Chapter 4 96 UPs and maternal and neonatal outcomes We found that on itself, UPs were not related to adverse maternal or neonatal outcomes. Our findings oppose most previous studies that showed robust associations between UPs and adverse outcomes in retrospective studies, prospective studies43-45 and meta-analysis originating from various geographic regions16,17. However, a recent large Swedish prospective cohort study found no association between UPs and severe pregnancy outcomes such as hypertensive disorders of pregnancy, gestational diabetes mellitus, assisted birth or cesarean section46. Possibly, free health care settings with possibilities to choose abortion, like in Sweden and the Netherlands, can influence the consequences of UPs. Another reason is that more positive feelings towards the pregnancy could have mediated stress levels during pregnancy and thus positively impact birth outcomes after UPs such as premature birth and low birthweight36. In our study, likewise, current/ past psychiatric diagnoses did not predict adverse maternal and neonatal outcomes. Irrespective of pregnancy planning, antenatal psychiatric disorders such as depressive disorders, anxiety disorders, schizophrenia spectrum disorders and bipolar disorders have been related to adverse maternal and neonatal outcomes in previous studies8,47-50. Mediation by current/past psychiatric diagnoses Our data showed a higher GA in women with UPs and current/past psychiatric diagnoses (p=0.001). This is probably a chance finding, as no other maternal or neonatal outcomes differed between the groups in our data, and no previous studies have shown more positive outcomes in women with both UPs and current/past psychiatric diagnoses. However, the lack of comparative literature illustrates the need for further evaluation of maternal and neonatal outcomes in these women. Additionally, there was no difference in the clinically relevant outcome preterm birth (p=0.618). A previous paper showed that adverse outcomes after UPs were similarly adverse in subsamples of women with prenatal depression17. Although antenatal depression severity was not measured in our population, we also found that in our sensitivity analysis of women with current/past depression versus without, UPs were not related to adverse maternal or neonatal outcomes. Due to the limited available literature on this association, it is challenging to interpret our findings. Implications for future research This research has thrown up several questions in need for further investigation. It would be interesting to study pregnancy planning amongst women with psychiatric diagnoses (other than severe mental illnesses) with qualitative research methods, to gain insight in the psychological mechanisms behind the wish for children and
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