Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

(SDAS) The Impact of Pregnancy Intentions on Early Childhood

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Project Number: R40 MC 25692
Grantee: Guttmacher Institute, Inc
Department/Center: Research
Project Date: 02/01/2013

Final Report


Principal Investigator

Laura Lindberg, Ph.D.
Senior Research Associate
125 Maiden Lane, 7th Floor
New York, NY  10038-4912
Phone: 212-248-1111


  • Women/Maternal
  • Prenatal
  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)


Public health policy is strongly influenced by the premise that unintended childbearing has significant negative effects on the behavior of mothers both during pregnancy and afterward, and that such behaviors directly affect the health and wellbeing of the infant. Presumably, these effects extend into early childhood, but there has been little empirical investigation of the associations between pregnancy intentions and early childhood outcomes in the U.S., and findings from the few existing studies are weak and inconsistent, due in part to challenges disentangling the effect of unintended pregnancy from the effects of pre-existing social and family conditions. The objective of this study is to improve the health and well-being of young children in the U.S. by examining the effect of pregnancy intention status on early childhood outcomes. This study will capitalize on unique and underutilized representative longitudinal data linking maternal reports of pregnancy intention (including the length of mistiming) in the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) to early childhood health and well-being measures from the 2006-2010 Oklahoma Toddler Survey (TOTS) collected when the children are two years old. Our research approach and overall strategy address the concern that similar background characteristics may influence both the likelihood of having an unintended birth and the outcomes under study by applying propensity scoring analysis methods. To achieve our central objective, we have identified four related aims of this project: Aims 1 and 2 are to examine the relationship between pregnancy intention status and children's physical health, and parental investment in child development and well-being at age two, respectively. Aim 3 is to capitalize on new and unique information available in TOTS (linked with the state PRAMS), to identify specific dimensions of childbearing intention, including timing and desire, and measure their predictive value in analyses of consequences. Aim 4 is to apply and evaluate an innovative statistical technique - propensity-scoring matched-sample methods - as a means of controlling for shared underlying causes of both unintended childbearing and its consequences. The central hypothesis is that children whose pregnancy had been mistimed or unwanted will experience poorer child health and well-being and fewer parental investments in child development than children from intended pregnancies. For both sets of outcomes - child health and well-being and parental investment in child development - we expect the association with intention status to vary by the extent of pregnancy mistiming. With a central focus on health in early childhood, this project addresses MCHB strategic research issue IV, promoting the healthy development of MCH populations. Research issue II, MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations, is also addressed: both pregnancy intention and infant and child health are characterized by significant demographic disparities. This study fits with the life course approach of MCH research in its focus on longitudinal analysis, linking influences over the early life course - from pregnancy and postpartum - to influences and outcomes when the child is two years old. It lays the groundwork for broader efforts to connect two important areas of study: women's childbearing intentions and early childhood health


Listed is descending order by year published.

Lindberg L, Maddow-Zimet I, Kost K, Lincoln A. Pregnancy intentions and maternal and child health: an analysis of longitudinal data in Oklahoma. Matern Child Health J. 2015 May;19(5):1087-96.


Parenting, Pregnancy, Social & Emotional Development, Mental Health & Wellbeing

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