Document Type : Original Article
Authors
1 associate of pediatric department –assistant director of health chancellery, Mashhad University of Medical Sciences, Mashhad, Iran
2 Mohammad ahmadian- MD –MPH- manager of health population, family, nutrition and School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
3 Mohammad bolbolian ghalibaf- assistant of statistic department- hakim Sabzevri University
4 Mitra hashemian- manage of productivity health, of health chancellery, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Keywords
Introduction: Nowaday reproductive health proposed as aprequisite of developing in world and it due to special noticeon it in recent years(1) . One of the most important defects countriesRecent research suggests that infants from unintended pregnancies may be at a greater risk of low birth weight than infants from planned pregnancies (1). A US study that examined the separate impacts of unwanted (unintended, in women not wanting more children) (2),
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* Corresponding author: Mohammad ahmadian- MD –MPH- manager of health population, family, nutrition, school in health chancellery Mashhad Medical University Email:ahmadianm1@mums.ac.ir |
Mistimed (unintended, in women desiring a child in the future), and planned (intended)
Pregnancies revealed that infants from unwanted but not mistimed pregnancies were slightly more likely than infants from planned pregnancies to be of low birth weight (3). Some studies showed that infants who delivery by unwanted mother pregnancy increase unhealthy behaviors (4). Considering weight in healthy infant and effects of unwanted pregnancy (5). When maternal Behaviors such as cigarette smoking were added to the model, however, unwanted Pregnancy was no longer a significant predictor of low birth weight in that study (6, 7).
Some studies showed that infants who delivery by unwanted mother pregnancy have mental and physically disorder (8, 9), also shiva rafati and colleagues (2005) and mostafa hoseini and colleagues (2005) found that unwanted pregnancy related to low weight birth deliver.
In IRAN survey on health population indications (2005), prevalence of unwanted pregnancy was 30.6%, in mashad medical university (31.5%) reported (10). Purpose of this study is assess the correlation between Unintentional pregnancy and low birth weight in delivery we also illustrate some key factors influencing low birth weight
Methods: The women in this study represented a subsample of women interviewed in the 1391
Who refer to health center no 9and participated in Health Survey, a sample of 838 women of reproductive age was selected. Pregnancy intention status was determined, as in most survey research, by opinion of man or woman did you want children [unwanted]?”In first mother refer to health center wanted or unwanted pregnancy determined. Exposed group (unwanted) size was 236, unexposed group (wanted) 602 persons participated. Infants weight was considered in data questioner. Infants weighing 2500 g or less were considered low-birth weight infants. A multivariate logistic regression model
Was usual to assess jointly the effects of pregnancy intention status and other factors on
Birth weight. The dependent variable was birth weight (low vs. other), and the independent variable of interest was pregnancy intention status. Control variables, identified in previous
Researches as covariates of low birth weight, included women’s reports of pregnancy
And delivery characteristics (site of delivery, prenatal care, anemia, blood pressure, cigarette smoking,…) and socio demographic characteristics (age group, sex of infant, birth order, urban/rural residence, and maternal education). All data coded in SPSS statistical software and analyzed. Nominal variables reported, percentage and frequency, quantity variables reported by mean and standard deviation, level of significant was 0.05 p-value. Used chi-square and t-student for analyze and regression logistic for accurate and precise covariate on LWB.
Results: Purpose of this study is assessment correlation between Unwanted pregnancy and low birth weight findings showed that in wanted group ( n=602) and unwanted (n=236) , 10.3 % of children have LWB respectivly, in wanted group 11% and unwanted group 8.5% reported. Age from term and pre-term determined. In unwanted group 9.3% and wanted group 9% were pre-term that there was not significant in two groups.
Demographic features and mothers statues separately shown in table 1. Using T-student test). T-STUDENT test showed that mean of mothers age and number of fertility in unwanted group is significantly related(p=0.05) also chi square test showed that some factors like residential place, mother job, mother education and husband education there were in significant relation. Some factors like unwanted pregnancy and blood pressure, diabetes, smoking, separately have effects on LWB however in mothers who use narcotics 40% and not use narcotic 9.7% had LWB.
