Chapter 1 12 contrast to lower levels of functioning in couples with planned pregnancies41. Qualitative and quantitative studies on (possible) positive aspects to unintended childbearing and parenting have hardly been conducted. This thesis will thus further explore the presence of both adverse and positive outcomes after UPs with qualitative and quantitative methods. Impact of psychiatric vulnerability on mothers and offspring The perinatal period (defined as the time from conception until one year after birth42) pregnancy and the postpartum period) can pose significant challenges for women with psychiatric vulnerability and their newborns. Psychiatric or mental disorders are ‘clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior’, according to the World Health Organization. In literature, the terms ‘psychiatric disorders’, ‘mental (health) disorders’, ‘psychiatric vulnerability’ and ‘mental health issues’ are used interchangeably. In this thesis, the term ‘psychiatric vulnerability’ captures any history of psychiatric disorders and represents both persons in remission but at risk for relapse or persons with current (ongoing) psychiatric disorders who experience symptoms. Although studies on the relapse risk of psychiatric disorders during pregnancy are inconclusive, it is known that pregnancy and especially the postpartum can exacerbate psychiatric symptoms in women with psychiatric vulnerabilities to develop psychosis, manic or depressive episodes after birth compared to their risk during other life stages43-48. Research shows that the presence of psychiatric vulnerability during pregnancy can result in serious complications for both mothers with psychiatric vulnerability and their newborns, including higher rates of intensive care admissions, unplanned cesarean sections, gestational diabetes, and lower rates of breastfeeding49-51. Offspring born to mothers with psychiatric vulnerability tend to have lower birth weights, higher chances of being born prematurely, and more frequent low 5-minute Apgar scores49,50,52. Mother infant attachment may be challenged in dyads with mothers who have psychiatric vulnerability during pregnancy or thereafter53. Most likely there is an overlap between psychosocial risk factors for adverse pregnancy and maternal outcomes between women with UPs and women with psychiatric vulnerability, such as maternal stress, unemployment and unhealthy prenatal behaviors such as smoking. Adverse pregnancy and maternal outcomes are particularly linked to unwanted pregnancies, as opposed to unplanned but wanted pregnancies, indicating that pregnancy acceptance can alter birth outcomes in addition to the planning status of the pregnancy54. No previous research has been performed to understand the interaction between the presence of psychiatric vulnerability and UPs on birth and maternal outcomes. Especially mood disorders are studied in relation to birth
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