A systematic review of non-binary measures of pregnancy perceptions, attitudes and reactions, and associated outcomes

“Unintended pregnancy” is a ubiquitous indicator of poor public health, but is highly problematic and limited. A conceptual evolution in pregnancy intention measurement and categorization has led to numerous, often hard-to-compare studies using a multitude of non-binary, multi-dimensional pregnancy measures. Herein we conducted a systematic review of research studying non-binary measures of pregnancy perceptions, attitudes, and reactions, as predictors of public health outcomes. Forty-three articles met inclusion criteria. We summarized existing pregnancy measures, cataloged the dimensions of pregnancy they measure, and tracked significant outcomes associated with these measures. We documented numerous pregnancy-related measures including those on ambivalence, acceptability, timing, intention, emotional response, use of contraception, preparation for pregnancy, opinions/reactions of partners and others, perceived fecundity, readiness, denial, and self-efficacy to prevent pregnancy. The strongest associations with maternal and child health outcomes were observed for depression. Relationships with pregnancy complications and outcomes, postpartum care, breastfeeding, attachment, and child health are very unclear. Temporal confounding precludes many conclusions about psychosocial outcomes. Acknowledging multiple dimensions of and pathways to pregnancy is critical for researchers in public health, clinical care, and the social sciences. Research questions should be clear in their hypothesized relationships and pathways, and specific in their dimensions of interest. New paradigms are needed that move beyond pregnancy planning and intention.