Unwanted pregnancy was more in rural regions than urban regions and in housekeeper mother were more than in employed mother (private or public section) also op. It reveals that high level of education decrease unwanted pregnancy.in caring there was three items ( 1- not cared 2- second week to twenties week 3- between 21-40 weeks), it showed that 60% without caring in unwanted pregnancy and 40% in wanted pregnancy.73% wanted pregnancy mothers have caring between second week to 20 th week and 27% were in unwanted group. Finding showed that in second item there was significant relation. Chi-square test showed that between interval pregnancy in two groups of less than 3 years and more than 3 years significant relation there was ( p<0.05). In our research factors like mothers BMI, abortion and premature delivery there were not significant relations.
In blood pressure survey showed that 1.6% of mothers had high blood pressure, in unwanted group the rate was 2.5% and in wanted group was 1.2% have blood pressure and there is not significant relation.
In diabetes survey showed that in unwanted group was 2.2% and wanted group was 2% have diabetes and there is not significant relation between two groups.
Also chi square test showed that some factors like residential place, mothers job, mothers education and husbands education were significant relation. With LBW Some factors like unwanted pregnancy and blood pressure, diabetes, smoking, separately have effects to LWB however in mothers who use narcotic 40% and not use narcotic 9.7% cause to LWB. Using regression logistic for accurate and precise covariate on LWB and showed in multiply analyzed table 2 , only using narcotic was significant relation.
Table number1- Demographic features and mothers statues
|
Variables |
wanted pregnancy n=602 |
unwanted pregnancy n=236 |
t |
p-value |
|
Mother’s age |
28.35 ± 5.12 |
29.34 ± 6.05 |
2.199 |
0.028 |
|
Number of fertility |
1.08 ± 1.05 |
2.58 ± 1.39 |
7.696 |
<0.001 |
|
Number of delivery |
1.50 ± 0.74 |
2.36 ± 1.18 |
10.230 |
<0.001 |
|
Variables |
wanted pregnancy |
unwanted pregnancy |
t |
p-value |
|
Residence place |
||||
|
Urban |
522(73.3%) |
201(26.7%) |
4.877 |
0.027 |
|
Rural |
48(61.5%) |
30(38.5%) |
||
|
Mother’s education |
||||
|
Illiteracy |
10(52.6%) |
9(47.7%) |
24.906 |
<0.001 |
|
Primary |
72(61.5%) |
45(38.5%) |
||
|
High school |
107(65.6%) |
56(34.4%) |
||
|
Diploma |
212(73.6%) |
76(26.4%) |
||
|
Further education |
200(81.6%) |
45(18.4%) |
||
|
Mother’s job |
||||
|
Household |
500(70.4%) |
210(29.6%) |
8.668 |
0.013 |
|
Public |
41(83.7%) |
8(16.3%) |
||
|
Private |
56(83.6%) |
11(16.4%) |
||
|
Husband’s job |
||||
|
Illiteracy |
13(91.6%) |
8(38.1%) |
19.795 |
0.0001 |
|
Primary |
59(62.8%) |
35(37.2%) |
||
|
High school |
133(65.5%) |
70(34.5%) |
||
|
Diploma |
203(73.8%) |
72(26.2%) |
||
|
Further education |
194(81.2%) |
45(18.8%) |
||
|
Variables |
wanted pregnancy |
unwanted pregnancy |
t |
p-value |
|
|
Interval to last delivery |
|||||
|
Less 3 year |
128(56.9%) |
97(43.1%) |
9.766 |
0.002 |
|
|
More 3 year |
178(70.6%) |
74(29.4%) |
|||
|
First caring |
|||||
|
None cared |
2(40%) |
3(60%) |
722.7 |
0.0019 |
|
|
2-20 week |
588(73%) |
218(27%) |
|||
|
21-40 week |
10(50%) |
10(50%) |
|||
|
Mothers BMI |
|||||
|
Underweight |
31(70.5%) |
13(29.5%) |
0.716 |
0.720 |
|
|
Normal |
263(72.9%) |
98(27.1%) |
|||
|
Overweight |
201(75.3%) |
66(24.7%) |
|||
|
Infant age |
|||||
|
Premature |
54(71.1%) |
22(28.9%) |
0.025 |
0.873 |
|
|
Mature |
548(71.9%) |
214(28.1%) |
|||
|
Age at birth |
|||||
|
g2500< |
66(76.7%) |
20(23.3%) |
2.097 |
0.350 |
|
|
g2500-4000 |
519(71.6%) |
206(28.4%) |
|||
|
>4000g |
17(63%) |
10(37%) |
|||
Table 2- regression multiply logistic on covariate LWB
|
Variables |
coefficient regression |
standard error |
R |
odds ratio |
p-value |
|
Unwanted pregnanc |
- 0.360 |
0.275 |
1.719 |
0.698 |
0.190 |
|
High blood pressure |
- 0.393 |
0.811 |
0.235 |
0.675 |
0.628 |
|
Diabetes |
0.572 |
1.041 |
0.302 |
1.773 |
0.583 |
|
Using narcotic |
- 1.851 |
0.568 |
10.621 |
0.157 |
0.001 |
|
Smoking |
- 0.046 |
0.413 |
0.012 |
0.955 |
0.912 |
Discussion:
In this research , infants from unwanted pregnancies were significantly more likely than those from planned pregnancies to be of low birth weight some studies showed that education has controversial relation (11,12,13,14). The mechanism by which pregnancy intention
