General introduction and outline of this thesis 11 symptoms in the year preceding their pregnancy and found they were more susceptible to UPs compared to women without psychiatric vulnerability25,26. Heightened stress levels and depressive symptoms in young women with mental health symptoms and prolonged illness duration in severe mental illness patients are predictive of UPs, pointing towards an association between symptomatology and difficulties with achieving pregnancy planning21,27. Understanding if and how women with psychiatric vulnerability have an increased risk of UPs is important. Not only to identify target groups for preventative measures, but also because some women with psychiatric vulnerability use psychoactive medication, which may be harmful for the development of the fetus. In addition, women with psychiatric vulnerability may experience worsening of their symptoms during pregnancy, which can have a negative effect on pregnancy outcomes. In conclusion, there is a lack of understanding in the relation between UPs and psychiatric vulnerability. In this thesis we aim to also contribute to this call for qualitative inquiries. Moreover, we aim to research the possible (adverse) outcomes after UPs with quantitative methods. Impact of unintended pregnancies on mothers and offspring The existing literature predominantly links UPs to adverse maternal outcomes, such as an increased risk in ante- and perinatal depression, stress and interpersonal violence28-30. Women with UPs had longer hospital stays after delivery10. Mental health problems during pregnancy, including stress, may negatively impact birth outcomes. Delayed enrolment in antenatal care, smoking or other intoxications during pregnancy and less use of folic acid may also contribute to adverse birth outcomes10. Premature birth and low birth weight were both linked to UPs in studies on high-, middle- and low-income populations28,31-33. The evidence on an increased risk of miscarriage, stillbirth and neonatal death after UPs is still inconclusive31. In women with UPs, the postpartum period may be marked by decreased rates of breastfeeding, reduced quality of parent-child interactions and higher occurrence of externalizing problems in offspring during adolescence34-36. Challenges in parenting may also arise from these circumstances37,38. Data in the Dutch setting is required to interpret the clinical significance of possible adverse outcomes after UPs in the Netherlands. Moreover, novel studies could shed light on the possible positive outcomes of (unintended) births. As the birth rate is declining, welcomed UPs could be of societal significance in increasing the national birth rate. But also on a personal level, it is questionable if UPs bring about disadvantages only. In general, pregnancy and childbirth have been linked to positive outcomes such as motivation for lifestyle change and improved maternal mental health39,40. A qualitative study illustrated how pregnancy intendedness could influence the partner relationship, as improved relationship functioning was measured in couples with unplanned pregnancies, in
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