26th July 2019, Volume 132 Number 1499

Bryndl E Hohmann-Marriott

In New Zealand, as in most low-fertility countries, there has been an increase in the number of pregnant women with chronic health conditions.1,2 This is at least partly due to…

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Summary

Unplanned pregnancies can be a health risk for those with chronic health conditions such as diabetes, asthma and depression. In a study of about 7,000 pregnant women in New Zealand, I found that 15% had been diagnosed with a chronic health condition. Nearly half of the pregnancies of these women with chronic health conditions were unplanned. This was higher than the number of unplanned pregnancies among women without chronic health conditions.

Abstract

Aim

Chronic health conditions can pose risks for pregnancy and childbearing which may be mitigated by preconception care and pregnancy planning. The objective of this study is to identify the proportion of pregnancies reported as unplanned among women in New Zealand with chronic health conditions and the co-occurrence of these pregnancies with socioeconomc disadvantage.

Method

This study included 6,822 pregnant women in the Growing Up in New Zealand study. Nearly 15% identified a chronic health condition, including diabetes, heart disease, asthma, depression and anxiety.

Results

Pregnancies were reported as unplanned by 45% of women with chronic health conditions, as compared to 39% of women without these conditions. Among women with chronic conditions, those who identified as Māori or Pacific Islander reported two-thirds of their pregnancies as unplanned, and those who were younger, had less education, were lower-income or did not have a co-resident partner reported between 50–80% of their pregnancies as unplanned.

Conclusion

Obstetricians and midwives in New Zealand should be prepared to provide care for women with chronic conditions who may have surprise pregnancies. Comprehensive family planning services, preconception care and systemwide reduction in health inequities are needed to help women with chronic health conditions enter pregnancy as healthy as possible.

Author Information

Bryndl E Hohmann-Marriott, Sociology, Gender Studies and Criminology, School of Social Sciences, University of Otago, Dunedin.

Acknowledgements

The author is grateful to the Growing Up in New Zealand team for access to the data.

Correspondence

Bryndl E Hohmann-Marriott, Sociology, Gender Studies and Criminology, School of Social Sciences, University of Otago, PO Box 56, Dunedin 9054.

Correspondence Email

bryndl.hohmann-marriott@otago.ac.nz

Competing Interests

Nil.

References

  1. Ministry of Health. Report on Maternity 2014. Wellington, NZ: Ministry of Health.
  2. Ministry of Health. Annual Update of Key Results 2015/16: New Zealand Health Survey. Wellington, NZ: Ministry of Health.
  3. Balbo N, Billari FC, Mills M. Fertility in advanced societies: a review of research, Euro J of Pop. 2013; 29(1):1–38.
  4. Balsells M, Garcia-Patterson A, Gich I, Corcoy R. Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and meta-analysis. J of Clin Endo Metabol. 2009; 94:4284–4291.
  5. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006; 295(5):499–507. doi:10.1001/jama.295.5.499
  6. Sawicki E, Stewart K, Wong S, et al. Management of asthma by pregnant women attending an Australian maternity hospital. Aus NZ J Ob Gyn. 2012; 52(2):183–188. 
  7. Siu SC, Sermer M, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001; 104:515–521. 
  8. Barker M, Dombrowski S U, Colburn T, et al. Intervention strategies to improve nutrition and health behaviours before conception. Lancet. 2018; 391:1853–64.
  9. Dunlop AL, Jack BW, Bottalico JN, Lu MC, James A, Shellhaas CS, et al. The clinical content of preconception care: Women with chronic medical conditions. American Journal of Obstetrics and Gynecology 2008; 199:S310–S327. 
  10. Hohmann-Marriott, BE. Unplanned pregnancies in New Zealand. Aust NZ J Ob Gyn. 2018; 58(2):247–250.
  11. Mallard SR, Houghton LA. Socio-demographic characteristics associated with unplanned pregnancy in New Zealand: implications for access to preconception healthcare. Aus NZ J Ob Gyn. 2013; 53:498–501. 
  12. Perritt JB, Burke A, Jamshidli R, et al. Contraception counseling, pregnancy intention and contraception use in women with medical problems: an analysis of data from the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS). Contraception. 2013; 88:263–268.
  13. Wellings K, Jones KG, Mercer CH, et al. The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet. 2013; 382:1807–1816.
  14. Sereika SM, Becker D, Schmitt P, et al. Operationalizing and examining family planning vigilance in adult women with Type 1 diabetes. Diabetes Care. 2016.
  15. Chang CH, Velott DL, Weisman CS. Exploring knowledge and attitudes related to pregnancy and preconception health in women with chronic medical conditions. Mat Child Health J. 2010; 14:713–719.
  16. Mosher W, Jones J, Abma J. Nonuse of contraception among women at risk of unintended pregnancy in the United States. Contraception. 2015; 92(2):170–176. 
  17. Bonnema RA, McNamara MC, Spencer AL. Contraception choices in women with underlying medical conditions. Am Fam Phys. 2010; 82(6):621–8.
  18. Aiken ARA, Borrero S, Callegari LS, Dehlendorf C. Rethinking the pregnancy planning paradigm: Unintended conceptions or unrepresentative concepts? Perspect Sexual Repro Health. 2016; 48(3):147–151. 
  19. Faasalele Tanuvasa, AE. The place of contraception and abortion in the lives of Samoan women. 1999. Unpublished doctoral thesis, Victoria University of Wellington, New Zealand.
  20. Le Grice, J. Māori and reproduction, sexuality education, maternity and abortion. 2014. Unpublished doctoral thesis, University of Auckland, New Zealand.
  21. Morton SMB, Atatoa Carr PE, Bandara DK, et al. Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Report 1: Before we are born. 2010. Auckland: Growing Up in New Zealand.
  22. Chatterjee S, Kotelchuck M, Sambamoorthi U. Prevalence of chronic illness in pregnancy, access to care, and health care costs: Implications for interconception care. Women’s Health Iss. 2008; 18(6) Supplement:S107–S116.

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