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What Are Some Financial/ Economics Burdens on a Low Income Family With a Unwanted Child?

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Impact of unintended pregnancy on maternal mental wellness: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC)

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Abstract

Background

Pregnancy intention is of import for maternal and child health outcomes. The purpose of this study was to examine the causal relation betwixt pregnancy intention and maternal depression and parenting stress in Korean women who gave birth during 2008.

Methods

This study is a retrospective evaluation of prospectively collected data from the Console Study on Korean Children from 2008 to 2010. Causal analyses were conducted using propensity score matching and inverse probability of treatment weighted methods. In add-on, mediation analyses were performed to exam mitigating effects of marital conflict, fathers' participation in childcare, and mothers' noesis of infant development on the relation between unintended pregnancy and agin maternal mental health.

Results

Results showed that the overall effect of an unintended pregnancy on maternal depression and parenting stress was statistically meaning. An unintended pregnancy was associated with 20–22% greater odds of maternal depression, 0.28–0.39 greater depression score, and 0.85–1.xvi greater parenting stress score. Relations betwixt pregnancy intention and maternal depression, maternal depression score and parenting stress score were moderately explained by marital disharmonize and fathers' participation in childcare.

Conclusions

Unintended pregnancy contributed to increased risks of maternal depression and parenting stress. Efforts to increment fathers' participation in childcare and subtract marital conflict might be helpful to mitigate adverse impacts of unintended pregnancy on perinatal maternal mental health.

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Background

An unintended pregnancy may exist an unwanted pregnancy (did not want to be pregnant at all) or a mistimed pregnancy (pregnancy occurred earlier than wanted), and the term is used interchangeably with unplanned pregnancy [1,2].

Pregnancy intent is an important determinant of both brusk- and long-term maternal and child health outcomes [three]. Pregnancy intention may bear on attitudes and behaviors in parenting and somewhen take an impact on child development. Compared to pregnant women with pregnancy intention, pregnant women without pregnancy intention had greater exposure to cigarette smoking, drinking alcohol, taking medications and illicit drugs, and X-ray during pregnancy, and were less likely to take folic acid and attend antenatal care [4-6]. If the pregnancy was intended, babies had a greater likelihood of prolonged breastfeeding and receiving proper vaccinations [7,8]. Pregnancy intention likewise has long-term influences on child health. Children built-in afterwards unintended pregnancy showed a cerebral delay at 3-years-erstwhile, more behavioral bug at 5- and seven-years-old, and increased problem behaviors and substance apply at 14-years-old than their counterparts [9-11]. Unwanted births may besides crusade poor relations between mother and offspring, even later the kid has become an developed [12]. Cleland and colleagues argued that preventing unintended pregnancy by providing family-planning services free of charge is a cost-effective preventive care service [13].

Unintended pregnancy rates vary by country and year, and across sub-populations [fourteen,15]. Singh and colleague estimated that 41% of all pregnancies that occurred worldwide in 2008 were unintended, and the regional prevalence of unintended pregnancies ranged from thirty% to 58% [xv]. In Southward Korea (hereafter 'Korea'), the prevalence of planned pregnancies reported past hospital- and/or customs health heart-based studies ranges from 51.4% to 74.3% [6,16,17]. A nationwide survey in 2008, the Console Study on Korean Children (PSKC), reported that 74.3% of pregnancies were intended [16].

An unintended pregnancy is a risk gene for poor maternal mental wellness including perinatal low, stress, and lower levels of psychological well-being and life satisfaction [4,18-22]. An unintended pregnancy increases the risk of maternal low [22-25] and parenting stress [4,26]. However, virtually prior studies of the consequences of an unintended pregnancy on maternal health were cross-sectional, and few studies were conducted in Asian countries. More chiefly, a causal relation between unintended pregnancy and maternal mental health has not been established. Gipson and colleagues argued that the relation between an unintended pregnancy and maternal and child outcomes may be confounded past many factors, including socioeconomic condition, and highlighted the need for well-designed studies that provide information on causality [3]. A randomized controlled study on the relation between pregnancy intention and maternal and child outcomes is not possible for ethical reasons. One alternative approach to investigate a causal relation is to perform causal assay using observational data, such equally propensity score matching (PSM) [27].

