Are pregnancy planning and timing associated with preterm or small for gestational age births?

Published:September 10, 2015DOI:


      To investigate whether unplanned or poorly timed pregnancies (self-reported at enrollment) are associated with preterm or small for gestational age births.


      Prospective cohort study.


      Not applicable.


      Two thousand six hundred fifty-four pregnant women <18 weeks estimated gestational age with a singleton pregnancy.



      Main Outcome Measure(s)

      Preterm and small for gestational age births.


      In adjusted analyses, pregnancy planning was not statistically significantly associated with preterm (odds ratio [OR] 1.18; 95% confidence interval [CI], 0.85–1.65) or small for gestational age birth (OR 1.17; 95% CI, 0.69–1.97). Similarly, poorly timed pregnancies were not statistically significantly associated with preterm (OR 0.85; 95% CI, 0.53–1.38) or small for gestational age birth (OR 0.92; 95% CI, 0.65–1.29). Combining pregnancy planning (yes/no) and timing (yes/no) into a 4-level category showed no statistically significant association with preterm birth or small for gestational age.


      In a large cohort with antenatally assessed pregnancy planning and timing, outcome data collected from medical record abstraction, and robust analysis adjusting for multiple confounding factors including maternal demographics, medical conditions, and other risk factors, neither pregnancy planning nor pregnancy timing showed a statistically significant association with preterm or small for gestational age infants. This study improves upon previous analyses that lacked adjustment for confounding and used retrospective self-reporting to assess pregnancy planning and timing, and preterm and small for gestational age births. Findings may differ in higher risk populations with higher prevalence of preterm or small for gestational age births.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Fertility and Sterility
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Finer L.B.
        • Zolna M.R.
        Shifts in intended and unintended pregnancies in the United States, 2001–2008.
        Am J Public Health. 2014; 104: S43-S48
        • Santelli J.
        • Rochat R.
        • Hatfield-Timajchy K.
        • Gilbert B.C.
        • Curtis K.
        • Cabral R.
        • et al.
        Unintended Pregnancy Working Group. The measurement and meaning of unintended pregnancy.
        Perspect Sex Reprod Health. 2003; 35: 94-101
        • Mosher W.D.
        • Jones J.
        • Abma J.C.
        Intended and unintended births in the United States: 1982–2010.
        Natl Health Stat Report. 2012; 55: 1-28
        • Cleland K.
        • Peipert J.F.
        • Westhoff C.
        • Spear S.
        • Trussell J.
        Family planning as a cost-saving preventive health service.
        N Engl J Med. 2011; 364: e37
        • Cheng D.
        • Schwarz E.
        • Douglas E.
        • Horan I.
        Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors.
        Contraception. 2009; 79: 194-198
      1. Logan C, Holcombe E, Manlove J, Ryan S. The consequences of unintended childbearing: a white paper. Washington, DC: Child Trends. Available at: Last accessed September 16, 2015.

