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

Height deficit in early adulthood following substantiated childhood maltreatment: a birth cohort study

Early life stress including childhood maltreatment has been associated with reduced head circumference and/or brain size, cognitive, and academic deficits in children and adolescents. However, little is known about the effect of childhood maltreatment on height, especially in early adulthood. This study was designed to examine the association between confirmed cases of multiple or subtypes of childhood maltreatment and stunted growth in young adulthood controlling for perinatal and familial confounding factors. A total of 2661 (48.4% female) young adults from the Mater Hospital-University Study of Pregnancy (MUSP) had data on standardised height-for-age score measurement as part of physical assessment at the 21-year follow-up. Prospectively substantiated cases of childhood maltreatment, 0–14 years of age, were linked to the MUSP dataset. Ethical approval was obtained from the Human Ethics Review Committee of The University of Queensland and the Mater Hospital. Multiple regression analyses were performed to determine the effects of childhood maltreatment on height in young adults. Childhood physical or emotional abuse and neglect were significantly associated with a deficit in height in young adulthood after controlling for perinatal and familial confounders. Multiple incidents of childhood maltreatment also were associated with a deficit in height

Gender-based differences in injecting drug use by young adults who experienced maltreatment in childhood: findings from an Australian birth cohort study

Background Childhood maltreatment has been associated with a range of adverse mental and psychosocial outcomes, but its association with subsequent injecting drug use (IDU) is less clear. This study investigates the associations between specific and multiple forms of substantiated childhood maltreatment and IDU reported at 21 years. Method The Mater-University of Queensland Study of Pregnancy is a prospective birth cohort study. It recruited pregnant women at their first antenatal clinic visit and collected data on their children at 21 years. Data from 3750 participants (1769 males and 1981 females) were analysed using agency substantiated childhood maltreatment from birth to 14 years of age and self-reports of ever IDU at 21 years. We used multivariable logistic regression analyses to control for possible confounders. Results The sample's mean age was 20.6 years. Some 4.1% (n\ua0=\ua072) of males and 4.6% (n\ua0=\ua091) of females had experienced substantiated childhood maltreatment. The prevalence of IDU was 6.6% (n\ua0=\ua0118) and 4.6% (n\ua0=\ua091) for males and females, respectively. In adjusted models, all forms of substantiated childhood maltreatment, with the exception of sexual abuse, were associated with IDU in females (adjusted odds ratios (AORs)\ua0=\ua02.69–3.02) but only emotional abuse (AOR\ua0=\ua02.51) was associated with IDU in males. Multiply occurring forms of childhood maltreatment were also associated with IDU in females (AORs\ua0=\ua02.36–3.41) but not in males. Conclusions Injecting drug use appears to be an adverse outcome of childhood maltreatment particularly in females. Additional research is needed to better understand why females appear to be more affected than males

Child maltreatment and mental health problems in 30-year-old adults: a birth cohort study

Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer with limited data at 30-year follow-up. This was a prospective record-linkage analysis to examine whether notified and/or substantiated child maltreatment was associated with adverse psychological outcomes in early adulthood when participants were 30 years old. We used data from 2861 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exposure to suspected child maltreatment was measured by linkage with state child protection data. The primary outcomes were DSM-IV diagnoses derived from the Composite International Diagnostic Interview-Auto version (CIDI). There were child abuse notifications on 171 participants, of which 103 were substantiated. The most common notifications were for physical abuse (n=96) followed by emotional abuse and neglect (n=80 each). There were 63 notifications of sexual abuse. Of those completing the CIDI at follow-up, 257 participants (9%) reported a depressive disorder, 703 (25%) an anxiety disorder and 138 (5%) PTSD. After adjustment for potential confounders, there were variations in the long-term effects of different types of abuse with physical abuse having a stronger association with depression, and sexual abuse with PTSD. Both emotional abuse and neglect were associated to varying degrees with depression, anxiety and PTSD. Substantiated abuse or multiple forms of abuse had generally the worst outcomes

