Pre-pregnancy predictors linked to miscarriage among Aboriginal and Torres Strait Islander women in North Queensland

Objective : Identify preventable pre‐pregnancy risk factors that may affect the prevalence of miscarriage among a cohort of Australian Indigenous women. Methods: Data from 1,009 Indigenous women of childbearing age who participated in a 1999–2000 health screening program in far‐north Queensland were linked to Queensland hospitalisation data. Women who attended hospital after their health check (censor date: March 2008) for a pregnancy‐related condition were identified. Characteristics associated with becoming pregnant and subsequent miscarriage were analysed using generalised linear models. Results: After adjusting for age and ethnicity, women who became pregnant were more likely to be smokers and to have low red cell folate at baseline. The risk of miscarriage increased with age. Women who reported risky drinking or had elevated gamma‐glutamyl transferase were also at higher risk. After further adjustment for risky drinking, the presence of chlamydia or gonorrhoea before pregnancy was associated with miscarriage. The presence of both infections at baseline compared with women who had no infection, again after further adjustment for risky drinking, was strongly associated with miscarriage; these women had more than a four‐fold increase in risk (PR: 4.57 [2.21–9.46]). Elevated body mass index, high blood pressure and smoking were not statistically significantly associated with risk of miscarriage. Conclusions and implications: A high prevalence of pre‐pregnancy sexually transmitted infections and high rates of risky drinking are associated with miscarriage among young Indigenous women in rural and remote communities in north Queensland.     

Association Between Domestic Violence and Miscarriage: A Population-Based Cross-Sectional Study Among Women of Childbearing Ages,Sivas, Turkey

Violence against women is a global issue, with ramifications for the reproductive health of women. The current study examined the relation of domestic violence (DV) to miscarriage among women who were victimized during their last pregnancy. The study was conducted in Sivas city center, in Turkey. Associations between self-reported DV and miscarriage were analyzed using multiple regression modeling. Physical and/or sexual DV during the last pregnancy was reported by 10.0% and 6.2% of women, respectively. Women who experienced physical violence were 2.5 times as likely (Odds Ratio (OR) = 2.47, 95% confidence interval [CI]: 1.37–4.84, p = .003) to have experienced a miscarriage than women who did not report physical violence. These findings suggest that victims who experience physical violence during the last pregnancy may be more likely to experience miscarriage. Preventing DV, especially physical violence, may, therefore, be beneficial for avoiding adverse pregnancy outcomes.     

Measurement of unmet need for family planning: longitudinal analysis of the impact of fertility desires on subsequent childbearing behaviors among urban women from Uttar Pradesh,India

Background

The measure of unmet need relies on women's reported fertility desires; previous research has demonstrated that fertility desires may be fluid and not firm.

Study Design

Our study uses recently collected longitudinal data from four cities in Uttar Pradesh, India, to examine whether women's fertility desires and family planning (FP) use at baseline predict pregnancy/birth experience in the 2-year follow-up period.

Results

Multivariate models demonstrate that women who were using any method of FP and reported an intention to stop childbearing were the least likely to experience a pregnancy/birth in the 2-year follow-up period. The stated desire to delay childbearing, whether or not the woman was using FP, did not distinguish pregnancy/birth experience. Ninety-two percent of pregnancies/births over the follow-up period were considered “wanted then” suggesting post-hoc rationalization of the pregnancy/birth even among those women who reported a desire to stop childbearing 2 years earlier.

Conclusions

More nuanced assessments of fertility intentions may be needed to adequately gauge latent FP needs. Non-users of FP may be ambivalent about future childbearing and the timing of future births; these women may not have an unmet need for FP as typically defined.     

