Reducing behavior problems in children born after an unintended pregnancy: A hypothetical intervention study in the population-based Generation R cohort

Abstract

Abstract Objectives: To examine differences in behavior problems between children from intended versus unintended pregnancies, and to estimate how much the difference in problem behavior would be reduced if we had intervened on eliminating postnatal depression and increasing social support within 6 months after birth. Methods: Data from the Generation R Study were used, a population-based birth cohort in Rotterdam, the Netherlands (N = 9621). Differences in child internalizing and externalizing behavior at ages 1.5, 3, 6, 9 and 13 years between pregnancy intention groups were estimated using linear regression. Associations of postnatal depression and social support with internalizing and externalizing problems were also estimated using linear regression. Child behavior outcomes where compared by presence or absense of the hypothetical interventions of ‘no postnatal depression’ or ‘high social support’. Results: Most pregnancies (72.9%) were planned, 14.8% were unplanned and wanted, 10.8% were unplanned with initially ambivalent feelings and 1.5% with prolonged ambivalent feelings. Children from unplanned pregnancies had more internalizing and externalizing problems at all ages as compared to children from a planned pregnancy, especially when ambivalent feelings were present. Hypothetical interventions on postnatal depression reduced the differences in internalizing and externalizing problems by 0.02 to 0.16 standard deviation. Hypothetical interventions on social support did not significantly reduce the difference in internalizing and externalizing problems. Conclusions: Children from an unplanned pregnancy have more behavior problems, in particular when mothers had prolonged ambivalent feelings. Intervening on postnatal depression may reduce the inequality in child behavior related to pregnancy intention.