      2. Brown S.S. Eisenberg L. The best intentions: unintended pregnancy and the well-being of children and families. National Academies Press, Washington, DC1995
        • Haider S.
        • Stoffel C.
        • Donenberg G.
        • Geller S.
        Reproductive health disparities: a focus on family planning and prevention among minority women and adolescents.
        Glob Adv Health Med. 2013; 2: 94-99
        • Takahashi S.
        • Tsuchiya K.J.
        • Matsumoto K.
        • Suzuki K.
        • Mori N.
        • Takei N.
        HBC Study Team. Psychosocial determinants of mistimed and unwanted pregnancy: the Hamamatsu Birth Cohort (HBC) study.
        Matern Child Health J. 2012; 16: 947-955
        • Flower A.
        • Shawe J.
        • Stephenson J.
        • Doyle P.
        Pregnancy planning, smoking behaviour during pregnancy, and neonatal outcome: UK Millennium Cohort Study.
        BMC Pregnancy Childbirth. 2013; 13: 238
        • Shah P.S.
        • Balkhair T.
        • Ohlsson A.
        • Beyene J.
        • Scott F.
        • Frick C.
        Intention to become pregnant and low birth weight and preterm birth: a systematic review.
        Matern Child Health J. 2011; 15: 205-216
        • Afable-Munsuz A.
        • Braveman P.
        Pregnancy intention and preterm birth: differential associations among a diverse population of women.
        Perspect Sex Reprod Health. 2008; 40: 66-73
        • Keeton K.
        • Hayward R.A.
        Pregnancy intention and birth outcomes: does the relationship differ by age or race?.
        J Womens Health (Larchmt). 2007; 16: 510-516
        • Mohllajee A.P.
        • Curtis K.M.
        • Morrow B.
        • Marchbanks P.A.
        Pregnancy intention and its relationship to birth and maternal outcomes.
        Obstet Gynecol. 2007; 109: 678-686
        • Pulley L.
        • Klerman L.V.
        • Tang H.
        • Baker B.A.
        The extent of pregnancy mistiming and its association with maternal characteristics and behaviors and pregnancy outcomes.
        Perspect Sex Reprod Health. 2002; 34: 206-211
        • Orr S.T.
        • Miller C.A.
        • James S.A.
        • Babones S.
        Unintended pregnancy and preterm birth.
        Paediatr Perinat Epidemiol. 2000; 14: 309-313
        • Sharma R.
        • Synkewecz C.
        • Raggio T.
        • Mattison D.R.
        Intermediate variables as determinants of adverse pregnancy outcome in high-risk inner-city populations.
        J Natl Med Assoc. 1994; 86: 857-860
        • D’Angelo D.V.
        • Gilbert B.C.
        • Rochat R.W.
        • Santelli J.S.
        • Herold J.M.
        Differences between mistimed and unwanted pregnancies among women who have live births.
        Perspect Sex Reprod Health. 2004; 36: 192-197
        • Korenman S.
        • Kaestner R.
        • Joyce T.
        Consequences for infants of parental disagreement in pregnancy intention.
        Perspect Sex Reprod Health. 2002; 34: 198-205
        • Eggleston E.
        • Tsui A.O.
        • Kotelchuck M.
        Unintended pregnancy and low birthweight in Ecuador.
        Am J Public Health. 2001; 91: 808-810
        • Ahluwalia I.B.
        • Merritt R.
        • Beck L.F.
        • Rogers M.
        Multiple lifestyle and psychosocial risks and delivery of small for gestational age infants.
        Obstet Gynecol. 2001; 97: 649-656
        • Sable M.R.
        • Spencer J.C.
        • Stockbauer J.W.
        • Schramm W.F.
        • Howell V.
        • Herman A.A.
        Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status.
        Fam Plann Perspect. 1997; 29: 76-81
        • Messer L.C.
        • Dole N.
        • Kaufman J.S.
        • Savitz D.A.
        Pregnancy intendedness, maternal psychosocial factors and preterm birth.
        Matern Child Health J. 2005; 9: 403-412
        • Joyce T.J.
        • Kaestner R.
        • Korenman S.
        The effect of pregnancy intention on child development.
        Demography. 2000; 37: 83-94
        • Bitto A.
        • Gray R.H.
        • Simpson J.L.
        • Queenan J.T.
        • Kambic R.T.
        • Perez A.
        • et al.
        Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study.
        Am J Public Health. 1997; 87: 338-343
        • Phipps M.G.
        • Nunes A.P.
        Assessing pregnancy intention and associated risks in pregnant adolescents.
        Matern Child Health J. 2012; 16: 1820-1827
        • Kost K.
        • Landry D.J.
        • Darroch J.E.
        The effects of pregnancy planning status on birth outcomes and infant care.
        Fam Plann Perspect. 1998; 30: 223-230
        • Goldenberg R.
        • Culhane J.F.
        • Iams J.
        • Romero R.
        Epidemiology and causes of preterm birth.
        Lancet. 2007; 371: 73-82
        • Mathews T.J.
        • MacDorman M.F.
        Infant mortality statistics from the 2010 period linked birth/infant death data set.
        Natl Vital Stat Rep. 2013; 62: 1-27
        • Saigal S.
        • Doyle L.W.
        An overview of mortality and sequelae of preterm birth from infancy to adulthood.
        Lancet. 2008; 371: 261-269
        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.J.
        • Curtin S.C.
        • Mathews M.A.
        • Mathews T.J.
        Births: Final data for 2012.
        Natl Vital Stat Rep. 2013; 62: 1-68
      3. National Center for Health Statistics, final natality data. Available at: Last accessed July 15, 2015.

