Pregnancy intention in relation to maternal and neonatal outcomes in women with vs without psychiatric diagnoses 93 Discussion Key results The results from our retrospective cohort study show that current/past psychiatric diagnoses are significantly associated with UPs after adjustment for relevant confounders (OR 1.56, CI 1.23–2.00, p<0.001). In sub analyses, women with depressive (OR 1.67, CI 1.24–2.26, p=0.001), personality (OR 2.64, CI 1.38– 5.11, p=0.004) and substance-related and addictive disorders (OR 4.29, CI 1.90– 10.03, p=0.001) showed a higher incidence of UPs compared to women without these disorders. In our population, maternal and neonatal outcomes were comparable between women with and without current/past psychiatric diagnoses in case of UPs, except from GA at delivery. Women with UPs and current/past psychiatric diagnoses had higher GA at delivery (mean difference 2.21 days, p=0.001) compared to the reference group, whereas women with UPs without current/past psychiatric diagnoses and women with planned pregnancies and current/past psychiatric diagnoses showed a lower GA at delivery (resp. –2.63 and –1.67 days). This effect was mainly driven by the group of women with a depressive disorder. Strengths and limitations We are the first to compare maternal and neonatal outcomes in a large group of women with and without UPs, also considering the effect of current/past psychiatric diagnosis. Our study is subject to several important limitations. Our dependability on uncontrolled naturalistic medical record information has serious implications on the availability of information on pregnancy intention and the reliability of our findings. Reporting bias probably played a role through various mechanisms. First, there could be an overreporting of UPs as UPs may draw more attention than intended pregnancies and subsequently are more likely to be reported in charts. We excluded files with missing data on pregnancy intention and/or psychiatric history. A comprehensive overview of incidences of UPs would require data on (elective abortions) amongst women with and without current/past psychiatric diagnoses. Unfortunately, these data were not available as our study presents data from a retrospective cohort of women with ongoing pregnancies. Although missing data on abortions could lead to an overall underestimation of UPs in the current study, there are no implications on the difference between women with and without current/past psychiatric diagnoses. Additionally, it is important to consider the possible response bias in women when inquiring for pregnancy intention. Pregnancy intention is notoriously difficult to assess and should be assessed prospectively with a validated instrument, if possible27. With our retrospective study design, we were unable to
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