人工流产女性非意愿妊娠现状调查分析

目的了解天津地区人工流产女性非意愿妊娠的现状,减少女性非意愿妊娠和重复流产的发生,维护和促进女性生殖健康。方法采用现况调查的方法,对天津医科大学第二医院计划生育科8 745例要求人工流产的女性进行问卷调查。主要调查内容包括一般人口学特征、人工流产情况以及非意愿妊娠原因等情况。以人工流产次数≥2次的患者为病例组,只有1次人工流产的患者为对照组,进行病例-对照研究。结果 8 745例人工流产患者,其中重复流产者共5 648例,占65.2%;在重复流产者中,≥3次者占全部对象的33.0%。患者意外妊娠原因主要为未避孕(50.1%)和避孕失败(34.4%)。多因素分析显示,年龄大者(OR=2.38,95%CI:2.10~2.69)和有过生育者(OR=1.50,95%CI:1.32~1.70)发生重复流产的风险较高。结论我国育龄妇女人工流产率及重复人工流产率均较高,应进一步开展人工流产后关爱服务,促进高效避孕方法的使用,从而保障女性身心健康。     

Evaluation of trained volunteer doula services for disadvantaged women in five areas in England: women's experiences

Disadvantaged childbearing women experience barriers to accessing health and social care services and face greater risk of adverse medical, social and emotional outcomes. Support from doulas (trained lay women) has been identified as a way to improve outcomes; however, in the UK doula support is usually paid‐for privately by the individual, limiting access among disadvantaged groups. As part of an independent multi‐site evaluation of a volunteer doula service, this study examined women's experiences of one‐to‐one support from a trained volunteer doula during pregnancy, labour and the post‐natal period among women living in five low‐income communities in England. A mixed methods multi‐site evaluation was conducted with women (total n = 137) who received the service before December 2012, using a combination of questionnaires (n = 136), and individual or group interviews (n = 12). Topics explored with women included the timing and nature of support, its impact, the relationship with the doula and negative experiences. Most women valued volunteer support, describing positive impacts for emotional health and well‐being, and their relationships with their partners. Such impacts did not depend upon the volunteer's presence during labour and birth. Indeed, only half (75/137; 54.7%) had a doula attend their birth. Many experienced volunteer support as a friendship, distinct from the relationships offered by healthcare professionals and family. This led to potential feelings of loss in these often isolated women when the relationship ended. Volunteer doula support that supplements routine maternity services is potentially beneficial for disadvantaged women in the UK even when it does not involve birth support. However, the distress experienced by some women at the conclusion of their relationship with their volunteer doula may compromise the service's impact. Greater consideration is needed for managing the ending of a one‐to‐one relationship with a volunteer, particularly given the likelihood of it coinciding with a period of heightened emotional vulnerability.     

Reproductive coercion and prenatal distress among young pregnant women in Monrovia,Liberia

Abstract

Women who experience reproductive coercion are at risk for poor reproductive health, but no study has examined prenatal distress as a consequence. Using cross-sectional data of 195 pregnant women aged 18–30 in Monrovia, Liberia, we examined the association between reproductive coercion and prenatal distress. The prevalence of current reproductive coercion was 9%. Young pregnant women who experienced reproductive coercion had more prenatal distress than women without these experiences. Reproductive coercion can heighten pregnancy-specific concerns for young Liberian women. Family-planning programs and providers should assess current reproductive coercion among young pregnant women and find ways to help women mitigate pregnancy concerns.     

Sex in Australia: reproductive experiences and reproductive health among a representative sample of women

OBJECTIVE: To document the reproductive experiences of a representative sample of Australian women aged 16-59 years. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men, and 77.6% among women). Women were asked the number of times they had experienced a live birth, a still birth, a miscarriage and a termination of pregnancy. RESULTS: Of the women surveyed, 15.5% reported having experienced difficulty in becoming pregnant and 76.1% had been pregnant at least once. Nearly all the women who had been pregnant reported experiencing a live birth. Substantial minorities of women reported having experienced a miscarriage (33.4%) or a termination of pregnancy (22.6%). The percentage of women who reported becoming pregnant the first time as a teenager declined from 22.8% among women aged 50-59 to 16.9% among women aged 20-29. Of those who had had vaginal intercourse, 19.2% had used emergency contraception, 53.3% of them only once. CONCLUSION: There was clear evidence of substantial changes in the fertility of Australian women over the past 40 years.     

