Poster Session 3
Nehaa Khadka, MPH, PhD (she/her/hers)
Post doctoral Research Fellow
Kaiser Permanente Southern California
Kaiser Permanente Southern California, California, United States
Vicki Y. Chiu, MS
Programer/Analyst
Kaiser Permanente Southern California
Department of Research & Evaluation, Kaiser Permanente Southern California/Pasadena, California, United States
Michael J. Fassett, MD
Kaiser Permanente West Los Angeles Medical Center
Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center/Los Angeles, California, United States
Darios Getahun, MD, PhD, MPH (he/him/his)
Research Investigator II MD/Associate Professor
Kaiser Permanente Southern California, Department of Research & Evaluation / Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science
Department of Research & Evaluation, Kaiser Permanente Southern California/Pasadena, CA, United States
To estimate rates of pregnancy intention, describe their characteristics, and examine pregnancy and postpartum mental health outcomes among intended vs. unintended pregnancies using electronic health records (EHRs) of pregnant patients in a large integrated healthcare system.
Study Design: We conducted a retrospective cohort study using EHRs on singleton pregnancies delivered at ≥20 weeks in Kaiser Permanente Southern California (KPSC) healthcare system (01/01/2014-12/31/2023). Data on pregnancy intentions (wanted, mistimed, unwanted) were extracted from a self-reported questionnaire administered at the first prenatal visit and in combination with an ICD-10 code (Z64.0) for unintended pregnancy. We extracted postpartum mental health outcomes using diagnostic codes. Multivariable logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI).
Results: Of 149,739 who had a record of pregnancy intentions, 34% (n=51,262) were intended and 66% (n=98,477) were unintended. Young age, lower socioeconomic status, and late/no prenatal care initiation were more common among unintended pregnancies. This group had higher rates of smoking (5.6% vs 2.6%) and illicit drug use (7.9% vs 3.5%) during pregnancy than those with intended. Unintended pregnancy was associated with higher odds of (pre)eclampsia (OR: 1.07, 95% CI: 1.02, 1.12), and lower odds of gestational diabetes (OR: 0.91, 95% CI: 0.87, 0.94), placenta previa (OR: 0.93, 95% CI: 0.88, 0.98) and cesarean delivery (OR: 0.93, 95% CI: 0.91, 0.96). Additionally, those with unintended pregnancies had higher odds of postpartum depression (OR: 1.24, 95% CI: 1.20, 1.28) and anxiety disorders (OR: 1.19, 95% CI: 1.15, 1.23)
Conclusion: Among completed records, unintended pregnancies were over half and independently associated with (pre)eclampsia and postpartum mental health outcomes. Pregnancy intention has a positive influence on selected birth outcomes. Findings suggest that mental health assessments and integrated services supporting high-risk pregnancy management are vital in improving pregnancy outcomes.
