{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:53:46Z","timestamp":1792587226863,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T00:00:00Z","timestamp":1713916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T00:00:00Z","timestamp":1713916800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This study used data (N = 9803) from a Dutch nationally representative registry of people with low\u2010risk pregnancies receiving primary midwife\u2010led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 \u20132.59), preterm birth (OR, 1.27; 95% CI, 1.02\u20101.58), small for gestational age (OR, 1.19; 95% CI, 1.00\u20101.41), and induction of labor (OR, 1.14; 95% CI, 1.01\u20101.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71\u20100.97). The timing of prenatal care initiation did not mediate any of these associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our findings suggest that people in primary midwifery\u2010led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jmwh.13634","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T01:58:48Z","timestamp":1714010328000},"page":"755-766","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Association Between Unintended Pregnancy and Perinatal Outcomes in Low\u2010Risk Pregnancies: A Retrospective Registry Study in the Netherlands"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0988-1567","authenticated-orcid":false,"given":"Amke M.G.","family":"van Tintelen","sequence":"first","affiliation":[{"name":"Department of Primary and Long\u2010Term Care University of Groningen University Medical Center Groningen  Groningen the Netherlands"},{"name":"Midwifery Academy Amsterdam Groningen  Inholland Groningen the Netherlands"},{"name":"Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2654-1038","authenticated-orcid":false,"given":"Danielle E.M.C.","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Primary and Long\u2010Term Care University of Groningen University Medical Center Groningen  Groningen the Netherlands"},{"name":"Department of Sociology and Interuniversity Center for Social Science Theory and Methodology University of Groningen  Groningen the Netherlands"},{"name":"University Center for Child and Adolescent Psychiatry  Accare Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie H.","family":"Bolt","sequence":"additional","affiliation":[{"name":"Research Department Fiom  \u2019s\u2010Hertogenbosch the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Catja","family":"Warmelink","sequence":"additional","affiliation":[{"name":"Department of Primary and Long\u2010Term Care University of Groningen University Medical Center Groningen  Groningen the Netherlands"},{"name":"Midwifery Academy Amsterdam Groningen  Inholland Groningen the Netherlands"},{"name":"Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corine J.","family":"Verhoeven","sequence":"additional","affiliation":[{"name":"Department of Primary and Long\u2010Term Care University of Groningen University Medical Center Groningen  Groningen the Netherlands"},{"name":"Midwifery Academy Amsterdam Groningen  Inholland Groningen the Netherlands"},{"name":"Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Division of Midwifery School of Health Sciences University of Nottingham, Queen's Medical Centre  Nottingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Henrichs","sequence":"additional","affiliation":[{"name":"Department of Primary and Long\u2010Term Care University of Groningen University Medical Center Groningen  Groningen the Netherlands"},{"name":"Midwifery Academy Amsterdam Groningen  Inholland Groningen the Netherlands"},{"name":"Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dey089"},{"key":"e_1_2_7_3_1","volume-title":"Seeing the Unseen: The Case for Action in the Neglected Crisis of Unintended Pregnancy: State of World Population Report","author":"UNFPA","year":"2022"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1931\u20102393.2003.tb00111.x"},{"key":"e_1_2_7_5_1","unstructured":"Guttmacher Institute.Unintended Pregnancy in the United States.Guttmacher Institute;2019. Accessed July 10 2023.https:\/\/www.guttmacher.org\/sites\/default\/files\/factsheet\/fb\u2010unintended\u2010pregnancy\u2010us.pdf"},{"key":"e_1_2_7_6_1","unstructured":"BakkerF deGraafH deHaasS KeddeH KruijerH WijsenC.Seksuele Gezondheid in Nederland 2009.Utrecht;2009."},{"key":"e_1_2_7_7_1","first-page":"121","article-title":"Zwangerschap en anticonceptie in Nederland. Pregnancy and contraception in the Netherlands","volume":"36","author":"Picavet C","year":"2012","journal-title":"Tijdschrift voor Seksuologie"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16024"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.06.058"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13524\u2010014\u20100359\u20109"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010016\u20102237\u20100"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010009\u20100546\u20102"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000255666.78427.c5"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.08.012"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1215\/00703370\u20109710311"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.13457"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew266"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.2307\/2991608"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102393\u20108\u201015"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010009\u20100542\u20106"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.52.8.501"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102458\u20107\u2010268"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010016\u20101478\u20103"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742\u20104755\u201010\u201050"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2015.01.005"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010014\u20101609\u20106"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/phn.12182"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2020.102784"},{"key":"e_1_2_7_29_1","unstructured":"Perined.Perinatale Zorg in Nederland Anno 2019.Perined;2020. Accessed July 10 2023.https:\/\/assets.perined.nl\/docs\/aeb10614\u201008b4\u20104a1c\u20109045\u20108af8a2df5c16.pdf"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229488"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010020\u201003053\u20100"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2014.06.008"},{"key":"e_1_2_7_33_1","volume-title":"Neonatal and Perinatal Mortality: Country, Regional and Global Estimates","author":"World Health Organization","year":"2006"},{"key":"e_1_2_7_34_1","unstructured":"deBoerJ ZeemanK VerhoevenC.Hypertensieve Aandoeningen Tijdens de Zwangerschap Bevalling en Kraamperiode: Aanbevelingen Voor Risicoselectie Diagnostiek en Beleid. Hypertensive Disorders During Pregnancy Childbirth and the Postpartum Period: Recommendations for Risk Selection Diagnosis and Policy.Royal Dutch Organization of Midwives;2011."},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l5517"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010022\u201004808\u20107"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.3758\/Brm.40.3.879"},{"key":"e_1_2_7_38_1","unstructured":"PARAMED: Stata Module to Perform Causal Mediation Analysis Using Parametric Regression Models.Statistical Software Components;2013. Accessed July 10 2023.https:\/\/ideas.repec.org\/c\/boc\/bocode\/s457581.html"},{"key":"e_1_2_7_39_1","unstructured":"Centers for Disease Control and Prevention.U.S. Pregnancy Rates Drop During Last Decade.Centers for Disease Control and Prevention;2023."},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2011.06.007"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmad036"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010021\u201003935\u2010x"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihz010"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2018.1500538"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102018\u2010000779"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800566"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12996"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckr164"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2022.115181"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1363\/48e10316"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40695\u2010017\u20100027\u20105"}],"container-title":["Journal of Midwifery &amp; Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jmwh.13634","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jmwh.13634","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jmwh.13634","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:13:29Z","timestamp":1777522409000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jmwh.13634"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,24]]},"references-count":50,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1111\/jmwh.13634"],"URL":"https:\/\/doi.org\/10.1111\/jmwh.13634","archive":["Portico"],"relation":{},"ISSN":["1526-9523","1542-2011"],"issn-type":[{"value":"1526-9523","type":"print"},{"value":"1542-2011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,24]]},"assertion":[{"value":"2024-04-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}