“These are not good things for other people to know”: How rural Tanzanian women’s experiences of pregnancy loss and early neonatal death may impact survey data quality

Little research in low-income countries has compared the social and cultural ramifications of loss in childbearing, yet the social experience of pregnancy loss and early neonatal death may affect demographers’ ability to measure their incidence. Ninety-five qualitative reproductive narratives were collected from 50 women in rural southern Tanzania who had recently suffered infertility, miscarriage, stillbirth or early neonatal death. An additional 31 interviews with new mothers and female elders were used to assess childbearing norms and social consequences of loss in childbearing. We found that like pregnancy, stillbirth and early neonatal death are hidden because they heighten women’s vulnerability to social and physical harm, and women’s discourse and behaviors are under strong social control. To protect themselves from sorcery, spiritual interference, and gossip—as well as stigma should a spontaneous loss be viewed as an induced abortion—women conceal pregnancies and are advised not to mourn or grieve for “immature” (late-term) losses. Twelve of 30 respondents with pregnancy losses had been accused of inducing an abortion; 3 of these had been subsequently divorced. Incommensurability between Western biomedical and local categories of reproductive loss also complicates measurement of losses. Similar gender inequalities and understandings of pregnancy and reproductive loss in other low-resource settings likely result in underreporting of these losses elsewhere. Cultural, terminological, and methodological factors that contribute to inaccurate measurement of stillbirth and early neonatal death must be considered in designing surveys and other research methods to measure pregnancy, stillbirth, and other sensitive reproductive events.     

Exploring risk factors for suicidal ideation in a population‐based sample of New Zealand women who have experienced intimate partner violence

Objective : To explore factors associated with suicidal thoughts among women who had experienced intimate partner violence (IPV), using data from the New Zealand replication of the WHO Multi‐country Violence Against Women study. Method : Face‐to‐face interviews were conducted. A population‐based cluster sampling scheme with a fixed number of dwellings per cluster was employed. Logistic regression was conducted to identify those variables independently associated with suicidal ideation. Results : Women who had experienced IPV were more likely to report they had thought about taking their own life if they: reported that their partner's behaviour had impacted on their mental health (OR = 4.81, 95% CI 3.30–7.01); were current or former users of recreational drugs (OR=1.94, 95% CI 1.43–2.64); had experienced a stillbirth/abortion/miscarriage (OR=1.93, 95% CI 1.44–2.58); and had experienced emotional abuse in the previous 12 months (OR=1.40, 95% CI 1.00–1.96). Conclusion and Implications : This study corroborates international findings that women's experience of IPV is associated with increased risk of suicidal thoughts. While the results point to the need for all health care providers to routinely enquire about intimate partner violence among their patients, they also argue for the need for health care providers to be aware of, and equipped to respond to, the mental health needs of their clients. The results also indicate that there is a need for mental health services to assess for, and respond to intimate partner violence among women presenting with suicidal ideation.     

Infertility in Australia circa 1980: an historical population perspective on the uptake of fertility treatment by Australian women born in 1946‐51

Objective: To estimate the prevalence of lifetime infertility in Australian women born in 1946‐51 and examine their uptake of treatment. Methods: Participants in the Australian Longitudinal Study on Women's Health born in 1946‐51 (n=13,715) completed up to four mailed surveys from 1996 to 2004. The odds of infertility were estimated using logistic regression with adjustment for socio‐demographic and reproductive factors. Results: Among participants, 92.1% had been pregnant. For women who had been pregnant (n=12738): 56.5% had at least one birth but no pregnancy loss (miscarriage and/or termination); 39.9% experienced both birth and loss; and 3.6% had a loss only. The lifetime prevalence of infertility was 11.0%. Among women who reported infertility (n=1511), 41.7% used treatment. Women had higher odds of infertility when they had reproductive histories of losses only (OR range 9.0‐43.5) or had never been pregnant (OR=15.7, 95%CI 11.8‐20.8); and higher odds for treatment: losses only (OR range 2.5‐9.8); or never pregnant (1.96, 1.28‐3.00). Women who delayed their first birth until aged 30+ years had higher odds of treatment (OR range 3.2‐4.3). Conclusions: About one in ten women experienced infertility and almost half used some form of treatment, especially those attempting pregnancy after 1980. Older first time mothers had an increased uptake of treatment as assisted reproductive technologies (ART) developed. Implications: This study provided evidence of the early uptake of treatment prior to 1979 when the national register of invasive ART was developed and later uptake prior to 1998 when data on non‐invasive ART were first collected.     

Determinants of depressive symptoms in the early weeks after miscarriage.

OBJECTIVES. We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. METHODS. We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS. Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. CONCLUSIONS. Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy.     

