas@gatesfoundation.org

Dharmendra Chandurkar: dharmendra@sambodhi.co.in

Kultar Singh: kultar@sambodhi.co.in

Jay Silverman: jgsilverman@ucsd.edu

Anita Raj: anitaraj@ucsd.edu

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 30 March 2020

Publication date PMC-release: 30 March 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 188

Affiliations

[1 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Center on Gender Equity and Health, Division of Global Public Health, , University of California, San Diego School of Medicine, ; La Jolla, CA USA

[2 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Joint Doctoral Program in Public Health (Global Health track), , University of California San Diego/San Diego State University, ; San Diego, USA

[3 ]Bill and Melinda Gates Foundation, 5th Floor, Capital Court, Olof Palme Marg, Munirka, New Delhi, India

[4 ]GRID grid.475646.2, Sambodhi Research and Communications Pvt. Ltd., ; C-126, Sector -2, Noida, Uttar Pradesh 201301 India

Author information

Nabamallika Dehingia http://orcid.org/0000-0003-1787-9050

Article

Publisher ID: 2848

DOI: 10.1186/s12884-020-2848-8

PMC ID: 7106893

PubMed ID: 32228511

SO-VID: 29d141c3-1de6-4a7a-b0bf-c699525b2ed7

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 3 July 2018

Date accepted : 28 February 2020

Funding

Funded by: FundRef http://data.crossref.org/fundingdata/funder/10.13039/100000865, Bill & Melinda Gates Foundation;

Award ID: OPP1083531

Award Recipient : Dharmendra Chandurkar

Funded by: FundRef http://dx.doi.org/10.13039/100000009, Foundation for the National Institutes of Health;

Award ID: R01HD084453-02

Award Recipient : Anita Raj

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: maternal health,unintended pregnancy,maternal complications,pregnancy care,india

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: maternal health, unintended pregnancy, maternal complications, pregnancy care, india

Unintended pregnancy and maternal health complications: cross-sectional analysis of data from rural Uttar Pradesh, India

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Abstract

Background

Methods

Results

Conclusion

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Advocacy for Maternal and Women’s Health

Most cited references 19

How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania

Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population.

Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan

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