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Meta-Analysis
. 2017 Mar;21(3):670-704.
doi: 10.1007/s10995-016-2237-0.

Pregnancy Intention and Pregnancy Outcome: Systematic Review and Meta-Analysis

Jennifer A Hall  1 , Lorna Benton  2 , Andrew Copas  3 , Judith Stephenson  4
Affiliations
Meta-Analysis

Pregnancy Intention and Pregnancy Outcome: Systematic Review and Meta-Analysis

Jennifer A Hall et al. Matern Child Health J. 2017 Mar.

Abstract

Introduction Previous systematic reviews concluded that rigorous research on the relationships between pregnancy intentions and pregnancy outcomes is limited. They further noted that most studies were conducted in high-income countries and had methodological limitations. We aim to assess the current evidence base for the relationship between pregnancy intention and miscarriage, stillbirth, low birthweight (LBW) and neonatal mortality. In March 2015 Embase, PubMed, Scopus and PsychInfo were searched for studies investigating the relationship between pregnancy intention and the outcomes of interest. Methods Studies published since 1975 and in English, French or Spanish were included. Two reviewers screened titles and abstracts, read the full text of identified articles and extracted data. Meta-analyses were conducted where possible. Results Thirty-seven studies assessing the relationships between pregnancy intention and LBW were identified. A meta-analysis of 17 of these studies found that unintended pregnancies are associated with 1.41 times greater odds of having a LBW baby (95%CI 1.31, 1.51). Eight studies looking at miscarriage, stillbirth or neonatal death were found. The limited data concerning pregnancy loss and neonatal mortality precluded meta-analysis but suggest these outcomes may be more common in unintended pregnancies. Discussion While there seems to be an increased risk of adverse pregnancy outcome in unintended pregnancies, there has been little improvement in either the quantity of evidence from low-income countries or in the quality of evidence generally. Longitudinal studies of pregnancy intention and pregnancy outcome, where pregnancy intention is assessed prospectively with a validated measure and where analyses include confounding or mediating factors, are required in both high- and low-income countries.

Keywords: Low birthweight; Meta-analysis; Miscarriage; Neonatal mortality; Pregnancy intention; Stillbirth; Systematic review.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of selection of studies for the literature review
Fig. 2
Fig. 2
Flow chart of the studies in the pregnancy intention and LBW meta-analysis
Fig. 3
Fig. 3
Forest plot of the random effects meta-analysis of studies assessing the relationship between pregnancy intention and LBW
Fig. 4
Fig. 4
Forest plot of the random effects meta-analysis of studies assessing the relationship between pregnancy intention and LBW stratified by location
Fig. 5
Fig. 5
Forest plot of the random effects meta-analysis of studies assessing the relationship between pregnancy intention and LBW stratified by timing of assessment of intention
Fig. 6
Fig. 6
Funnel plot for pregnancy intention and LBW
See this image and copyright information in PMC

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