意外怀孕在美国很常见，与不良的母婴健康结果有关;然而，目前还缺乏针对当前美国人口的这些关联的估计。该项研究旨在评估通过与美国当前临床实践和公共卫生相关的研究，评估意外怀孕与妊娠和产后孕产妇和婴儿健康结局的关系。

纳入36项研究(N = 524522名参与者)，与预期怀孕相比，意外怀孕与怀孕期间抑郁的发生率显著相关(23.3% vs 13.9%;调整后的优势比[aOR]， 1.59 [95% CI, 1.35-1.92];I2 = 85.0%;15项研究[n = 41054])和产后(15.7% vs 9.6%;aOR, 1.51 [95% CI, 1.40-1.70];I2 = 7.1%;10项研究[n = 86,673])、人际暴力(14.6% vs 5.5%;aOR, 2.22 [95% CI, 1.41-2.91];I2 = 64.1%;5项研究[n = 42 306])，早产(9.4% vs 7.7%;aOR, 1.21 [95% CI, 1.12-1.31];I2 = 1.7%;10项研究[n = 94 351])，婴儿出生体重过低(7.3% vs 5.2%;aOR, 1.09 [95% CI, 1.02-1.21];I2 = 0.0%;8项研究[n = 87 547])

在这项针对美国人群的流行病学观察研究的系统综述和荟萃分析中，意外怀孕与有意怀孕相比，与不良母婴结局显著相关。

Abstract

Importance: Unintended pregnancy is common in the US and is associated with adverse maternal and infant health outcomes; however, estimates of these associations specific to current US populations are lacking.

Objective: To evaluate associations of unintended pregnancy with maternal and infant health outcomes during pregnancy and post partum with studies relevant to current clinical practice and public health in the US.

Data sources: Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE databases (January 1, 2000, to June 15, 2022) and manual review of reference lists.

Study selection: Epidemiologic studies relevant to US populations that compared key maternal and infant health outcomes for unintended vs intended pregnancies and met prespecified eligibility criteria were included after investigators' independent dual review of abstracts and full-text articles.

Data extraction and synthesis: Investigators abstracted data from publications on study methods, participant characteristics, settings, pregnancy intention, comparators, confounders, and outcomes; data were validated by a second investigator. Risk of bias was independently dual rated by investigators using criteria developed by the US Preventive Services Task Force. Results of studies controlling for confounders were combined by using a profile likelihood random-effects model.

Main outcomes and measures: Prenatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth, and infant low birth weight.

Results: Thirty-six studies (N = 524 522 participants) were included (14 cohort studies rated good or fair quality; 22 cross-sectional studies); 12 studies used large population-based data sources. Compared with intended pregnancy, unintended pregnancy was significantly associated with higher odds of depression during pregnancy (23.3% vs 13.9%; adjusted odds ratio [aOR], 1.59 [95% CI, 1.35-1.92]; I2 = 85.0%; 15 studies [n = 41 054]) and post partum (15.7% vs 9.6%; aOR, 1.51 [95% CI, 1.40-1.70]; I2 = 7.1%; 10 studies [n = 82 673]), interpersonal violence (14.6% vs 5.5%; aOR, 2.22 [95% CI, 1.41-2.91]; I2 = 64.1%; 5 studies [n = 42 306]), preterm birth (9.4% vs 7.7%; aOR, 1.21 [95% CI, 1.12-1.31]; I2 = 1.7%; 10 studies [n = 94 351]), and infant low birth weight (7.3% vs 5.2%; aOR, 1.09 [95% CI, 1.02-1.21]; I2 = 0.0%; 8 studies [n = 87 547]). Results were similar in sensitivity analyses based on controlling for history of depression for prenatal and postpartum depression and on study design and definition of unintended pregnancy for relevant outcomes. Studies provided limited sociodemographic data and measurement of confounders and outcomes varied.

Conclusions and relevance: In this systematic review and meta-analysis of epidemiologic observational studies relevant to US populations, unintended pregnancy, compared with intended pregnancy, was significantly associated with adverse maternal and infant outcomes.

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jamanetwork.com/journals/jama/article-abstract/2797874?resultClick=1

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