In this study, we examined the causal relation between pregnancy intention and maternal mental health (maternal low and parenting stress) by employing PSM and inverse probability of treatment weighted (IPTW) analyses. We used nationally representative, prospective nativity cohort information collected in Korea from 2008 to 2010, and nosotros used repeated measures of maternal mental health obtained over the study period. Nosotros hypothesized that unintended pregnancy would have a stiff adverse effect on maternal mental health in the early on stages of postpartum but that the strength of this effect would diminish with time. This hypothesis was partly based on our assumption that unintended pregnancy may cause short-term adverse mental health issues because of its nature, i.e., unintended pregnancy being an unexpected incident and burden in the female parent's life, simply that growing female parent-babe attachment and intimacy after birth would minimize this initial upshot. This hypothesis was too partly based on literature showing an effect of pregnancy intention on antenatal and postpartum maternal mental wellness [iv,18,21,23] but no event of pregnancy intention on maternal mental health in later stages of parenting [28-30]. We likewise hypothesized that marital disharmonize, fathers' participation in childcare, and mothers' knowledge of infant development would mediate the relation between pregnancy intention and maternal mental health. This 2nd hypothesis is supported by prior studies on the effects of such mediators on maternal mental health [31,32].

Methods

Data

We used publicly available data from the 2008–2010 PSKC conducted by the Korea Institute of Child Care and Educational activity. The PSKC is a longitudinal survey on a representative national sample of children born between Apr and July 2008 and their parents. Participants were recruited from 30 sampled hospitals beyond the country. The first wave of PSKC was conducted in 2008, and follow-up surveys accept been performed annually. The initial interview was face-to-face and was conducted at the fourth dimension of childbirth in the hospital. A subsequent phone survey (the 2d survey of the starting time moving ridge of PSKC) was conducted at ane calendar month postpartum. The third survey was initiated and conducted at the participant'due south home at iv months postpartum. The mean fourth dimension of the tertiary survey was 5.6 months after birth (standard deviation (SD) = 1.2 months). These three surveys (at birth, one month postpartum, and 4 months postpartum) were conducted in 2008 and contain the beginning moving ridge of PSKC. The second and tertiary waves of PSKC were contiguous interviews conducted in the participant's dwelling house at 1 yr postpartum (hateful = 14.one months; SD = 1.ane months) and 2 years postpartum (mean = 25.8 months; SD = 1.4 months). The number of responding families was 2,078 in the start wave, 1,904 in the second wave, and 1,802 in the tertiary wave. This study was approved by the Asan Medical Center Institutional Review Lath. Written informed consent was obtained from each participant at the time of recruitment by the Korea Establish of Child Intendance and Education.

Pregnancy intention

Pregnancy intention was determined in the initial interview (i.e., the first survey of the beginning wave) past asking the mother "Did you and your husband (or partner) programme the pregnancy or want to have the baby?" Response categories were: one) only I as the mother of the baby planned or wanted the pregnancy, 2) just my married man (or partner) as the father of the baby planned or wanted the pregnancy, 3) both my married man (or partner) and I planned or wanted the pregnancy, and 4) neither my husband (or partner) nor I planned or wanted the pregnancy. In this study, we focused on the mother'south intention, as we viewed this as more straight related to maternal mental health than the male parent's intention. Therefore, we grouped responses 1) and 3) every bit intended pregnancy, and responses 2) and 4) as unintended pregnancy.

Depression

Maternal depression was assessed using the Kessler vi-Item Psychological Distress Scales (K6). The K6 is a brusque screening instrument for mental illness in the general population. In the PSKC, the response to each of the six items was scored on an ordinal scale from 1 to 5, and the total score ranged from 6 to 30. An additional file shows full questionnaires [see Boosted file 1]. The reliability of the K6 is high (Cronbach alpha = 0.89) [33]. Subjects scoring ≥14 were classified as depressed [34-36]. Maternal low was measured v times during the report flow: at the time of childbirth, and at 1 month, 4 months, one year and two years postpartum). The survey conducted at the fourth dimension of childbirth asked mothers nigh their feelings during the i month prior to giving birth (antenatal low), and the surveys conducted at 1 calendar month, 4 months, 1 yr and 2 years postpartum asked mothers about their feelings during the preceding 30 days. The same vi items and response categories were used throughout the study period.