The correspondence between intention to avoid childbearing and subsequent fertility: a prospective analysis

CONTEXT: Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy. METHODS: Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews. RESULTS: Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth. CONCLUSIONS: There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.     

Experience of miscarriage in the UK: qualitative findings from the National Women's Health Study

Miscarriage is the most common adverse outcome in pregnancy. For many women it is a traumatic experience. Previous research has identified shortcomings in the emotional and social support provided for miscarriage sufferers but personal accounts of pregnancy loss remain relatively under-explored. The UK National Women's Health Study (NWHS) is a nationally representative survey of women's reproductive histories. It provided an opportunity to study accounts of miscarriage written in response to an invitation for further comments on the survey questionnaire. In conjunction with quantitative findings from the NWHS, we thematically analysed 172 detailed narratives that facilitated qualitative exploration of a characteristically private event. Analysis of the narratives suggested that few women who had planned their pregnancy were satisfied with fatalistic explanations of miscarriage. Those who were not given medical explanations for their loss engaged in complex searches for meaning, often linked to accounts of their moral deservedness as mothers. The narratives highlighted tensions between biomedical and lay understandings of pregnancy loss. There were reports of inappropriate medicalisation and a perceived lack of emotional support, but also a desire for medical validation of the reality of miscarriage and investigations to identify medical causes. Professionals' reported behaviour played a key role in women's accounts. These findings remind providers that: women do not experience miscarriage as a routine complication; medicalisation is both resisted and desired; and, for some women, more support and information is needed to assist their search for meaning.     

Correlates of Depressive Symptoms After Birth for Latinas Who Are Overweight or Obese

Depression symptoms and overweight/obesity are common concerns during childbearing. Both conditions are associated with poor outcomes at birth and can have long-lasting consequences. Predictors of depressive symptoms among overweight and obese low-income and ethnically diverse women are not known. Data are from the Madres para la Salud trial with 139 postpartum Latinas. Depressive symptoms during a prior pregnancy were positively related, while social support and moderate intensity physical activity (PA) were negatively related to depressive symptoms after birth. Social support and PA may be effective interventions, particularly for women who have experienced depressive symptoms in a prior pregnancy.     

Trends in Risk of Pregnancy Loss Among US Women, 1990–2011

Background

Pregnancy loss can have physical and psychological consequences for women and their families. Though a previous study described an increase in the risk of self‐reported pregnancy loss from 1970 to 2000, more recent examinations from population‐based data of US women are lacking.

Methods

We used data from the 1995, 2002, 2006–2010, 2011–2015 National Survey of Family Growth on self‐reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15–44 years) who reported at least one pregnancy conceived during 1990–2011 that did not result in induced termination (n = 20 012 women; n = 42 526 pregnancies). Trends in the risk of self‐reported pregnancy loss and early pregnancy loss (<12 weeks) were estimated, separately, by year of pregnancy conception (limited to 1990–2011 to ensure a sufficient sample of pregnancies for each year and maternal age group) using log‐Binomial and Poisson models, adjusted for maternal‐ and pregnancy‐related factors.

Results

Among all self‐reported pregnancies, excluding induced terminations, the risk of pregnancy loss was 19.7% and early pregnancy loss was 13.5% during 1990–2011. Risk of pregnancy loss increased by a relative 2% (rate ratio [RR] 1.02, 95% confidence interval [CI] 1.01, 1.02) per year in unadjusted models and 1% per year (RR 1.01, 95% CI 1.00, 1.02) during 1990–2011, after adjustment for maternal characteristics and pregnancy‐related factors. In general, trends were similar for early pregnancy loss.

Conclusion

From 1990 to 2011, risk of self‐reported pregnancy loss increased among US women. Further work is needed to better understand the drivers of this increase in reported pregnancy loss in the US.     

A burden and a blessing--young Swedish women's experience of fertility. A study among women lacking experience of pregnancy and parenthood

We used phenomenological method to describe fertility as it was experienced by young women who have chosen to take contraceptive pills. The women lacked experience from pregnancy and parenthood. We interviewed ten women aged 23-27 years. We found that fertility was experienced as paradoxical, as follows: fertility as a power that has to be suppressed, experiencing fertility in the present time and as a future finite possibility, and having one's own fertile responsibility governed by society. Striving for a perfect life was a central aspect of fertility. Expectations on female fertility seem to influence young women's planning in life.     