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

Predictors of persistent body weight misclassification from adolescence period to adulthood: a longitudinal study

This study examined whether body weight misclassification continues from adolescence to adulthood and the associated predictors behind that misclassification. Data are from a sample of a longitudinal Australian birth-cohort study. Data analyses were restricted to 2938 participants whose measured and perceived body weights were recorded during their adolescence and adulthood follow-ups. To identify misclassification, we objectively compared their measured and perceived body weights at each follow-up. Potential predictors during early life or adolescence periods were included in data analyses. At each follow-up, underestimation was recorded more often among overweight and obese participants, whereas overestimation was mostly recorded among underweight ones. Over 40% males and females were able to correctly estimate their body weight at one followup, whereas almost 30% males and 40% females were able to do so in more than one follow-ups. One-third females and 45% males underestimated their body weight at one follow-up, whereas 13% females and a quarter of males were able to do so in more than one follow-ups. Being female, dieting, being overweight, having an overweight mother, and having poor mental health were the most significant predictors for more than one follow-up misclassifications. Further studies are needed to evaluate the impact of persistent misclassification on population health benefits

Childhood maltreatment and high dietary fat intake behaviors in adulthood: A birth cohort study

Childhood maltreatment has been associated with a wide range of chronic medical conditions including obesity, other metabolic events and eating disorders. However, little is known about the association between childhood maltreatment and high dietary fat intake. This study addresses the extent to which co-occurring and specific forms of substantiated childhood maltreatment are associated with self-reported high dietary fat intake in adulthood and whether there is a gender-childhood maltreatment interaction in predicting this association. The study also examines the association between age at substantiation of maltreatment, number of childhood maltreatment substantiations and high dietary fat intake-related behaviors. The data were from a prospective Australian pre-birth mother-child dyads study, the Mater-University of Queensland Study of Pregnancy. The study followed 7223 mother-child dyads following the birth of a live, singleton baby at the Mater hospital. Recruitment was early in pregnancy, and then follow-ups at 3-5days postpartum and again when the child was 6 months, 5, 14 and 21 years of age. The data were linked to agency-substantiated cases of childhood maltreatment 0-14 years. This study extended the data linkage to 3766 (47.4% female) participants who had complete data on dietary fat intake behaviors at the 21-year follow-up. Consecutive logistic regressions were used to estimate odds ratios with respective 95% confidence intervals for high dietary fat intake for multiple and specific forms of childhood maltreatment, as well as age at and number of childhood maltreatment substantiations. Finally, a gender-childhood maltreatment interaction term was used to predict the outcome. In both unadjusted and adjusted analyses, substantiated childhood maltreatment including physical abuse were associated with high dietary fat intake-related behaviors. Similarly, substantiation of childhood maltreatment between the ages of 5 and 14 years was significantly associated with high dietary fat intake-related behaviors as were two or more substantiations of maltreatment. Inclusion of gender-childhood maltreatment interaction only had a minor impact on the size and direction of the association. Chronic and severe forms of childhood maltreatment including physical abuse are associated with a higher rate of dietary fat intake in young adulthood. Further research to replicate this association might focus on possible neuro-hormonal mechanisms that might explain this behavior

Gender differences in the association between childhood sexual abuse and risky sexual behaviours: a systematic review and meta-analysis

