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

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Enthoven, Jeremy A. Labrecque, M. Elisabeth Koopman-Verhoeff, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3816656/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version 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. Unintended Pregnancy Postnatal Depression Social Support Problem Behavior Hypothetical Intervention Figures Figure 1 Figure 2 Introduction Unintended pregnancies are very common all around the world. The highest rates of unintended pregnancies have been found in Latin America and the Caribbean (56%), whereas lower rates are reported in Western Europe (34%) [ 1 ]. The Netherlands has a relatively low rate of unintended pregnancies as compared to other countries, yet 18% of the pregnancies are unintended [ 2 ]. Whether a pregnancy is unintended or unplanned is complex to determine as feelings towards the pregnancy may change over time [ 3 ]. In this study, pregnant women reported during the first trimester of the pregnancy whether the pregnancy was planned or not, and in case of an unplanned pregnancy, how they felt about the pregnancy. Unintended pregnancies are associated with poorer mental health in children. Research has shown that children born from an unintended pregnancy are more likely to display behavior problems at 5 and 7 years [ 4 ], aggression and externalizing problems at 14 years [ 5 ], and a lower self-esteem and more depressive symptoms in their 20s [ 6 , 7 ]. A causal relationship is debatable, as many maternal factors (e.g. lower socioeconomic position and history of psychopathology) that are associated with later child problem behavior may already be present prior to the unintended pregnancy [ 8 ]. However, even though potentially explained by other underlying factors, children born from an unintended pregnancy still have a different starting point in life as compared to children from an intended pregnancy. Knowledge on which pathways drive the difference in child behavioral outcomes of intended versus unintended pregnancies is largely lacking. Two potential pathways are via maternal psychiatric problems (e.g. postnatal depression) and psychosocial problems (e.g. lack of social support), because they are both more common among women with unintended pregnancies [ 9 , 10 ], are associated with child problem behavior [ 11 ] and thus may mediate the association between unintended pregnancy and child problem behavior [ 12 ]. Ideally, one would study these pathways using randomized controlled trials. However, besides unethical, it is also impossible to randomize women into intended versus unintended pregnancies. Therefore, our aim is to study these pathways by emulating hypothetical interventions on postnatal depression and social support using an observational population-based birth cohort [ 13 ]. In this study, we examined differences in child behavior between children born from an intended versus unintended pregnancy, and aim to identify mechanisms contributing to these differences. We used a statistical technique called G-estimation to determine the difference in problem behavior across childhood and early adolescence that is associated with (un)intended pregnancies. Then, we estimated how much the difference in child problem behavior would be reduced if we had intervened on reducing postnatal depression symptoms and increasing social support. Our hypothesis is that the absence of postnatal depression and the presence of high social support reduces differences in child problem behavior resulting from (un)intended pregnancies. Methods Study population This study is embedded in the Generation R Study, a multiethnic population-based prospective cohort from fetal life onwards. The study is designed to identify early environmental and genetic determinants of growth, development, and health. The cohort has previously been described in detail [ 14 , 15 ]. Briefly, all pregnant women who resided in Rotterdam at the time of their delivery and with a due date between April 2002 and January 2006 were invited to participate. Enrollment was aimed in early pregnancy (gestational age < 18 weeks), but was possible until birth of the child. In total, 9778 (response rate 61%) women were enrolled in Generation R, of whom 9621 were included in the analyses, see paragraph below. The study has been approved by the Medical Ethics Committee of Erasmus MC in Rotterdam, the Netherlands, and is conducted in accordance with the Declaration of Helsinki of the World Medical Association. Written informed consent was obtained from all parents and children (if older than 12). This project was pre-registered at Open Science Framework (doi: 10.17605/OSF.IO/G86SF ). Measurements Unintended pregnancy Pregnancy intention was measured using a self-report questionnaire at inclusion of the study. Women reported whether their pregnancy was planned or not. This variable was compared with pre-pregnancy folic acid use and contraceptive use at conception. We excluded those who reported both an unplanned pregnancy and pre-pregnancy folic acid intake (n = 104) and those who reported a planned pregnancy and contraceptive use at conception (n = 173), leaving n = 9621 participants for