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Childhood abuse and unplanned pregnancies: a cross-sectional study of women in the Norwegian Mother and Child Cohort Study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.ORCID iD: 0000-0003-4806-5471
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.ORCID iD: 0000-0002-8623-2413
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Department of Statistics, Stockholm University.ORCID iD: 0000-0003-3691-8326
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2020 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 127, no 4, p. 438-446Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study if childhood emotional, physical and sexual abuse are determinants for having an unplanned pregnancy, if the categories of abuse interact, and if a potential bias due to the selection of the participants (collider stratification bias) could explain the effect of childhood abuse.

DESIGN: A cross-sectional study.

SETTING: The study is based on the Norwegian Mother and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway.

SAMPLE: Women participating in the MoBa for the first time, ≥18 years of age who responded to questions regarding childhood abuse and pregnancy planning (n = 76 197).

METHODS: Data were collected using questionnaires. We conducted analyses using modified Poisson regressions and the relative excess risks due to interaction (RERI). Sensitivity analyses were performed.

MAIN OUTCOME MEASURE: An unplanned pregnancy (yes/no).

RESULTS: Exposure to childhood emotional (adjusted relative risk (RR) 1.14, 95% CI 1.10-1.19), physical (adjusted RR 1.11, 95% CI 1.04-1.18) and sexual (adjusted RR 1.20, 95% CI 1.14-1.27) abuse increased the risk of having an unplanned pregnancy. The effects could not be explained by the collider stratification bias. The different combinations of categories of abuse did not show any interaction effects.

CONCLUSIONS: Childhood emotional, physical and sexual abuses separately increase the risk of having an unplanned pregnancy. The results indicate that victims of childhood abuse are in greater need of support to achieve their reproductive goals.

TWEETABLE ABSTRACT: Childhood abuse increases the risk of having an unplanned pregnancy. #reproductivehealth #epitwitter

Place, publisher, year, edition, pages
2020. Vol. 127, no 4, p. 438-446
Keywords [en]
MoBa, The Norwegian Mother and Child Cohort Study, abortion, child abuse, family planning services, induced, preconception care, pregnancy, unplanned
National Category
Gynaecology, Obstetrics and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-402741DOI: 10.1111/1471-0528.16037ISI: 000504970000001PubMedID: 31802594OAI: oai:DiVA.org:uu-402741DiVA, id: diva2:1386672
Funder
NIH (National Institute of Health), N01-ES-75558NIH (National Institute of Health), 1 UO1 NS 047537-01NIH (National Institute of Health), 2 UO1 NS 047537-06A1Available from: 2020-01-18 Created: 2020-01-18 Last updated: 2025-02-11Bibliographically approved
In thesis
1. Measuring Pregnancy Planning and the Effect of Childhood Abuse on Reproductive Health
Open this publication in new window or tab >>Measuring Pregnancy Planning and the Effect of Childhood Abuse on Reproductive Health
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The London Measure of Unplanned Pregnancy (LMUP) and the Swedish Pregnancy Planning Scale (SPPS) are two measurements of pregnancy planning. Adverse childhood experiences (ACEs) and childhood abuse are stressful events that have been suggested to have both short- and long-term effects.

Study I investigated the psychometric properties of the LMUP and the SPPS and compared their assessments. Questionnaire data from 2,314 pregnant women showed medium-high construct validity and high test-retest reliability for both measurements. The convergent validity of LMUP was low. The assessments of the LMUP and the SPPS corresponded substantially.

Study II explored how the SPPS was interpreted and what women considered when responding to it. Twenty-five pregnant women were interviewed. Women responding to the SPPS took into account their life situation, intentions, desires, timing, actions to prepare for, or avoid, pregnancy, having discussed becoming pregnant with their partner, and reactions after learning of the pregnancy.

Study III analysed the association between ACEs and pregnancy-related pain. Pregnant women (n = 142) responded to questionnaires in early and late pregnancy, respectively, and reported their pain intensities and pain distributions. Greater exposure to ACEs was associated with higher pain distribution and women exposed to ACEs reported higher worst pain intensities compared to non-exposed.

Study IV investigated effects of childhood emotional, physical and sexual abuse on pregnancy planning. The effect of a potential collider-stratification bias were also studied. Questionnaire data from 76,197 pregnant Norwegian women showed separate but no joint effects of the categories on having an unplanned pregnancy and a collider-stratification bias could not explain the effects.

The LMUP and the SPPS measure somewhat different aspects of pregnancy planning and there is a substantial agreement between their assessments. Both the LMUP and the SPPS showed good validity and test-retest reliability. However, the LMUP would likely benefit from item reduction and the SPPS poorly captures any health-related changes made in and the preconception period.

The results suggest that childhood abuse and ACEs have an effect on pregnancy planning and pregnancy-related pain. The findings suggest that preventing child abuse could have a positive effect on later reproductive health.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 71
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1555
Keywords
pregnancy planning, unplanned pregnancy, childhood abuse, adverse childhood experiences, reproductive health
National Category
Medical and Health Sciences
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-379739 (URN)978-91-513-0603-2 (ISBN)
Public defence
2019-05-10, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 01:15 (Swedish)
Opponent
Supervisors
Available from: 2019-04-12 Created: 2019-03-21 Last updated: 2020-05-18

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Drevin, JenniferHallqvist, JohanSonnander, KarinRosenblad, AndreasPingel, RonnieBjelland, Elisabeth K.

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Centre for Research Ethics and BioethicsFamily Medicine and Preventive MedicineResearch in Disability and HabilitationClinical diabetology and metabolismDepartment of Statistics
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British Journal of Obstetrics and Gynecology
Gynaecology, Obstetrics and Reproductive Medicine

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