title: Pregnancy context and women's health-related quality of life.
abstract: OBJECTIVE
  The objective was to quantify the association of pregnancy context and health-related quality of life (HRQoL).
  
  
  METHODS
  English- or Spanish-speaking women, aged 16-44, with pregnancies <24 weeks' gestation were enrolled in this cross-sectional study between June 2014 and June 2015. Participants completed self-assessments of pregnancy "context," including timing, intention, wantedness, desirability, happiness, and planning (measured with the London Measure of Unplanned Pregnancy). HRQoL was measured using the Patient Reported Outcomes Measurement Information System Global Short Form. Associations between measures of pregnancy context and HRQoL scores in the lowest tertile were examined using multivariable logistic regression to adjust for potential confounding variables.
  
  
  RESULTS
  We enrolled 161 participants (mean age=27.2±6.6 years). Only 14% self-identified as White, non-Hispanic; 42% Hispanic; 37% Black, non-Hispanic; and 7% multiracial. Most (79%) participants were unmarried, and 75% were parenting. Mean gestational age was 9±4.6 weeks. In unadjusted models, women reporting mixed feelings about wanting to have a baby, an undesired pregnancy or feeling unhappy about learning of their pregnancy more frequently had low mental and physical HRQoL compared to women reporting wanted, desired, happy pregnancies. Women with an unplanned pregnancy or pregnancy occurring at the wrong time also had lower physical HRQoL than women reporting pregnancies that were planned or happened at the right time. However, after multivariate adjustment, including history of depression, pregnancy contexts were not associated with low mental or physical HRQoL.
  
  
  CONCLUSIONS
  After adjusting for multiple confounders, pregnancy context is not significantly associated with HRQoL.
  
  
  CONCLUSIONS
  The focus on pregnancy intention in public health programs may not sufficiently assess multidimensional aspects of pregnancy context and may not align with patient-centered outcomes such as HRQoL.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT. Electronic address: aileen.gariepy@yale.edu.
authors.forename: Aileen
authors.initials: A
authors.lastname: Gariepy
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
authors.forename: Lisbet S
authors.initials: LS
authors.lastname: Lundsberg
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
authors.forename: Nicole
authors.initials: N
authors.lastname: Vilardo
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
authors.forename: Nancy
authors.initials: N
authors.lastname: Stanwood
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Yonkers
authors.affiliation: Department of Internal Medicine, University of California, Davis, CA.
authors.forename: Eleanor B
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D003863:Depression; D004644:Emotions; D005260:Female; D005865:Gestational Age; D006240:Happiness; D006304:Health Status; D006630:Hispanic or Latino; D006801:Humans; D033182:Intention; D008603:Mental Health; D011247:Pregnancy / Q000523:psychology*; D049168:Pregnancy, Unplanned / Q000523:psychology; D011275:Pregnancy, Unwanted / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D044465:White People; D016387:Women's Health; D055815:Young Adult
keywords: London Measure of Unplanned Pregnancy; PROMIS; Pregnancy intention; Quality of life; Unplanned pregnancy