analyses (n = 1765 participants with missing data on pregnancy intention were imputed). In case of an unplanned pregnancy, women reported how they felt about the pregnancy using the following four answering categories: “pleased from the start”; “initially mixed feelings”; “still mixed feelings”; or “mostly unhappy about the pregnancy”. Few women reported having “still mixed feelings” or “mostly unhappy”, which we combined into prolonged ambivalent feelings. Pregnancy intention was categorized into “planned”, “unplanned and wanted from the start”, “unplanned and initially ambivalent feelings”, and “unplanned and prolonged ambivalent feelings”. Child internalizing and externalizing problem behavior The validated Child Behavior Checklist (CBCL/1½–5 and CBCL/6–18) was completed by the main caregiver of the child at ages of 1.5, 3, 6, 9 and 13 years [ 16 , 17 ]. The CBCL consists of 99 items (CBCL/1½–5) or 118 items (CBCL/6–18) and assesses behavioral and emotional problems in the preceding 2 (CBCL/1½–5) or 6 (CBCL/6–18) months. Items of the CBCL/1½–5 and CBCL/6–18 were comparable and scored on a 3-point Likert scale (0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true). Mean scale scores for internalizing (anxious/depressed, withdrawn/depressed and somatic complaints) and externalizing (rule-breaking behavior, and aggressive behavior) behavior were computed and converted to standardized T-scores per wave. Cronbach’s alpha at the different time points were calculated and are shown in supplemental table 1 . Sensitivity analyses were performed with similar scores, but based on self-report by the children. At age 9 years, children were asked to complete the Brief Problem Monitor which is a validated, 19-item abbreviated version of the Youth Self Report (YSR) [ 18 ]. At age 13 years, children completed the full YSR containing 110 items [ 19 ]. Postpartum psychiatric symptoms Postpartum psychiatric symptoms were measured 2 months after delivery with the Edinburgh Postnatal Depression Scale (EPDS). This validated self-report questionnaire includes 10 items assessing symptoms of postpartum depression in the previous week, rated on a 4-point scale from 0 (no, not at all) to 3 (yes, quite often) [ 20 , 21 ]. A sum score ranging from 0 to 30 was calculated with higher scores indicating more depressive symptoms. Women with a score of more than 12 were classified as having postpartum depression. This cut-off score had a sensitivity of over 80% and specificity of 95% in diagnosing postnatal depression in a clinical population [ 22 , 23 ]. Social Support Social support was measured 6 months after delivery using the Social Support List 12 – Interactions (SSL12-I), a validated 12-item abbreviated version of the full Social Support List – Interactions [ 24 , 25 ]. Women were asked to indicate whether people around them are nice to them (e.g. give them compliments, invite them to join a party or dinner) or would help them (e.g. provide help in case of illness or moving houses, provide good advice), rated on a 4-point scale from 1 (seldom or never) to 4 (very often). A sum score ranging from 12 to 48 was calculated with higher scores indicating more social support. Women in the lowest tertile were classified as having low social support. Covariates The following variables were included as covariates and were measured during pregnancy or at birth: maternal age, migration background, socioeconomic factors (maternal education and household income), marital status, maternal and paternal lifetime psychopathology, substance use (drugs, smoking, alcohol) and gestational age at birth [ 26 – 29 ]. Statistical analysis Prior to analyses, multiple imputations were performed to replace the missing values in child behavior, unintended pregnancy, postnatal depression, social support and the covariates using MICE package [ 30 ]. We created 30 imputed datasets with 100 iterations. Performing multiple imputation on the variables of interest is recommended to minimize attrition bias, in particular when auxiliary variables are available [ 31 , 32 ]. Besides our variables of interest and covariates, we used the following variables as predictors for imputation because they have been related to pregnancy intention and/or child behavior problems and contain only a small amount of missing data: four digit zip code at birth, parity, maternal pre-pregnancy body mass index, folic acid intake, number of sexual partners in the year prior to pregnancy; and child ethnicity, birth weight and Apgar score after 5 minutes. These variables were all self-reported, except for birthweight and Apgar score. Though our method shares some similarities with mediation analyses, it does not estimate the controlled or natural direct or indirect effects, which target the effect of changing the ‘exposure’ while fixing the value of the mediator [ 33 ]. Changing the ‘exposure’ (unintended pregnancy) would be very complicated, if not impossible, because the counterfactual of an unintended pregnancy is either an intended pregnancy or no pregnancy at all. In practice, it would only be possible to prevent unintended pregnancies. Hence, the prevention of unintended pregnancies (no pregnancy) would result in an absence of the outcome (childhood behavior). Therefore, we