A systematic review of unintended pregnancy in cross-cultural settings: Does it have adverse consequences for children?

Introduction: Although there has been a great deal of concern about the consequences of unintended pregnancies on child health, there has been little documented evidence across specific outcomes to inform programs and policies. This paper highlights the association between unintended pregnancy, and its health and developmental consequences to children.Methods: Published and grey evidence available adverse effects of unintended pregnancy on children were extracted electronically using search engines: PubMed, EMBASE and Google Scholar for the period January 1981 through January 2017. The PRISMA checklist was used and qualities of eligible studies were assessed for method validity and result interpretation. Effect-size odds ratioswere calculated from extracted data.Results: Of the 107 studies identified after removal of duplications, 29 studies with a quality score ranging from 3 to 6 (Mean = 5.65; SD±0.65) were included. Pattern of child rearing, development and health were found to differ for children classified to be breads of an unintended pregnancy. However, many of the available studies appear to have methodological limitations such as recall bias and brief period of follow-ups limiting causal inferences and to determine a temporal sequence. The findings were found to be inconsistent across studies.Conclusion: Studies provide evidence relating to adverse health outcomes for children of unintended births. The existing knowledge is limited by weak research methodologies and a paucity of studies addressing subsequent health and developmental effects beyond the early childhood period. There is a need for more multi-wave longitudinal studies to assess child health and developmental trajectories associated with unintended pregnancies. [Ethiop. J. Health Dev. 2017;31 (3):138-154]Keywords: Unplanned pregnancy, unwanted pregnancy, child development, child health consequenc

Continuity of sleep problems from adolescence to young adulthood: results from a longitudinal study

Background: Considering the lack of evidence on incidence and continuity of sleep problems from adolescence to young adulthood, this study explores sleep problems’ incidence and their continuation rates from 14 to 21 years. Methods: Sleep data from the 14-year (n = 4,924) and 21-year (n = 3660) follow-up of the Mater-University of Queensland Study of Pregnancy cohort were used. Sociodemographic, lifestyle, and psychological conditions were explored for their role in sleep problems. Modified Poisson regression with a robust error variance was used to identify predictors. Inverse probability weights were used to account for attrition. Results: Of all subjects, 26.0% of the subjects at 14 years and 28.3% of the subjects at 21 years reported “often” sleep problems, with 41.7% of adolescent sleep problems persisting at 21 years. Perinatal and early-life maternal factors, for example, drug abuse (incidence rate ratio (IRR), 1.32; 95% confidence interval [CI], 1.02-1.71), smoking, depression, and anxiety, were significant predictors of adolescent sleep problems. Female sex (IRR, 2.13; 95% CI, 1.55-2.94), advanced pubertal stages, and smoking were the important predictors of sleep problems at 21 years. Adolescent depression/anxiety supported the continuity of sleep problems (IRR, 1.21; 95% CI, 1.05-1.40), whereas exercise was seen to exert a protective effect. Conclusion: This study indicates high rates of sleep problems in young subjects, with around half of sleep problems originating in adolescence persisting in young adulthood. Therefore, early interventions are needed to manage sleep problems in young subjects and prevent further progression to other life stages. Future studies should explore if sleep problems in young adults also persist in later life stages and identify the factors supporting the continuity of sleep problems

Chronicity, severity and timing of maternal depressive symptoms: Relationships with child outcomes at age 5

The relationships between severity, chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on children's behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems

Early adversity and health outcomes in young adulthood: the role of ongoing stress.

ObjectiveThe current study examined the prospective effects of exposure to stressful conditions in early childhood on physical health in young adulthood, and explored continuing exposure to stressors, as well as depression, in adolescence as possible mechanisms of this relationship.MethodA prospective longitudinal design was used to examine 705 mother-child pairs from a community-based sample, followed from offspring birth through age 20 years. Mothers provided contemporaneous assessments of early adverse conditions from offspring birth through age 5. Offspring responses to the UCLA Life Stress Interview, Structured Clinical Interview for DSM Disorders, Physical Functioning subscale of the SF-36 Health Survey, and questions about the presence of chronic disease were used to assess youth stress at age 15, depression from ages 15-20, and physical health at age 20.ResultsEarly adversity conferred risk for elevated levels of social and nonsocial stress at youth age 15, as well as depression between ages 15 and 20. Social and nonsocial stress, in turn, had effects on physical health at age 20, directly and indirectly via depression.ConclusionFindings suggest that early adverse conditions have lasting implications for physical health, and that continued exposure to increased levels of both social and nonsocial stress in adolescence, as well as the presence of depression, might be important mechanisms by which early adversity impacts later physical health

Predictors of hazardous alcohol consumption among young adult amphetamine-type stimulant users: a population-based prospective study

