# Pregnancy preferences, reproductive autonomy, and maternal health: A novel prospective study

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2023 · $516,420

## Abstract

PROJECT SUMMARY
Research linking unintended pregnancy with increased risk of adverse maternal and child health outcomes is
fraught with significant conceptual and scientific limitations, including cross-sectional designs, residual
confounding, and simplistic, retrospective assessment of pregnancy intentions. A critical gap in our scientific
knowledge thus remains: Are the adverse maternal health outcomes associated with unintended pregnancy
and childbearing due to unintended pregnancy itself or rather contextual factors that are associated with
increased risk of unintended pregnancy? The proposed research is the first to apply state-of-the-art methods
and theory to the measurement of pregnancy intentions to rigorously address this long-standing scientific gap.
This prospective study follows a cohort of 2,200 non-pregnant women over one year, measuring preferences
about a possible pregnancy using a new, robust instrument: the Desire to Avoid Pregnancy (DAP) scale. This
validated psychometric
scale captures a continuum of cognitive, affective, and practical considerations about
pregnancy and childbearing, moving beyond conceptually limited “intending” and “not intending” labels.
Participants experiencing incident pregnancies – and a matched subset of non-pregnant women with similar
pregnancy preferences – are then followed for an additional three years to measure mental and physical health
outcomes during pregnancy and after birth. This innovative design positions us to address three aims. In Aim
1, we will identify the time-varying and invariant contextual factors in women’s lives that shape their
preconception pregnancy preferences, such as relationship factors and financial stability, and test how
preferences predict incident pregnancy. In Aim 2, among women who experience a new pregnancy, we will
examine the relationship between prospectively assessed pregnancy preferences and maternal health
outcomes, accounting for temporally important confounding factors (from Aim 1). In Aim 3, we will investigate
how the relationship between pregnancy and adverse health outcomes differs by pregnancy preferences.
Specifically, with our matched design, we will compare health outcomes among pregnant women to those of
women who best represent their counterfactual: women who had similar pregnancy preferences yet who did
not experience pregnancy. Thereby, we emulate a hypothetic trial in which women, conditional on
confounders, are randomly assigned to pregnancy, allowing us to examine whether the negative health effects
of pregnancy are amplified among those who most desire to avoid pregnancy. Achieving these aims will
contribute new insights into the health repercussions of unintended pregnancy for women and elucidate the
degree to which adverse outcomes stem from the intention status of pregnancies or underlying social and
contextual factors. These insights are critical to developing appropriately focused maternal morbidity
prevention efforts. Robust data on h...

## Key facts

- **NIH application ID:** 10709491
- **Project number:** 5R01HD108643-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Corinne H. Rocca
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $516,420
- **Award type:** 5
- **Project period:** 2022-09-30 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10709491

## Citation

> US National Institutes of Health, RePORTER application 10709491, Pregnancy preferences, reproductive autonomy, and maternal health: A novel prospective study (5R01HD108643-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10709491. Licensed CC0.

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