examined whether hypothetical interventions on postnatal depression and social support may improve internalizing and externalizing problems in children of unintended pregnancies and thereby have the potential to reduce the differences in behavioral outcomes between children of intended and unintended pregnancies. This modelling approach is called G-estimation [ 13 , 34 ]. As a first step we estimated the observed difference in problem behavior, and the association between postnatal depression, social support and problem behavior based on the observed data. Second, we hypothetically ‘intervened’ on postnatal depression and social support by setting all participants to ‘no postnatal depression’ and ‘high social support’. Third, we used the intervention models of the second step to estimate the difference in problem behavior after the ‘hypothetical intervention’ was implemented. The epidemiological design requires three causal assumptions: exchangeability, positivity and consistency. Exchangeability means no residual confounding or selection bias in the relationship of postnatal depression and social support with child behavior. We therefore adjusted for the earlier mentioned covariates [ 26 – 29 ]. Positivity indicates enough variation in postnatal depression and social support by levels of the covariates, which is likely satisfied given the sample size of the study population and there are no known structural reasons why positivity would be violated. Consistency requires well defined interventions, which might be violated because postnatal depression and lack of social support can be intervened on in different ways possibly resulting in different causal effects. This should be kept in mind when interpreting the results. First, differences in internalizing and externalizing problems between pregnancy intention groups were estimated using linear regression models adjusted for child age and sex. Second, the associations of (1) postnatal depression, and (2) social support with internalizing and externalizing problems were estimated using linear regression analyses adjusted for the earlier mentioned covariates [ 26 – 29 ]. This model was subsequently used to obtain the estimated child behavioral outcomes if the intervention was set to ‘no postnatal depression’ or ‘high social support’. By comparing child behavior with and without the hypothetical intervention, the reduction in the differences in child behavior was estimated [ 13 ]. All analyses were run for internalizing and externalizing problems at ages 1.5, 3, 6, 9 and 13 years separately. Bootstrapping with 1000 iterations was used to calculate the 95% confidence intervals. Several sensitivity analyses were performed. Firstly, we used child self-reported internalizing and externalizing problems from the BPM at age 9 years and the YSR at age 13 years to determine whether reporting bias may have influenced our results. Secondly, in women who participated in the study with multiple pregnancies and/or women who gave birth to twins, a random child was excluded (analytical sample N = 9621). Finally, complete case analyses were performed by excluding dyads with missing data on unintended pregnancy, postnatal depression, social support or all child behavior questionnaires (N = 4244 for analyses with postnatal depression, and N = 3484 for analyses with social support). All analyses were conducted in IBM SPSS version 28 and R statistical software version 4.2.1. Results The mothers were on average 29.9 (SD = 5.4) years old and 72.9% of them had a planned pregnancy, 14.8% had a wanted unplanned pregnancy, 10.8% had an unplanned pregnancy with initially ambivalent feelings and 1.5% had an unplanned pregnancy with prolonged ambivalent feelings. Most mothers were married (49.6%) or cohabiting (25.8%), had a low (26.6%) or mid-low (30.7%) educational level and around half of them (49.8%) had a migration background. Table 1 shows the characteristics of the mothers per pregnancy intention group, and figure S1 shows the correlations between all variables of interest. At all ages, children from unplanned pregnancies had more internalizing and externalizing problems as compared to children from planned pregnancies (Figs. 1 and 2; Tables 2 and 3 ). The difference was largest for children from unplanned pregnancies with prolonged ambivalent feelings and smallest for children from wanted unplanned pregnancies. For example, at age 1.5 years, children from wanted unplanned pregnancies had β = 0.19 (95% CI = 0.13; 0.25) more internalizing and β = 0.15 (95% CI = 0.09; 0.21) more externalizing problems; children from an unplanned pregnancy with initially ambivalent feelings had β = 0.33 (95% CI = 0.25; 0.40) more internalizing and β = 0.23 (95% CI = 0.16; 0.30) more externalizing problems; and children from an unplanned pregnancy with prolonged ambivalent feelings had β = 0.50 (95% CI = 0.30; 0.72) more internalizing and β = 0.39 (95% CI = 0.22; 0.57) more externalizing problems as compared to children from planned pregnancies. Hypothetical interventions on postnatal depression reduced the differences in offspring internalizing and externalizing problems to some extent, with largest reductions seen for unplanned pregnancies with prolonged ambivalent feelings (Table 2 ). For