Background: Very high levels of alcohol consumption have been observed in young adult amphetamine-type stimulant (i.e., ecstasy and methamphetamine) users. The reasons for this association are poorly understood. Objective: To examine predictors of hazardous alcohol consumption in a sample of young adult amphetamine-type stimulant users after 30 months of follow-up, controlling for potential confounders. Method: Analysis of longitudinal data from a population-derived sample of Australian young adult amphetamine-type stimulant users (n = 292). A prediction model of alcohol use at 30 months was developed using generalized linear latent and mixed modeling (GLLAMM). Results: Concurrently using ecstasy (Adjusted Odds Ratio [AOR] = 2.67, 95% Confidence Interval [CI] = [1.41, 5.07]), frequently attending nightclubs (AOR = 2.53, 95% CI = [1.04, 6.16]), high baseline alcohol use patterns (AOR = 2.06, 95% CI = [1.32, 3.20]), and being male (AOR = 3.60, 95% CI = [1.48, 8.78]) were associated with an increased likelihood of hazardous alcohol use at 30 months. Conclusion: Concurrent, but not baseline, ecstasy use was associated with hazardous alcohol use, suggesting that combined use of these substances may have an instrumental role in terms of the social functions of drug use (e.g., increasing capacity to drink). Integration of educational interventions concerning alcohol and stimulants is warranted

Preschool children perceived by mothers as irregular eaters: physical and psychosocial predictors from a Birth Cohort Study

Objective: Parents often report their children display irregular eating patterns. Our aim is to describe the stability of maternal-perceived irregular eating of their offspring from 6 months to 2-4 years of age and to investigate factors that are associated with maternal perceived irregular eating of their 2-4 year old offspring. Methods: A longitudinal mother-child linked analysis was carried out using 5 year follow-up data from a population-based prospective birth cohort of 5122 mothers who were participants in the Mater-University Study of Pregnancy, Brisbane. Measures included responses to standardized questionnaires, pediatrician review and standardized measures such as the Peabody Picture Vocabulary Test-Revised and the Child Behavior Checklist. Results: 20.2% and 7.6% of mothers respectively stated their 2-4 year old was sometimes or often an irregular eater. Continuity of feeding difficulties from age 6 months was prominent: 48% of 6 month Olds with a feeding problem were 'sometimes' or 'often' irregular eaters at age 2-4 years. From a multivariable analysis, both child-intrinsic factors (chronic physical morbidity, sleeplessness and anxiety-depressive symptoms) and factors that impinge upon the child (poor maternal health and maternal depression and anxiety) independently contributed to irregular eating status at age 2-4 years. Conclusions: We conclude that approximately one third of mothers had some concern with their child's irregular eating, 7.6% of mothers were often concerned. irregular eating children were usually physically well, more likely to have persisting feeding problems, sleeplessness, behavioral problems and lived with mothers with perceived poor physical and mental health. Ontervention strategies should be family orientated and include child, mother and mother-child psychosocial approaches

The association of hypertensive disorders of pregnancy with weight gain over the subsequent 21 years: Findings from a prospective cohort study

Obesity is an important risk factor for hypertensive disorders of pregnancy, but most cases of hypertensive disorders of pregnancy occur in women of normal weight. There may be predisposing factors to both hypertensive disorders of pregnancy and obesity. To test this hypothesis, the authors compared changes in body mass index (weight (kg)/height (m)(2)) overtime in women with and without hypertensive disorders of pregnancy. They used data from 3,572 women who received antenatal care at a major public hospital in Brisbane, Australia, between 1981 and 1984 and who were followed up for 21 years. A total of 318 women (8.9%) had experienced hypertensive disorders in the index pregnancy, and 233 of them (73.3%) had a baseline body mass index of = 5 kg/m(2) were 59% greater for women who experienced hypertensive disorders of pregnancy compared with those who did not (odds ratio = 1.59, 95% confidence interval: 1.24, 2.04). The authors concluded that hypertensive disorders of pregnancy are associated with increased weight gain over 21 years

Is there a fetal origin of depression? Evidence from the Mater University Study of Pregnancy and its outcomes

It is unclear whether there is a fetal origin of adult depression. In particular, previous studies have been unable to adjust for the potential effect of maternal depression during pregnancy on any association. The association of birth weight with adult symptoms of depression was examined in an Australian prospective birth cohort, the Mater University Study of Pregnancy and its outcomes. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale among 3,719 participants at the 21-year follow-up in 2002-2005. In multivariable analyses, there were a weak inverse association between birth weight and symptoms of depression in the whole cohort and some evidence of sex differences in this association. Among females, there was a graded inverse association: In the fully adjusted model, the odds ratio for a high level of depressive symptoms for a 1-standard deviation increase in birth weight (gestational age-standardized z score) was 0.82 (95% confidence interval: 0.73, 0.92). Among males, there was no association (with sex in all models: p(interaction) < 0.004). Study results provide some support for a fetal origin of adult depression and suggest that the association is not explained by maternal mental health characteristics during pregnancy. Further research is needed to better understand the mechanisms underlying the association