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Factors Associated With Changes in Pregnancy Intention Among Women Who Were Mothers of Young Children in New York City Following the COVID-19 Outbreak

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Were there changes in pregnancy intentions among women who were mothers of young children around the peak of the first wave of COVID-19 in New York City?

Findings  In this cross-sectional study of 1179 women in New York City who were mothers of young children, nearly half of those who had been attempting to become pregnant and more than a third who had been thinking about trying before the COVID-19 pandemic stopped in the first few months of the outbreak. Women who responded to a survey during the lockdown were more likely to cease attempts or plans to become pregnant.

Meaning  The results of this study suggest that the outbreak of the COVID-19 pandemic was associated with fewer women planning or attempting to become pregnant; these findings may have long-term effects on fertility rates.

Abstract

Importance  Early evidence shows a decrease in the number of US births during the COVID-19 pandemic, yet few studies have examined individual-level factors associated with pregnancy intention changes, especially among diverse study populations or in areas highly affected by COVID-19 in the US.

Objective  To study changes in pregnancy intention following the outbreak of the COVID-19 pandemic and identify factors possibly associated with these changes.

Design, Setting, and Participants  A cross-sectional, population-based study was conducted among women who were currently pregnant or had delivered a live infant and responded to a survey emailed to 2603 women (n = 1560). Women who were mothers of young children enrolled in the prospective New York University Children’s Health and Environment Study birth cohort were included; women who were not currently pregnant or recently postpartum were excluded.

Exposures  Demographic, COVID-19–related, stress-related, and financial/occupational factors were assessed via a survey administered from April 20 to August 31, 2020.

Main Outcomes and Measures  Pregnancy intentions before the COVID-19 pandemic and change in pregnancy intentions following the outbreak.

Results  Of the 2603 women who were sent the survey, 1560 (59.9%) who were currently pregnant or had delivered a live infant responded, and 1179 women (75.6%) answered the pregnancy intention questions. Mean (SD) age was 32.2 (5.6) years. Following the outbreak, 30 of 61 (49.2%) women who had been actively trying to become pregnant had ceased trying, 71 of 191 (37.2%) women who had been planning to become pregnant were no longer planning, and 42 of 927 (4.5%) women who were neither planning nor trying were newly considering pregnancy. Among those who ceased trying, fewer than half (13 [43.3%]) thought they would resume after the pandemic. Of those pre–COVID-19 planners/triers who stopped considering or attempting pregnancy, a greater proportion had lower educational levels, although the difference was not statistically significant on multivariable analysis (odds ratio [OR], 2.14; 95% CI, 0.92-4.96). The same was true for those with higher stress levels (OR, 1.09; 95% CI, 0.99-1.20) and those with greater financial insecurity (OR, 1.37; 95% CI, 0.97-1.92. Those who stopped considering or attempting pregnancy were more likely to respond to the questionnaire during the peak of the outbreak (OR, 2.04; 95% CI, 1.01-4.11). Of those pre–COVID-19 nonplanners/nontriers who reported newly thinking about becoming pregnant, a smaller proportion responded during the peak, although the finding was not statistically significant on multivariable analysis (OR, 0.52; 95% CI, 0.26-1.03). Likewise, fewer respondents who were financially insecure reported newly considering pregnancy, although the finding was not statistically significant (OR, 0.69; 95% CI, 0.46-1.03). They were significantly less likely to be of Hispanic ethnicity (OR, 0.27; 955 CI, 0.10-0.71) and more likely to have fewer children in the home (OR, 0.62; 95% CI, 0.40-0.98) or self-report a COVID-19 diagnosis (OR, 2.70; 95% CI, 1.31-5.55).

Conclusions and Relevance  In this cross-sectional study of 1179 women who were mothers of young children in New York City, increased stress and financial insecurity owing to the COVID-19 pandemic paralleled a reduction in pregnancy intention in the early months of the pandemic, potentially exacerbating long-term decreases in the fertility rate.

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Article Information

Accepted for Publication: July 6, 2021.

Published: September 15, 2021. doi:10.1001/jamanetworkopen.2021.24273

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Kahn LG et al. JAMA Network Open.

Corresponding Author: Melanie H. Jacobson, PhD, MPH, Division of Environmental Pediatrics, Department of Pediatrics, NYU Langone Medical Center, 462 First Ave, Building A, 8th Floor, Room 850, New York, NY 10016 (melanie.jacobson2@nyulangone.org).

Author Contributions: Dr Jacobson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kahn, Trasande, Liu, Mehta-Lee, Jacobson.

Acquisition, analysis, or interpretation of data: Kahn, Liu, Brubaker, Jacobson.

Drafting of the manuscript: Kahn, Trasande, Jacobson.

Critical revision of the manuscript for important intellectual content: Kahn, Liu, Mehta-Lee, Brubaker, Jacobson.

Statistical analysis: Kahn, Liu, Jacobson.

Administrative, technical, or material support: Trasande, Brubaker.

Supervision: Mehta-Lee.

Conflict of Interest Disclosures: Dr Liu reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Funding/Support: The New York University Children’s Health and Environment Study is supported by institutional funds of NYU Grossman School of Medicine as well as the Environmental Influences on Child Health Outcomes Program in the National Institutes of Health Office of the Director (UG3/UH3OD023305). Dr Kahn acknowledges support from the National Institute of Environmental Health Sciences (K99ES030403).

Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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