This meta-analytic review examines the association between childhood sexual abuse and risky sexual behaviours with sub-group analyses by gender. Systematic searches of electronic databases including MEDLINE, PubMed, EMBASE, and PsycINFO were performed using key terms. We used a priori criteria to include high quality studies and control for heterogeneities across eligible studies. The review was registered with PROSPERO and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final meta-analysis applied fixed-effects model to generate pooled odds ratio (OR). Subgroup analyses were conducted to identify potential methodological moderators. The meta-analysis included 8 eligible studies (N = 38,989, females = 53.1%). The overall syndemic of risky sexual behaviors at adulthood was 1.59 times more common in childhood sexual abuse victims. There was a similar association between childhood sexual abuse in general and subsequent risky sexual behaviors in both females and males. However, in cases of substantiated childhood sexual abuse, there was a greater odds of risky sexual behaviors in females (OR = 2.72) than males (OR = 1.69). The magnitude of association of childhood sexual abuse and risky sexual behaviors was similar for males and females regardless of study time, study quality score and method of childhood sexual abuse measurement. There were nonsignificant overall and subgroup differences between males and females. Childhood sexual abuse is a significant risk factor for a syndemic of risky sexual behaviors and the magnitude is similar both in females and males. More research is needed to explore possible mechanisms of association. (C) 2016 Elsevier Ltd. All rights reserved

Child maltreatment and mental health problems in adulthood: birth cohort study

Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer.AimsTo examine, using a prospective record-linkage analysis, whether substantiated child maltreatment is associated with adverse psychological outcomes in early adulthood.The participants were 3778 mother and child pairs enrolled in a population-based birth cohort study in Brisbane, Australia. Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. The primary outcomes were the internalising and externalising scales of the Youth Self-Report and the Centre for Epidemiological Studies-Depression scales (CES-D) at approximately 21 years of age. A subset completed the Composite International Diagnostic Interview-Auto version (CIDI-Auto).In total, 171 (4.5%) participants had a history of substantiated child maltreatment, most commonly emotional abuse (n = 91), followed by physical abuse (n = 78), neglect (n = 73) and sexual abuse (n = 54). After adjustment for potential confounders, depressive symptoms on the CES-D, as well as internalising and externalising behaviours were strongly associated with substantiated abuse in all forms, except sexual abuse. The results for the subset of the sample who completed the CIDI-Auto were less clear. Anxiety, especially post-traumatic stress disorder, showed the strongest association whereas the findings for depressive disorder were equivocal. However, across all diagnostic categories, emotional abuse and neglect, as well as multiple forms of abuse, showed a consistent association.Child maltreatment, particularly neglect and emotional abuse, has serious adverse effects on early adult mental health. These two warrant the attention given to other forms of child maltreatment. Children experiencing more than one type of maltreatment are at particular risk.Declaration of interestNone

Substantiated childhood maltreatment and young adulthood cannabis use disorders: A pre-birth cohort study

This study investigates the association between exposure to prospectively-substantiated childhood maltreatment between 0 and 14 years of age and lifetime cannabis use, abuse and dependence reported at 21 years. Data were taken from 2526 (51.6% female) participants in the Mater Hospital-University of Queensland Study of Pregnancy, a pre-birth, prospective, cohort study. Prospectively-substantiated cases of childhood maltreatment, reported to the government child protection agencies between 0 and 14 years of age, were linked to CIDI DSM-IV self-report data from the 21-year follow-up. Exposure to any childhood maltreatment, and childhood neglect in particular, predicted subsequent cannabis abuse with adjusted odds ratios (AORs) of 1.79 and 2.62, respectively. Any childhood maltreatment, physical abuse, emotional abuse and neglect predicted cannabis dependence with AORs of 2.47, 2.81, 2.44 and 2.68, respectively. The associations for an early age of onset of cannabis abuse and dependence were significant and consistent for maltreated children. In addition, frequency of maltreatment substantiations predicted cannabis abuse, dependence and an early age of onset of these disorders. The AORs for cannabis ever use without any DSM-IV cannabis disorder were 1.78 for any maltreatment and 2.15 for emotional abuse. Any childhood maltreatment and neglect predicted lifetime ever cannabis use, as well as cannabis use disorder. There was little evidence for any interaction between gender and different forms of childhood maltreatment and its association with cannabis use disorders. Physical abuse, emotional abuse and neglect, as well as multiple episodes of maltreatment independently predicted cannabis use disorders