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- Title
Pregnancy Intention, Changes in Pregnancy Intention, and Pregnancy Incidence Among Female Nurses in North America.
- Authors
Wang, Siwen; Minguez-Alarcon, Lidia; Capotosto, Melissa Perez; Mitsunami, Makiko; Gaskins, Audrey J.; Charlton, Brittany M.; Hart, Jaime E.; Rich-Edwards, Janet W.; Chavarro, Jorge E.
- Abstract
Key Points: Question: Is stated pregnancy intention stable and associated with incidence of pregnancy among nurses of reproductive age? Findings: In this prospective cohort study of 18 376 premenopausal, nonpregnant, female nurses, those who were actively trying to become pregnant were 23 times more likely to conceive within 12 months, and those contemplating pregnancy were 13 times more likely to conceive within 12 months compared with women who were neither attempting to become pregnant nor contemplating pregnancy. Approximately half (46%) of women who were contemplating pregnancy at baseline changed pregnancy intention during follow-up. Meaning: These findings suggest that preconception pregnancy intention is fluid but strongly associated with pregnancy incidence. This cohort study of reproductive-age nurses evaluates the association of pregnancy intention and changes in pregnancy intention with the probability of pregnancy during a 12-month period. Importance: Pregnancy intention assessment is a key element of preconception and contraceptive care. The association between a single screening question and the incidence of pregnancy is unknown. Objective: To prospectively evaluate the dynamics of pregnancy intention and pregnancy incidence. Design, Setting, and Participants: This prospective cohort study (the Nurses' Health Study 3) was conducted from June 1, 2010, to April 1, 2022, in 18 376 premenopausal, nonpregnant female nurses aged 19 to 44 years. Main Outcomes and Measures: Pregnancy intention and pregnancy status were assessed at baseline and approximately every 3 to 6 months thereafter. Cox proportional hazards regression models were used to estimate the association between pregnancy intention and pregnancy incidence. Results: A total of 18 376 premenopausal, nonpregnant women (mean [SD] age, 32.4 [6.5] years) participated in the study. At baseline, 1008 women (5.5%) were trying to conceive, 2452 (13.3%) were contemplating pregnancy within 1 year, and the remaining 14 916 (81.2%) were neither trying to conceive nor thought they would be pregnant within 1 year. A total of 1314 pregnancies were documented within 12 months of pregnancy intention assessment. The cumulative incidence of pregnancy was 38.8% in women actively trying to conceive (median [IQR] time to pregnancy, 3.3 [1.5-6.7] months), 27.6% in women contemplating pregnancy (median [IQR] time to pregnancy, 6.7 [4.2-9.3] months), and 1.7% in women neither trying to conceive nor contemplating pregnancy (median [IQR] time to pregnancy, 7.8 [5.2-10.5] months) among those who became pregnant. Women who were actively trying to conceive were 23.1 times (95% CI, 19.5-27.4 times) and women who were contemplating pregnancy were 13.0 times (95% CI, 11.1-15.2 times) more likely to conceive within 12 months than women who were neither attempting nor contemplating pregnancy. Among women contemplating pregnancy at baseline who did not get pregnant during follow up, 18.8% were actively trying and 27.6% were not trying by 12 months. Conversely, only 4.9% of women neither trying to conceive nor contemplating pregnancy within 1 year at baseline changed pregnancy intention during follow up. Conclusions and Relevance: In this cohort study of reproductive-aged nurses in North America, pregnancy intention was highly fluid among women who were contemplating pregnancy but relatively stable among women trying to conceive and women who were neither trying to conceive nor contemplating pregnancy. Pregnancy intention was strongly associated with pregnancy incidence, but the median time to pregnancy points to a relatively short time window to initiate preconception care.
- Subjects
NORTH America; CONTRACEPTION; CONFIDENCE intervals; DISEASE incidence; PREGNANT women; CONTRACEPTIVES; PSYCHOLOGY of nurses; PREGNANCY outcomes; COMPARATIVE studies; DESCRIPTIVE statistics; KAPLAN-Meier estimator; INTENTION; ODDS ratio; PRECONCEPTION care; CONTRACEPTIVE drugs; LONGITUDINAL method; PROBABILITY theory; REPRODUCTIVE health; COVID-19 pandemic; PROPORTIONAL hazards models; PREGNANCY
- Publication
JAMA Network Open, 2023, Vol 6, Issue 5, pe2311301
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.11301