Parenting stress

The mothers' parenting stress was measured with ten questions on perceived difficulties and distress in taking intendance of the baby and performing parental roles (meet questionnaires in Boosted file 1). These 10 questions originated from a Korean written report [37] and were adult based on the Parenting Stress Index [38-40], Parenting Daily Hassles [41], and Maternal Guilt Scale [42]. The reliability of the questions is high (Cronbach alpha = 0.88) [37]. The ten items focus on negative psychological states that arise from parenting demands. Each of 10 items is scored on a five-point Likert calibration ranging from 1 to 5. The total score ranges from ten to 50, with higher scores indicating greater maternal parenting stress [37]. Parenting stress was measured at three time points during the study menstruation: 4 months, i yr, and 2 years postpartum. The same ten items and response categories were used throughout the study catamenia.

Mediators

Nosotros selected three variables as potential mediators of the relation between pregnancy intention and maternal mental wellness: marital conflict, male parent's participation in childcare, and mother'southward noesis on infant development. Mediators evaluated by the female parent at iv months postpartum were used in the analysis.

Marital conflict

We hypothesized that women with an unintended pregnancy may experience marital conflict with their husband that was related to unexpected pregnancy, and therefore were more likely to experience marital conflict than women with an intended pregnancy. Marital conflict was evaluated using the Korean version of the marital conflict index (see questionnaires in Additional file 1), which consists of eight items regarding conflictual situations including escalation, invalidation, negative interpretations, withdrawal and abstention between couples. This alphabetize was derived from Markman et al.'s relation dynamics scale [43] translated by Chung [44]. The reliability of the index is loftier (Cronbach alpha = 0.96) [44]. Each item is scored on a five-betoken Likert scale ranging from i to 5. The total score ranges from 8 to forty, with higher scores indicating a greater level of marital conflict.

Fathers' participation in childcare

Nosotros hypothesized that women with an intended pregnancy would report greater participation of the father in childcare than women with an unintended pregnancy. The female parent was asked almost the cooperation of the child's father in childcare using four items from the husband's family role operation questionnaire adult by Hong [45] that were extracted by a previous study [46]. Each item is scored on a v-point Likert scale ranging from i to 5. The full score ranges from 4 to xx, with higher scores indicating more than involvement of the child's begetter in childcare. The reliability of the questions is high (Cronbach blastoff = 0.86) [33].

Knowledge of babe development

We hypothesized that women with an intended pregnancy would be more likely to assemble information on infant development than women with an unintended pregnancy, and thus would be more knowledgeable on infant development than women with an unintended pregnancy. Knowledge of infant development was assessed using the Noesis of Babe Development Inventory, which was developed to mensurate the mothers' knowledge of childrearing and child development [47]. The original Knowledge of Infant Development Inventory consists of four sub-sections: norms and milestones, parenting strategies, principles of development, and wellness and prophylactic. The PSKC used thirteen items from the principles of development sub-section. Mothers responded to each item by yeah or no, or reporting they were not certain. Full score was computed past the sum of the number of items correctly answered.

Socio-demographic characteristics

Socio-demographic characteristics evaluated at iv months postpartum (baseline) were used in the analysis. Maternal and paternal education were categorized as high school or under, inferior college, or academy or over. Maternal occupation was categorized as not-transmission, transmission, or housewife/other, and paternal occupation was categorized as non-manual or transmission. Household income was adapted for family size and then divided into quintiles. Maternal and paternal cigarette smoking and alcohol drinking behaviors (yes or no) were likewise assessed at 4 months postpartum. The sex and birth order (outset built-in vs. later on born) of the infant were besides recorded.

Statistical assay

Chiselled variables are presented as frequencies and percentages and were compared beyond women with intended pregnancies and women with unintended pregnancies using the chi-foursquare test or Fisher's exact test. Continuous variables are expressed every bit hateful ± standard deviation (SD) and were compared across women with intended pregnancies and women with unintended pregnancies using Student's unpaired t-test. Logistic and linear regression analyses were conducted for each time indicate to evaluate the effect of pregnancy intention on each consequence, and generalized linear mixed models were used to examine time trends in the furnishings of pregnancy intention.

