Previous research has reported prevalence of unplanned pregnancy in new mothers in the UK to be 41% [26]. Here we find that even when restricting to partnered mothers, approximately 1 in 3 report their pregnancy as unplanned (23% reported positive feelings about the unplanned pregnancy, 4% ambivalent feeling and 6% had a negative response). Consistent with previous research, mothers reporting unplanned pregnancies tended to be in more disadvantaged groups and to report lower levels of relationship quality and social support. In many cases, these effects were particularly pronounced in those reporting ambivalent or negative feelings about their unplanned pregnancy.
There was a clear increased risk of psychological distress (PD) at 9 months postpartum after unplanned pregnancy that remained after adjustment for confounders, and the effect was more marked for the mothers who reported feeling ambivalent or negative when they realised that they were pregnant, than for those who felt happy or very happy at that time. Analysis of the roles of relationship quality and levels of wider social support suggest that these factors play an important role in the association between pregnancy intention and later symptoms of psychological distress.
Pregnancy intention and psychological distress
Unplanned pregnancy among partnered mothers was associated with an increased risk of PD at 9 months postpartum, relative to a planned pregnancy: OR 1.22, 1.96 and 2.19 for “unplanned/positive”, “unplanned/ambivalent” and “unplanned/negative” groups, respectively, after adjustment for sociodemographic, economic and pregnancy-related factors. This is consistent with the existing literature [12, 14]. The stress associated with the transition into parenthood [14] may be exacerbated in cases of unplanned pregnancy by factors relating to socioeconomic position, such as the increased financial pressures of a new child, and psychological readiness for motherhood. Little research exists to examine the impact of unplanned pregnancy on the lives of partnered mothers, specifically. Single motherhood is strongly associated with reporting a pregnancy as unintended or mistimed [7], and so in studies that include both single and partnered women the substantial impact of lone parenting on women’s wellbeing can mask more subtle effects. Findings of the present study demonstrate that a strong association remains between unplanned pregnancy and PD, even after the effects of single motherhood are removed.
Relationship quality
Among partnered mothers, factors such as postpartum marital closeness [17], partner support and occurrence of interpersonal violence [19] are significantly associated with risk of depressive symptoms in the postpartum period, demonstrating the importance of a good quality relationship to the mental health of partnered mothers. Adjustment for relationship quality reduced the odds of PD, suggesting that this plays a significant role in the association between unplanned pregnancy and development of PD. As well as practical assistance, a stable relationship may increase resilience and aid the mother’s development of coping mechanisms in the transition to an unplanned parenthood. Unplanned pregnancy may have a detrimental impact on the quality of the partner relationship, increasing the risk of psychological distress in this group.
Social support
Research into the roles of perceived and actual support after unplanned pregnancy is limited. In this study population, women who described their pregnancy as unplanned reported lower levels of perceived support and less frequent contact with friends and family, particularly in the case of those reporting ambivalent or negative feelings around their unplanned pregnancy. Adjustment for perceived support reduced the odds of PD after unplanned pregnancy, further emphasising the potential role it plays in the association between the unplanned pregnancy and PD. Perceived support is well-established as a major predictive factor for postpartum affective disorders, but literature on actual support is less consistent [19]. However, its buffering role has been demonstrated in a range of high-stress contexts [10]. Such support may decrease feelings of isolation and reduce the impact of stressful events on an individual’s life [27].
Strengths and limitations
Few studies to date have examined the impact of unplanned pregnancy on subsequent wellbeing in partnered mothers, a group who represent a significant proportion of all unplanned pregnancies. Use of the MCS population provides a large sample of women who had a baby after an unplanned pregnancy, and permits generalisation of findings to partnered mothers across the UK. Key potential confounding factors were included in the analysis.
A number of limitations must be considered. Retrospective ascertainment of pregnancy intention may be affected by post-hoc rationalization [28]. However, it has been reported that collecting data on pregnancy intention in this way does not affect estimates of either number or consequences of unintended births [29]. We analysed women who reported feeling happy about their unplanned pregnancy separately from those who said that they felt negative or ambivalent when they realised that they were pregnant, to explore the impact that underlying desire for a child may have on PD after an unplanned conception. However, this classification was based on asking mothers to recall their emotional response which may be affected by current mood or depressive symptoms. To mitigate against the potential impact of current mood, we also analysed all ‘unplanned’ pregnancies together, which did not take feelings about the pregnancy into account – and the significant association with PD was evident. While the data used here are approximately 15 years old, unplanned pregnancy remains a common occurrence in the UK. Cultural changes around single parenthood may (perhaps) have influenced the impact of an unplanned pregnancy for single women since the data were collected, but it is difficult to see what societal changes will have altered the psychological impact unintended motherhood among partnered women. We therefore believe these results continue to be generalizable to partnered women.
MCS used a slightly modified version of the GRIMS questions to assess relationship quality, offering an option of “can’t say” as a response which was not part of the original instrument design. The <1.5% of women who responded in this way were coded to ‘missing’ for the individual components of GRIMS; 6% of women were excluded because they had one or more items missing for the GRIMS. If this response is associated with negative outcomes, then we may have underestimated the prevalence of poor relationship quality. This would serve to underestimate any observed effect between pregnancy intention and PD.
The data analysed here are cross-sectional and therefore represent a snapshot of the study participants’ lives when their babies were 9 months old, on average. As a consequence, these results apply to women’s wellbeing at around 9 month postpartum and associations between pregnancy intention and PD at different times may vary. Past history of psychiatric illness is a risk factor for postpartum depression [10]. Depending on the timing of previous episodes, a prior history of psychiatric disorders might affect the intention to get pregnant, or consistency of contraceptive use [30], well as social support and relationship quality during pregnancy and after delivery. The majority of couples who were married or cohabiting at the birth of their child remained in these groups at 9 months, there were insufficient numbers to assess the impact of changing relationship status (e.g. cohabiting to married). Data were not available to allow us to assess the quality of partner relationship or mental health prior to or during pregnancy, so we could not investigate this further.
Relationship quality and social support were treated and interpreted here as confounding factors. However, this could be a simplification of the complex inter-relationships between psychological wellbeing, relationship quality, social support and pregnancy intention. It could be postulated that relationship quality and social support in fact act as mediating or moderating factors in this relationship, given that each has been previously shown to be associated with reporting a pregnancy as unplanned and with PD postpartum [5, 16–19]. The exact roles of relationship quality and social support in this association thus require further research in order to disentangle these complex relationships and determine their specific pathways at work.