Does pregnancy or pregnancy loss increase later maternal risk of diabetes?

Evidence that childbearing is associated with future development of diabetes remains conflicting and the role of pregnancy loss in this association has not been investigated. We aimed to examine whether pregnancy and/or pregnancy loss (miscarriage, abortion, or stillbirth) are associated with maternal higher risk of diabetes later in life, using a population-based prospective cohort study (mean follow-up = 10.7 years), including 13,612 women (aged 35-65 at baseline). We found pregnancy per se did not change the risk of diabetes after considering the effect of education, smoking, alcohol consumption, physical activity, BMI, waist/hip ratio, hypertension, and hyperlipidemia (fully-adjusted OR: 1.04, 95 % CI: 0.82-1.31). Having more than four live births was associated with around two times higher risk of diabetes later in life (fully-adjusted OR: 1.77, 95 % CI: 1.12-2.80). Having more than two miscarriages was associated with about two-fold higher risk of diabetes (fully-adjusted Odd ratio (OR): 1.85, 95 % CI: 1.17-2.93). After further adjustment for parity, the higher risk of diabetes in those who had history of more than two miscarriages did not change substantially (OR: 1.82; 95 % CI: 1.15-2.88), but the association between more than four live births and diabetes disappeared when the role of pregnancy loss was considered (fully-adjusted HR: 1.06; 95 % CI: 0.54-2.08). No significant association was found between abortion, stillbirth and risk of maternal diabetes. Pregnancy per se did not increase risk of diabetes. Women who experience more than two miscarriages are at around two times higher risk of diabetes later in life. The association between high parity and diabetes is mediated by history of miscarriages and known risk factors of diabetes. The underlying reason for association between miscarriage and diabetes needs further investigation.     

Pregnancy outcomes among U.S. women Vietnam veterans

BACKGROUND: Since the 1965-1975 Vietnam War, there has been persistent concern that women who served in the U.S. military in Vietnam may have experienced adverse pregnancy outcomes. METHODS: We compared self-reported pregnancy outcomes for 4,140 women Vietnam veterans with those of 4,140 contemporary women veterans who were not deployed to Vietnam. As a measure of association, we calculated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression adjusting for age at conception, race, education, military nursing status, smoking, drinking and other exposures during pregnancy. RESULTS: There was no statistically significant association between military service in Vietnam and index pregnancies resulting in miscarriage or stillbirth, low birth weight, pre-term delivery, or infant death. The risk of having children with "moderate-to-severe" birth defects was significantly elevated among Vietnam veterans (adjusted OR = 1.46, 95% CI = 1.06-2.02). CONCLUSIONS: The risk of birth defects among index children was significantly associated with mother's military service in Vietnam.     

The impact of perinatal loss on adjustment to subsequent pregnancy.

The current study compared the emotional adjustment of pregnant couples with and without a history of perinatal loss. Thirty-one pregnant women with a history of perinatal loss and 31 pregnant women with an unremarkable reproductive history were assessed between their 10th and 24th week of gestation. Partners were also recruited. Twenty-eight men were in the loss group and 23 men in the comparison group. Couples with a history of loss reported significantly more depressive symptomatology and pregnancy-specific anxiety than couples in the comparison group. Women reported more depressive symptomatology than men. Regression analyses revealed that for the group with a previous loss, depressive symptomatology was significantly associated with self-criticism, interpersonal dependency and number of previous losses. For the comparison group, depressive symptomatology was significantly associated dyadic adjustment. Pregnancy-specific anxiety of women with a previous loss was associated with their belief that their behavior affects fetal health; for women in the comparison group, pregnancy-specific anxiety was associated with the belief that health professionals' behavior affects fetal health. Implications for practice of health care professionals are discussed. The importance of early intervention to reduce distress is highlighted by the finding that alterations in mood are apparent in the early stages of pregnancy for both women and men who have experienced a previous perinatal loss. While carefully reducing personal responsibility for fetal health in women with a previous loss may reduce their pregnancy-specific anxiety, women with an unremarkable obstetrical history may benefit from an approach diminishing their perception of the power that medical staff has on fetal health.