PSM and IPTW were used for causal analyses. Propensity score assay and regression based approaches can exist used to gauge handling effects in observational data. Several advantages of propensity score analysis over regression based approaches exist. For example, propensity score assay can be used to reduce or eliminate the effects of misreckoning when using observational data to estimate treatment furnishings [27]. To reduce the effect of choice bias and potential misreckoning, differences in baseline characteristics (maternal age, paternal age, babe's sex, baby'southward birth order, maternal education, paternal education, maternal occupation, paternal occupation, household income, maternal smoking, paternal smoking, maternal booze consumption, paternal alcohol consumption) were adjusted using weighted generalized linear mixed models with inverse probability of handling weighting [48]. With this technique, weights for women with unintended pregnancy were the inverse of the propensity score and weights for women with intended pregnancy were the inverse of 1 - propensity score. The propensity score is the probability, given baseline variables, that any participant in either group would be selected for unintended pregnancy. The propensity scores were estimated without regard to outcomes past multiple logistic regression analysis. A full not-parsimonious model was developed that included all variables shown in Table one. Model discrimination was assessed with C statistics (C = 0.618) and model calibration was assessed with Hosmer-Lemeshow statistics (p = 0.3340). The results of IPTW were verified past PSM. The propensity score-matched pairs (one-to i matching) were created by matching women with unintended and intended pregnancies on the logit of the propensity score using calipers of width equal to 0.ii of the SD of the logit of the propensity score. After propensity score matching, we examined the similarity of women with unintended and intended pregnancies in the propensity score-matched sample past calculating standardized differences for each of the baseline variables listed in Table one. All of the standardized differences for each of the baseline variables were less than 0.06 (6%) (See Additional file 1: Table S1). Arbitration analyses were conducted to test the hypotheses that marital conflict, fathers' participation in childcare, and mothers' knowledge of babe development mediated the relation between pregnancy intention and outcomes. The role of mediators in the relation between pregnancy intention and the presence of maternal low was evaluated using the percentage excess odds explained by inclusion of the mediators in the model, which was calculated as (ORbaseline model – ORbaseline model + mediators)/(ORbaseline model – ane) [49]. Similarly, the role of mediators in the relation betwixt pregnancy intention and maternal low score and parenting stress score was evaluated using the percent backlog beta explained past inclusion of the mediators in the model, which was calculated equally (Betabaseline model – Betabaseline model + mediators)/(Beta baseline model). This excess odds or beta explained the degree to which a mediator explains the relation between pregnancy intention and maternal mental health. All statistical analyses were performed with SAS version 9.one (SAS Institute, Cary, NC). A two-tailed value of p < 0.05 was considered statistically pregnant.

Table 1 Baseline characteristics of report subjects according to pregnancy intention

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Results

Table 1 shows the neonatal and socio-demographic characteristics of written report subjects according to pregnancy intention. Of 2076 pregnancies, 525 (25.3%) were unintended. The prevalence of unintended pregnancy was significantly higher among subsequently-born infants, fathers with a transmission job, lower household income, and fathers who were smokers than their counterparts (Table 1).

Figure ane shows the prevalence of maternal low (Figure 1a), the maternal depression score (Effigy 1b), and the parenting stress score (Figure 1c) co-ordinate to pregnancy intention over the written report period. In both groups, the prevalence of maternal low and the boilerplate maternal depression score decreased shortly after delivery (at i month postpartum) and then returned to the antenatal level at iii months postpartum (Effigy 1a and b). At the beginning 4 fourth dimension points, women with an unintended pregnancy had a higher prevalence of depression than women with an intended pregnancy, only this deviation had disappeared past the terminal fourth dimension point (two years postpartum; Effigy 1a). Withal, the difference of prevalence of low between 2 groups was not statistically significant over the written report menstruation. At 4 months postpartum, the low score was higher in women with an unintended pregnancy than in women with an intended pregnancy (p = 0.0397; Effigy 1b). At 4 months, i year and 2 years postpartum, the parenting stress score was higher in women with an unintended pregnancy than in women with an intended pregnancy (p = 0.0351, p = 0.0113, p = 0.0043), and in both groups the parenting stress score increased at 2 years postpartum (Figure 1c).