        • American College of Obstetricians and Gynecologists
        Fetal growth restriction. Practice Bulletin No. 134.
        Obstet Gynecol. 2013; 121: 1122-1133
        • Yonkers K.A.
        • Norwitz E.R.
        • Smith M.V.
        • Lockwood C.J.
        • Gotman N.
        • Luchansky E.
        • et al.
        Depression and serotonin reuptake inhibitor treatment as risk factors for preterm birth.
        Epidemiology. 2012; 23: 677-685
        • Yonkers K.A.
        • Gotman N.
        • Smith M.V.
        • Forray A.
        • Belanger K.
        • Brunetto W.L.
        • et al.
        Does antidepressant use attenuate the risk of a major depressive episode in pregnancy?.
        Epidemiology. 2011; 22: 848-854
        • Cox J.
        • Holden J.
        Perinatal psychiatry: use and misuse of the Edinburgh Postnatal Depression Scale.
        Royal College of Psychiatrists, Glasgow1994
        • Falsetti S.
        • Resnick H.
        • Pesick P.
        • Kilpatrick D.
        The modified PTSD symptom scale: a brief self-report measure of posttraumatic stress disorder.
        Behav Ther. 1993; 16: 161-162
        • Cohen S.
        • Williamson G.M.
        Perceived stress in a probability sample of the United States.
        in: Spacapan S. Oskamp S. The social psychology of health. Sage, New York1988: 31-67
        • Spoozak L.
        • Gotman N.
        • Smith M.V.
        • Belanger K.
        • Yonkers K.A.
        Evaluation of a social support measure that may indicate risk of depression during pregnancy.
        J Affect Disord. 2009; 114: 216-223
        • World Health Organization
        Composite International Diagnostic Interview (CIDI, version 2.1).
        World Health Organization, Geneva1997
        • Committee on Practice Bulletins—Obstetrics
        • The American College of Obstetricians and Gynecologists
        Practice bulletin no. 130: prediction and prevention of preterm birth.
        Obstet Gynecol. 2012; 120: 964-973
        • Iams J.D.
        Clinical practice. Prevention of preterm parturition.
        N Engl J Med. 2014; 370: 254-261
        • Hall K.S.
        • Kusunoki Y.
        • Gatny H.
        • Barber J.
        The risk of unintended pregnancy among young women with mental health symptoms.
        Soc Sci Med. 2014; 100: 62-71
        • Terplan M.
        • Cheng D.
        • Chisolm M.S.
        The relationship between pregnancy intention and alcohol use behavior: an analysis of PRAMS data.
        J Subst Abuse Treat. 2014; 46: 506-510
        • Heil S.H.
        • Jones H.E.
        • Arria A.
        • Kaltenbach K.
        • Coyle M.
        • Fischer G.
        • et al.
        Unintended pregnancy in opioid-abusing women.
        J Subst Abuse Treat. 2011; 40: 199-202
        • Grote N.K.
        • Bridge J.A.
        • Gavin A.R.
        • Melville J.L.
        • Iyengar S.
        • Katon W.J.
        A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.
        Arch Gen Psychiatry. 2010; 67: 1012-1024
        • Diego M.A.
        • Field T.
        • Hernandez-Reif M.
        • Schanberg S.
        • Kuhn C.
        • Gonzalez-Quintero V.H.
        Prenatal depression restricts fetal growth.
        Early Hum Dev. 2009; 85: 65-70
        • Harris L.F.
        • Roberts S.C.
        • Biggs M.A.
        • Rocca C.H.
        • Foster D.G.
        Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study.
        BMC Womens Health. 2014; 14: 76
        • Allsworth J.E.
        • Secura G.M.
        • Zhao Q.
        • Madden T.
        • Peipert J.F.
        The impact of emotional, physical, and sexual abuse on contraceptive method selection and discontinuation.
        Am J Public Health. 2013; 103: 1857-1864
        • Bloch J.R.
        • Webb D.A.
        • Mathew L.
        • Culhane J.F.
        Pregnancy intention and contraceptive use at six months postpartum among women with recent preterm delivery.
        J Obstet Gynecol Neonatal Nurs. 2012; 41: 389-397
        • Orr S.T.
        • Miller C.A.
        Unintended pregnancy and the psychosocial well-being of pregnant women.
        Womens Health Issues. 1997; 7: 38-46
        • Kavanaugh M.L.
        • Schwarz E.B.
        Prospective assessment of pregnancy intentions using a single- versus a multi-item measure.
        Perspect Sex Reprod Health. 2009; 41: 238-243
        • Grimes D.A.
        • Schulz K.F.
        Bias and causal associations in observational research.
        Lancet. 2002; 359: 248-252
        • Petersen R.
        • Moos M.K.
        Defining and measuring unintended pregnancy: issues and concerns.
        Womens Health Issues. 1997; 7: 234-240
        • Barrett G.
        • Smith S.C.
        • Wellings K.
        Conceptualisation, development, and evaluation of a measure of unplanned pregnancy.
        J Epidemiol Community Health. 2004; 58: 426-433
        • Gipson J.D.
        • Koenig M.A.
        • Hindin M.J.
        The effects of unintended pregnancy on infant, child, and parental health: a review of the literature.
        Stud Fam Plann. 2008; 39: 18-38
        • Schwarz E.B.
        • Lohr P.A.
        • Gold M.A.
        • Gerbert B.
        Prevalence and correlates of ambivalence towards pregnancy among nonpregnant women.
        Contraception. 2007; 75: 305-310
        • Barrett G.
        • Wellings K.
        What is a ‘planned’ pregnancy? Empirical data from a British study.
        Soc Sci Med. 2002; 55: 545-557