Assessing pregnancy intention and associated risks in pregnant adolescents

Unintended pregnancy and associated behaviors may play a substantial role in the increased risk of adverse maternal and neonatal outcomes associated with teen pregnancy. We evaluate a multi-dimensional measure of pregnancy intention among pregnant adolescents and quantify the association between intention dimensions and adverse outcomes and risk behaviors. Pregnancy intention measures were examined in a cohort of 300 pregnant adolescent women. We considered 18 items assessing elements of pregnancy intention including pregnancy planning, timing, emotional response, and readiness. Latent class analysis was performed to identify dimensions of pregnancy intention. Parsimonious scores were created by minimizing the number of covariates while maintaining substantial agreement with the latent class. Associations between intention measures and prenatal care, risk behaviors, and pregnancy outcomes were quantified using multivariable logistic regression. Two constructs of pregnancy intention were identified: planning and emotional readiness. Compared with emotionally ready adolescents, adolescents categorized as not emotionally ready had an increased odds of inadequate prenatal care (OR = 2.70, 95% CI:1.27-5.72), delayed prenatal care (OR = 2.54, 95% CI:1.27-5.09), and self-reported depression at the time of the first prenatal visit (OR = 2.21, 95% CI:1.03-4.77). Pregnancy planning was not associated with adverse pregnancy risk factors or outcomes. Among pregnant adolescents, emotional readiness for pregnancy and parenting was inversely associated with known risk factors for adverse pregnancy outcomes, suggesting that emotional readiness rather than pregnancy planning may be the more pertinent intention construct for adolescents.