Figure 1
figure 1

Distribution of maternal mental wellness status according to pregnancy intention. ● Intended ■ Unintended. Note. (a) the prevalence of maternal depressive symptoms, (b) the hateful maternal depression score, and (c) the mean maternal parenting stress score according to pregnancy intention. Data are adjusted for maternal historic period, birth order, maternal educational activity, paternal occupation and household income. Error confined indicate 95% confidence interval. *P < 0.05, **P < 0.01.

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Table 2 shows the scores for marital conflict, fathers' participation in childcare, and mothers' knowledge of infant development in women with intended and unintended pregnancy. Women with an unintended pregnancy reported significantly greater levels of marital conflict than women with an intended pregnancy and lower participation of the child's male parent in childcare. Women with an unintended pregnancy showed a tendency for lower noesis of infant development than their counterparts, but the difference was not statistically meaning.

Table two Adjusted hateful scores of potential mediating variables according to pregnancy intention

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Tables 3 and 4 show the results of PSM and IPTW analyses. The odds ratios for maternal depression varied over the survey menstruum and, in PSM analysis, were statistically meaning at the early fourth dimension points (antenatal and the first month postpartum) but not at the 1 and 2 yr postpartum time points. However, the interaction betwixt pregnancy intention and time betoken was not statistically significant in the PSM nor the IPTW analyses (p = 0.1819, p = 0.2402). The overall effect of an unintended pregnancy on the presence of maternal depression was statistically significant in both analyses, with an unintended pregnancy associated with 22% or twenty% greater odds of maternal depression in PSM and IPTW analyses, respectively (Table 3). We conducted additional analysis to calculate the deviation in maternal depression score co-ordinate to pregnancy intention. Boosted file i: Table S3) shows the results of PSM and IPTW analyses for maternal depression score, and the findings were similar as those for the presence of maternal low. Maternal depression score was higher in women with unintended pregnancy than in women with intended pregnancy at the early fourth dimension points (antenatal low score in PSM assay, and one month and 4 months postpartum depression scores in the IPTW analysis). The interaction between pregnancy intention and time point was non statistically significant. The overall effect of an unintended pregnancy on maternal depression score was statistically pregnant (Additional file 1: Tabular array S3).

Table three Odds ratio of maternal depressive symptoms according to pregnancy intention

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Table four Difference in parenting stress scores according to pregnancy intention

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Table 4 shows the results of PSM and IPTW analyses for parenting stress scores. In contrast to the findings for the presence of maternal depression and maternal low score, the differences in parenting stress score between groups was statistically significant throughout the study periods, and the interaction betwixt pregnancy intention and time point was non statistically significant. There was a statistically significant overall effect of pregnancy intention on parenting stress scores in both PSM and IPTW analyses (Table 4).

Table 5 presents the results of analyses on the part of marital conflict, fathers' participation in childcare, and mothers' knowledge of baby development on the relation between pregnancy intention and maternal mental health. In both PSM and IPTW analysis, odds ratios decreased with adjustments for the three potential mediators. The overall pct reduction for maternal low after adjusting for mediators was 71.4% in PSM assay. Across all fourth dimension points, the mediators explained 26.0% (PSM) and 27.ii% (IPTW) of the relation betwixt pregnancy intention and parenting stress score (Tabular array 5). The mediators explained 32.i% (PSM) and 33.i% (IPTW) of the relation between pregnancy intention and parenting stress score at ane year postpartum, and xix.three% (PSW) and 21.5% (IPTW) of the relation between pregnancy intention and parenting stress score at 2 years postpartum. In addition, Additional file 1: Table S5) shows that, across all time points, the mediators explained 81.5% (IPTW) of the relation between pregnancy intention and maternal depression score (Additional file 1: Tabular array S5).

Table five Function of examined mediators in the relation between unintended pregnancy and maternal mental health

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The role of each mediator in the relation between unintended pregnancy and maternal mental health is shown in the Additional file one: Table S6-eight). In general, marital conflict was a stronger mediator than fathers' participation in childcare and mothers' knowledge of infant development. The role of noesis of infant development was minimal.

