Chapter 9 240 with psychiatric vulnerability, except for a slightly longer gestational age at delivery in women with UPs in addition to psychiatric vulnerability versus UPs without psychiatric vulnerability without clinical relevance. Our results are supported by another study performed in a comparable obstetric setting (Northern-European)3. Severe birth outcomes were comparable between women with and without UPs, irrespective of psychiatric history. Several factors could explain the inconsistency between these studies and previous research on outcomes after UPs. First, the access to free and high-level healthcare could mitigate outcomes after UPs3. Second, women in the MoMentUm study delivered at the OLVG hospital, indicating they finally opted to continue their pregnancies to birth. It is likely that pregnancies that are unplanned but welcomed have better maternal outcomes compared to unplanned and unwanted pregnancies18. If this also applies to birth and neonatal outcomes is unsure, although previous research did relate low birth weight specifically to ambivalent pregnancies (versus mistimed), and preterm birth to unwanted pregnancies (versus mistimed)19. The findings in Chapter 4 are based on a large retrospective dataset with reliable birth outcomes from patient files. Although we were certain about the presence of a psychiatric vulnerability at the time of conception, the study is limited by an uncertainty about the psychiatric symptoms of women during pregnancy. As adverse birth outcomes are related to more severe psychiatric symptoms and/or disorders, this could have impacted birth outcomes20,21. Third, the geographical region in which studies have been conducted greatly impacts outcomes, varying from severe stunting in children born after UPs in low-income countries to no severe outcomes in settings with free abortion and high level, freely available health care3,22. It is likely that the socioeconomic impact of UPs is less profound in high-income countries and most parents can financially support their children during the first years of life, which results in comparable growth and developmental outcomes in children born after pregnancies that were intended or unintended. Another remarkable finding is that birth outcomes were not different between women with and without a psychiatric vulnerability (Chapter 4). Nelson and colleagues found comparable neonatal outcomes in women with UPs, with consideration of a history of depression23. Although these findings support the results from the MoMentUM cohort, in which a history of psychiatric vulnerability did not alter birth outcomes, low birth weight and premature birth were related to UPs in this meta-analysis which is predominantly based on data from the US or in comparable settings. The positive
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