Status affects birth weight is not yet fully understood, in some studies showed that anemia during pregnancy was 10, 3% reported, Mahmodi and colleague (2012) reported more than 70% prevalence of low weight birth (15). Based on world health organization 17% of children all over world has low birth Wight, 7% in developed countries and more than 19% in developing countries, In IRAN approximately 10% reported that plausibility to this research( 23,37) , Unwanted pregnancy may contribute To low birth weight by means of maternal behaviors such as luck of prenatal care and smoking during pregnancy . Infants from unwanted pregnancies may also have been more likely to be low birth weight because their mothers nutritions was less than women with planned pregnancies and gained inadequate weight during pregnancy (16).
IMES research showed that more than 28.2% pregnancy were unwanted and in mashad medical university it was 31.5% reported.
Several measurement constraints should be kept in mind when considering the findings
Of this study. First, numerous researchers have commented on the difficulty of quantifying
Women’s feelings about their pregnancies (19), further work is needed to refine currently used measures of pregnancy, there was not significant relation between education and low birth weight (20.21,22) it may be attributed to low sample size.
Indicated that these women were more likely than others to have characteristics associated
With low birth weight. (We estimated a second logistic regression model among all women who experienced a live singleton birth in the time period of interest, using birth size as a proxy for weight among infants missing birth weight data. All women surveyed were asked, “In comparison to other newborns, what do you consider to be [your child’s] size when he/she was born—very small, small, medium-sized, or large?” Mothers’ assessments of birth size as “very small” were coded as low birth weight if birth weight was missing( 19,23,24) in two groups there was significant relation to mean of number fertility. There is plausibility to nation survey and there is significant relation to unwanted pregnancy and number of fertility (25) however forum and colleagues showed that there is no relation (26). For Preventing to effects of pregnancy advice caring for first three month, special for women who are in low social-economics (27). Time of caring has important effect to mothers mortality and low birth weight (28). If weight was reported, low birth weight was coded according to numeric weight in our study it showed that 60% without caring in unwanted pregnancy and 40% in wanted pregnancy. Many studies reveal that unwanted pregnancy is related to none cared women or with delay caring (29.30), in north Carolina showed that delay caring and none cared women is more than 2.8% (31).Unwanted pregnancy remained a significant predictor of low birth weight and mistimed pregnancy was not as associated with low birth weight (17,32,33). Despite the obvious limitations of birth as an indicator of birth weight, its use reinforced the findings of our analysis involving only infants with reported numeric birth weights.(34) study in 18 hospital Syria showed that there are not significant to BMI, abortion and premature delivery however there is significant relation to pregnancy duration and weighting (35), similarly to karimian and del aram and their colleagues (34,36). This low-birth weight study is one of the Few conducted among populations of developing countries, and it emphasizes the importance Of distinguishing between the effects of unwanted and mistimed pregnancies. Although the potential biases of the pregnancy intention status measure and the exclusion Of many women from the study as a result of missing birth weight data cannot be ignored, The study highlights the potential health value of helping women and couples avoid unwanted Pregnancy. Improving access to caring and quality of family planning services may contribute to reducing the proportion of infants low in birth weight (39).
Conclusion: considering weight in healthy infant and effects of unwanted pregnancy, pre-pregnancy caring for increase knowledge to families and mothers are necessary. Health staff have effective role to consulting and education to mothers.
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