Discussion

The results of this study showed that an absence of intention for a pregnancy had an agin effect on maternal low and parenting stress, and that the relation between pregnancy intention and maternal mental health was partly mediated by marital conflict, fathers' participation in child care, and mothers' noesis of infant development. These findings were obtained from causal analyses (PSM and IPTW) of longitudinal follow-upwardly data obtained from a national sample of an Asian population. Many prior investigations have reported an association between unintended pregnancy and maternal mental wellness [4,xviii,21,23,l], but the associations were often assumed to be non-causal or due to confounding variables [iii]. The results of our PSM and IPTW analyses provide support for a causal relation between pregnancy intention and maternal mental health in a non-Western population.

We hypothesized that the magnitude of the relation betwixt pregnancy intention and maternal mental health would decrease with time. The results of this report showed statistically significant differences in the prevalence of maternal low co-ordinate to pregnancy intention at the showtime three time points (from antenatal to 4 months postpartum), just no difference at one year or 2 years postpartum. These results support our hypothesis, although there was no significant interaction betwixt pregnancy intention and the fourth dimension of inquiry on the prevalence of maternal low or the maternal depression score, this might be due to fluctuating non-linear patterns in the upshot of pregnancy intention on maternal depression over the five time points. Several international studies have reported an increased risk of antenatal and postpartum depression for women with unintended pregnancy [four,xviii,21,23]. Most of these studies examined postpartum low from a few days to 9 months postpartum, but a few studies accept explored the long-term effect of pregnancy intention on postpartum depression. Christensen and colleagues reported that the difference in mean depressive symptom score between depression-income Hispanic women with intended and unintended pregnancies was lower at 12 months postpartum than at 4 months postpartum [28], and an Australian written report reported that the affect of pregnancy intention on maternal low diminished over the perinatal period [30]. These studies showed abating tendency, which is like to our results.

In this study, nosotros found that women with an unintended pregnancy reported higher levels of parenting stress over the report period. An Irish cohort study reported that women with unintended pregnancy were more likely to have a high parenting stress level at nine months postpartum than women with intended pregnancy [4]. A U.S. study explored the parenting stress of mothers when the child was approximately one-year-onetime according to whether or not they considered aborting the pregnancy, and reported that mothers who considered an ballgame had a higher parenting stress score than women who did non consider an abortion [51]. Some other U.Due south. study reported that women who had a later-built-in child with an unplanned pregnancy tended to feel more parenting stress than women who had a afterwards-born child with a planned pregnancy over the first 3 years after childbirth [50]. These studies showed like results to our study that the relation between pregnancy intention and parenting stress lasted for a couple of years.

We hypothesized that the magnitude of the relation betwixt pregnancy intention and maternal mental wellness would subtract with time. One of the challenges that arises from our findings is to explain why the effect of pregnancy intention on maternal depression macerated with time merely the differences in parenting stress did not. These differences might be due to the differences in the nature of the two measures. The questions on maternal depression measure the internal emotional status of mothers, whereas the questions on parenting stress are more closely related to external sources of stressors such every bit economic burden and childcare hassles. The presence of external stressors associated with unintended pregnancy and subsequent childbirth may have a sustained upshot on parenting stress, in contrast to internal emotional bug acquired by unintended pregnancy, which diminish with time. The results of this report suggest that maternal low and parenting stress are both important aspects of maternal mental health that are associated with unintended pregnancy and that they may affect childcare and child development in the kickoff year after birth, but across the get-go postpartum year, reducing parenting stress should be the focus for women with unintended pregnancy. Farther study is needed to confirm these findings.

Nosotros hypothesized that marital disharmonize, fathers' participation in child care, and mothers' knowledge of infant development would mediate the relation between pregnancy intention and maternal mental wellness. Our results showed that the relation betwixt pregnancy intention and maternal mental health was partially explained by these variables. This supports a previous report that marital relation was a significant predictor of postpartum low [31]. Our assay showed that pregnancy intention was strongly associated with marital conflict, and that marital conflict explained more than of the relation between pregnancy intention and maternal mental health than either of the other two mediators. These results suggest that unintentional pregnancies may have an adverse consequence on after maternal mental wellness as they brought near marital conflict and lowered the fathers' participation in childcare, which eventually contributed to perinatal depression and parenting stress in mothers. A female parent's noesis of infant evolution affects her conviction of babe care [31,32]. Still, our analysis showed that a mother's knowledge of infant development had a minimal office as mediator of the relation between pregnancy intention and maternal mental health. This is partly because the mother's knowledge of babe development was not strongly related to pregnancy intention.

