Pregnancy Recognition Trajectories: A conceptual framework

Whether, how, and when a person comes to recognise they may be pregnant can have significant implications for their health and wellbeing. Little theoretical or empirical work has interrogated the time-bound, varied processes that lead to pregnancy recognition. We develop a novel conceptual framework, using an inductive saturation approach to review literature published between 2000 and 2023 and workshops with multi-disciplinary researchers and experts. Our framework comprises three overlapping domains: assessing the possibility of becoming pregnant; interpreting signs and symptoms of a (potential) pregnancy; and opportunities for pregnancy confirmation. The framework includes an individual’s trajectory to recognising a pregnancy, recognising there is no pregnancy following suspicion there may be, and not recognising a pregnancy that could be recognised through other means (e.g. using biomedical testing). It is inclusive of diverse conceptualisations of what constitutes a pregnancy. Within these intersecting domains, we map factors influencing trajectories operating at micro, meso, and macro levels, identifying the connections between individuals, communities, policies, health systems and institutional structures. While pregnancy duration is linear, time manifests in different ways across an individual’s trajectory. Individuals might experience one or all the domains of pregnancy recognition, different factors within those domains, and may encounter them in differing order. Individuals may move between states of recognition and non-recognition, and experience liminal states in between them. A better understanding of pregnancy recognition provides policy and care practitioners with new insights into care-seeking related to pregnancy.