Are pregnancy planning and pregnancy timing associated with maternal psychiatric illness, psychological distress and support during pregnancy?

•Unclear if unplanned/poorly timed pregnancies associated with psychological distress.•Prior analyses limited by methodological limitations; no adjustment for confounding.•Current study: individual assessments in large prospective cohort of pregnant women.•Key Findings:•Unplanned and poorly timed pregnancies significantly associated with MDE & high stress.•Poorly timed pregnancies associated with GAD and low social support.•Worst outcomes for planned pregnancies that were subsequently deemed poorly timed.•Findings support screening for unplanned/poorly timed pregnancy during prenatal care.

BackgroundPregnancy planning and timing may be associated with psychiatric illness, psychological distress and support during pregnancy.MethodsWe performed secondary analyses of a prospective cohort of 2654 pregnant women evaluating the impact of depression on preterm birth. We used multivariable logistic regression to test associations between pregnancy planning (“Was this pregnancy planned? Yes/No”) and/or timing (“Do you think this is a good time for you to be pregnant?”) with Composite International Diagnostic Interview generated psychiatric diagnoses and measures of psychological distress and support.Results37% and 13% of participants reported an unplanned or poorly timed pregnancy, respectively. Unplanned pregnancies were associated with a Major Depressive Episode (MDE) (adjusted odds ratio (aOR) 1.69, 95%CI 1.23-2.32) and the Cohen Perceived Stress Scale's (CPSS) highest quartile (aOR 1.74, 95%CI 1.40-2.16). Poorly timed pregnancies were associated with a MDE (aOR 3.47, 95%CI 2.46-4.91) and the CPSS's highest quartile (aOR 5.20, 95%CI 3.93-6.87). Poorly timed pregnancies were also associated with General Anxiety Disorder (GAD; aOR 1.60, 95%CI 1.07-2.40), and the modified Kendler Social Support Inventory's (MKSSI) lowest quartile (aOR 1.64, 95%CI 1.25-2.16). Psychiatric conditions were strongly associated with planned pregnancies that were subsequently deemed poorly timed (MDE=aOR 5.08, 95%CI 2.52-10.25; GAD=aOR 2.28, 95%CI 1.04-5.03); high CPSS=aOR 6.48, 95%CI 3.59-11.69; and low MKSSI=aOR 3.19, 95%CI 1.81-5.62.LimitationsParticipant characteristics may limit generalizability of findings.ConclusionsPregnancy timing was a stronger predictor of maternal psychiatric illness, psychological distress and low social support than pregnancy planning in our cohort.