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. 2024 Sep 6;10(18):e37565.
doi: 10.1016/j.heliyon.2024.e37565. eCollection 2024 Sep 30.

Pathway linking unwanted pregnancy to low birth weight in Indonesia: A conditional mediation analysis

Dedik Sulistiawan  1   2 , Chyi-Huey Bai  1   3
Affiliations

Pathway linking unwanted pregnancy to low birth weight in Indonesia: A conditional mediation analysis

Dedik Sulistiawan et al. Heliyon. .

Abstract

Unwanted pregnancies resulting in detrimental consequences for both the mother and the child, including low birth weight, pose a remarkable challenge in developing countries. Although the association between low birth weight (LBW) and unwanted pregnancy is widely demonstrated, the results have been inconsistent, and the underlying mechanisms remain unclear. We examined maternal antenatal care (ANC) completeness as a potential mediating factor of the association between unwanted pregnancy and LBW among women in Indonesia, as well as the moderating effect of family support during pregnancy. We used women's records from the Indonesian Demographic and Health Survey (IDHS), a population-based survey conducted in 2017. This study involved 13,179 women aged 15-49 whose most recent child was aged 1-5 years. The multiple logistic regression results demonstrated that unwanted pregnancy was not associated with LBW. The generalized structural equation modeling (GSEM) results depicted that the effect of unwanted pregnancy on LBW was overwhelmingly explained by incomplete ANC, suggesting the mediation and suppression effect in the model (b = 0.32; 95 % Bias-corrected CI = 0.19-0.50; p = <0.001). The indirect impact of unwanted pregnancy on LBW also varied among different family support levels. This study filled the gaps in previous research on how unwanted pregnancy affects maternal and health outcomes. In conclusion, adequate ANC intervention and positive family support should be strengthened in future policy implementation to prevent the adverse effects of unwanted pregnancy.

Keywords: Family support; Low birth weight infant; Prenatal care; Unwanted pregnancy.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Chyi-Huey Bai reports financial support and article publishing charges were provided by 10.13039/501100004663Ministry of Science and Technology of Taiwan. Chyi-Huey Bai reports financial support and article publishing charges were provided by 10.13039/100020595National Science and Technology Council of Taiwan. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Conditional mediating effect of incomplete antenatal care and family support on the association between unwanted pregnancy and low birth weight. b represents unstandardized path coefficient, whereas Sb is standard error. Path a is coefficient for the effect of unwanted pregnancy and interaction term of unwanted pregnancy with family support on the mediator (incomplete antenatal care) after adjusted for covariates. Path b is coefficient for the effect of mediator on low birth weight after the main independent variable and covariates are adjusted for. Path c’ represents the direct effect of unwanted pregnancy on low birth weight when the mediator is adjusted for. ab is indirect effect of unwanted pregnancy on low birth weight, quantified as the product of path a and b coefficient. Path c is the total effect of unwanted pregnancy on low birth weight, quantified as the sum of c’+ab. ∗∗Significant at p < 0.001; ∗p < 0.05. † Standard error from 1000 bootstrap samples.
Fig. 2
Fig. 2
A visual representation of the moderation of the effect of pregnancy status on antenatal care completeness by family support.
See this image and copyright information in PMC

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