Another interesting question from this study would be what additional variables mediate the relation between pregnancy intention and maternal mental wellness. The three mediators examined in this report explained approximately 26-27% of the relation between unintended pregnancy and parenting stress, and a future challenge is to place the boosted variables that mediate the relation between pregnancy intention and postpartum parenting stress. Candidate variables are bug related to unpreparedness for giving birth, such every bit monetary preparedness. Even so, several socioeconomic status variables were considered in the analyses. Farther research is required to identify potential mediators.

In this study, results showed that pregnancy intention had an upshot on maternal mental health, withal, it should be noted that the owing run a risk for pregnancy intention on maternal mental health would not be great. For case, overall odds ratios of pregnancy intention on maternal depressive symptoms were 1.20-1.22 and the value of Cohen'southward d for parenting stress scores in each yr ranged from 0.20 to 0.25. Thus, even though three mediators explained more than one-fourth of the magnitude of the relationship between unintended pregnancy and parenting stress, the accented reduction of odds and beta past mediators would be small, considering the relatively small impact of pregnancy intention on maternal mental health in the baseline model.

In this written report, the prevalence of maternal depression and the maternal low score were lower in the beginning month postpartum than in the antenatal period (measured immediately later on birth). It is uncertain why maternal depression decreased in the offset month postpartum, when postpartum blues and postpartum low are prevalent. However, information technology should be noted that the survey related to the first month postpartum was conducted via telephone, but the other surveys were conducted via contiguous interviews. Mothers might accept better disclosed their emotional problems in face-to-face interviews than in telephone surveys. The parenting stress score increased from iv months to 2 years postpartum, and the increase was due to an increases in the scores for the following questions: "I feel bad because it seems to be my mistake when my baby appears emotionally unstable", "I have difficulty beingness friendly and warm toward my child", and "I get irritated if my child pesters me to play with him or her when I am tired". These three questions accounted for 62.6% of the increase in parenting stress score (information not shown). High scores on these questions indicate a dysfunctional parent–kid interaction. An interactive mother-child relation might strengthen the attachment and intimacy, and bear on the child's emotional development.

In this study, we only focused on the mother'south intention. When nosotros conducted sensitivity analysis using different approaches to pregnancy intention (unintended by female parent, unintended by female parent and begetter, and unintended by mother or father), the results were by and large similar, but the interaction between pregnancy intention and fourth dimension of inquiry for depressive symptoms was statistically significant in PSM analysis when the pregnancy was unintended by mother or father (see Additional file 1: Table S9). Nearly prior studies used maternal pregnancy intentions [3], even so, further studies are needed to explore consequences of disagreement on pregnancy intention between partners or the office of partner'due south intentions on maternal mental health.

This study has limitations. First, the question on pregnancy intention did not distinguish if the pregnancy was unwanted, mistimed, or unplanned, and pregnancy intention was assessed after delivery. Pregnancy intentions can exist viewed as a spectrum and thus may be measured with continuous variables to capture doubtfulness about conspicuously defined intention of pregnancy [52]. In 2005, the estimated induced abortion rate in Korea was 29.8 per 1000 women, and women with unwanted pregnancies were more likely to finish their pregnancy with induced abortion; therefore, the rate of unintended pregnancy may be underestimated [53,54]. 2d, antenatal low was not assessed during pregnancy simply was examined before long afterwards the nascency of a kid, when women were asked questions regarding the 30 days prior to giving nascency. The antenatal depression status may therefore exist inaccurate and may hamper causality for the relationship between unintended pregnancy and antenatal depression. Third, perinatal depression was measured with the K6 and not with structured clinical interview or another more popular tool; therefore, caution should exist exercised when comparison our results with other studies. Quaternary, women with mental health problems might be more than likely to have unintended pregnancy than women without mental wellness problems. Hall and colleagues showed that, amongst young women aged 18–20 years with no intention of pregnancy, women with stress or depression and stress at baseline had college risks of pregnancy over the course of i year [55]. A longitudinal study showed that males and females who had depressive symptoms in their adolescent periods were more likely to report an unintended first nascency between the ages of 18 and 24 [56]. The insufficient contraception might be related to the gamble of unintended pregnancy among depressed women. Women with elevated depression and stress were more likely to be at risk for inconsistent contraceptive utilise [57]. Although we employed causal analyses in this written report, we cannot completely exclude the possibility of this reverse causation because nosotros did not assess pre-formulation mental wellness status.

