Pregnancy Burden: An Integrative Review and Dimensional Analysis of Pregnancy's Hidden Challenges

Outcomes surrounding childbirth have focused on survival, leaving gaps in understanding the comprehensive experience of pregnancy for the pregnant individual. Anecdotally, pregnancy and the opportunity to reproduce is often received with a celebratory response. Yet whether planned or unplanned, a wide array of burdens may exist throughout pregnancy ranging from minor inconveniences to dangerous contributions to morbidity and mortality. The experience of pregnancy is superimposed onto the physical, mental, and social reality that already exists as an individual's life and consistently accentuates aspects of stress that can lead to increased physical, mental, emotional, financial, or other burden that many health and social systems globally lack resources to support. To address this gap, this analysis sought to explore the concept of pregnancy burden.

A formal search of 5 databases was conducted using integrative review methodology, with a total of 37 articles meeting inclusion criteria. To better conceptualize pregnancy burden, a dimensional analysis was then undertaken posing the research question, "What is pregnancy burden?"

The current social construction of pregnancy burden revealed multidimensional contributors to burden that were identified as both intrinsic and extrinsic, with no current definition available. Five dimensions of pregnancy burden were discovered: health, education, financial or cost, inequity, and social support. Three distinct perspectives were identified that included the pregnant person; their partners, family, or friends; and health systems or care providers. To best answer the research question and focus on the personal experience, the scope of this analysis was limited to the perspective of the pregnant individual.

The term burden is discussed and well-developed in chronic disease literature but has not been inclusive of pregnancy. This review revealed that pregnancy burden exists but remains unclassified and understudied, supporting the need for further exploration. Better understanding and valuing of the total experience of pregnancy, inclusive of burden, has the potential to improve the pregnancy experience.