This study has several strengths. We used a prospective accomplice data from a nationally representative sample of a non-Western population. Many of the existing studies on the adverse effect of unintended pregnancy were conducted in a Western population [3]. Nosotros used longitudinal data assessed by repeated observations, with consistent measurement of maternal depression and parenting stress for two years after childbirth, and we conducted analysis using PSM and IPTW, which allowed us to reduce confounding effects and estimate causal effects based on the assumption that there is no unmeasured confounders [58,59]. Nosotros too provide evidence on the part of mediators in the relation between pregnancy intention and maternal mental health.

Conclusions

The results suggested that reducing unintended pregnancy too as increasing fathers' participation in childcare and decreasing marital conflict might be helpful in improving maternal mental health. Future studies should examine longer term furnishings of unintended pregnancy on maternal mental health.

Abbreviations

PSKC:

Panel study on korean children

K6:

Kessler vi-item psychological distress scales

PSM:

Propensity score matching

IPTW:

Inverse probability of treatment weight

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Acknowledgements

This study was supported past the Health Promotion Fund, Ministry of Health & Welfare, Republic of korea (Number 13–twenty).

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Affiliations

  1. Institute of Health Policy and Management, Seoul National Academy Higher of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South korea

    Jinwook Bahk & Young-Ho Khang

  2. Department of Clinical Epidemiology and Biostatistics, University of Ulsan Higher of Medicine, Asan Medical Center, 388-ane Poongnap-2dong Songpa-gu, Seoul, 138-736, South korea

    Sung-Cheol Yun

  3. Department of Preventive Medicine, Dong-A Academy College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-715, South korea

    Yu-mi Kim

  4. Department of Health Policy and Direction, Seoul National University Higher of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South korea

    Immature-Ho Khang

Corresponding author

Correspondence to Sung-Cheol Yun.

Additional information

Competing interests

The authors declare that they have no competing interests

Authors' contributions

YHK developed the research concept. SCY, YK and JB analyzed and interpreted the data, and prepared the manuscript. YHK, SCY and JB were involved in drafting and critically revising the manuscript. All authors read and approved the final manuscript.

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Survey questionnaires. Table S1. Baseline covariates after propensity score matching: standardized difference of mean (%) between matched pair for each of the baseline variables. Table S2. Crude prevalence of depression and mean depression and parenting stress scores according to pregnancy intention. Table S3. Departure in maternal depression score according to pregnancy intention. Table S4. The relationships between mediating variables and effect variables. Tabular array S5. Part of examined mediators in the relation between unintended pregnancy and maternal depression score. Table S6. Part of marital conflict as a mediator in the relation between pregnancy intention and maternal mental health. Per centum reduction in odds ratio of maternal depression and divergence in mean maternal low and parenting stress scores later adjustments for mediators. Table S7. Role of fathers' participation in childcare as a mediator in the relation between pregnancy intention and maternal mental health. Percent reduction in odds ratio of maternal depression and difference in mean maternal depression and parenting stress scores after adjustments for mediators. Tabular array S8. Function of mother'due south cognition of infant development equally a mediator in the relations between pregnancy intention and maternal mental wellness. Percent reduction in odds ratio of maternal depression and difference in maternal depression and parenting stress scores subsequently adjustments for mediators. Table S9. Results of the sensitivity analysis on the classification of pregnancy intention.

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Bahk, J., Yun, SC., Kim, Ym. et al. Bear upon of unintended pregnancy on maternal mental health: a causal analysis using follow upwardly information of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth 15, 85 (2015). https://doi.org/10.1186/s12884-015-0505-4

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  • DOI : https://doi.org/ten.1186/s12884-015-0505-4

Keywords

  • Inverse probability
  • Korea
  • Perinatal low
  • Propensity scores
  • Stress
  • Unintended pregnancy

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