example, at age 1.5 years, the reduction of planned vs. unplanned and wanted pregnancies was β = 0.03 (95% CI = 0.00; 0.07) for internalizing and β = 0.02 (95% CI=-4.6e-3; 0.05) for externalizing problems. The reduction of planned vs. unplanned pregnancies with initially ambivalent feelings was β = 0.08 (95% CI = 0.03; 0.13) for internalizing and β = 0.04 (95% CI = 2.2e-3; 0.08) for externalizing problems. The reduction of planned vs. unplanned pregnancies with prolonged ambivalent feelings was β = 0.14 (95% CI=-0.02; 0.32) for internalizing and β = 0.04 (95% CI=-0.03; 0.25) for externalizing problems. Reductions were quite comparable across ages. Hypothetical interventions on social support did not result in significant changes in differences in internalizing problems and externalizing problems between the different pregnancy intention groups at all ages (Table 3 ). Sensitivity analyses using child self-reported internalizing and externalizing problems (n = 9260) and excluding a random child in case women participated in the study with multiple children (n = 8892) both showed similar results (Supplemental Tables 2–5). Complete case analyses excluding dyads with missing data on unintended pregnancy, postnatal depression, social support or child behavior questionnaires (leaving n = 4034 for postnatal depression and n = 3484 for social support) showed a smaller difference in internalizing and externalizing problems between planned and unplanned pregnancies. The hypothetical intervention on postnatal depression showed smaller and non-significant reductions in the differences, while the hypothetical intervention on social support showed non-significant increases in the differences with very wide confidence intervals (Supplemental Tables 6 and 7). Discussion The results of this study showed that children from unintended pregnancies had more internalizing and externalizing problems as compared to children from intended pregnancies across the childhood years into early adolescence. Problem behavior in the children was higher when the mother had more ambivalent feelings towards the unplanned pregnancy. Hypothetical interventions on postnatal depression reduced the differences between intended and unintended pregnancies by 0.02 (95% CI= -0.01; 0.05) to 0.16 standard deviation (95% CI=-0.01; 0.33) for internalizing problems; and 0.02 (95% CI=-0.01;0.05) to 0.11 standard deviation (95% CI=-0.03; 0.25) for externalizing problems. These are substantial changes at a population level in a relatively healthy cohort. Surprisingly, the results suggested that a hypothetical intervention on social support would not result in any reductions in internalizing and externalizing problems in the offspring. Previous studies were in line with our findings and demonstrated more internalizing and externalizing problems in children from women with unplanned or unwanted pregnancy as compared to planned pregnancies [ 4 , 5 , 35 , 36 ]. Only few studies focused on the potential pathways behind this association. In 14-year-old Australian children, the association between (un)planned pregnancy and internalizing and externalizing problems was reduced by 50% after adjustment for potential confounders (mother's age, mother's marital status, mother's anxiety, depression and smoking at first clinic visit). Additional adjustment for mother’s attitudes towards caring for a baby at 6 months did not change the results [ 5 ]. In children aged 5 and 7 years from the United Kingdom, child behavior was measured using the Strengths and Difficulties Questionnaire. Children from unplanned and mistimed pregnancies had more difficulties than children from planned pregnancies. Again, the association was reduced by 50% after adjustment for pregnancy and postnatal factors, such as gestational age, alcohol drinking, smoking, breastfeeding, maternal mental health, attachment and parenting [ 4 ]. These studies suggest that predisposing or coinciding factors may result in behavioral problems in children from unintended pregnancies. The statistical design of these studies hamper causal interpretation, because of violating the exchangebility assumption due to adjustment for potential colliders (postnatal factors) [ 33 , 37 ]. We therefore applied G-estimation, that has the advantage to provide estimates under less restrictive identification conditions. Our results provided more solid evidence that hypothetically intervening on postnatal depression also reduced the association between (un)planned pregnancy and internalizing and externalizing problem behavior by 14–36%. Our findings suggest that preventing postnatal depression may be promising to reduce differences in behavior problems between children from intended versus unintended pregnancies, in particular when ambivalent feelings towards the pregnancy are present. Some studies have shown that mothers who had an unintended pregnancy more often suffered from postnatal depression [ 38 , 39 ]. A recent study also showed that ambivalent feelings towards the pregnancy were associated with psychological distress in mothers within the first year after childbirth [ 40 ]. However, one of the strongest predictors for postnatal depression is prenatal depression [ 41 ]. Therefore, it is very important to screen and treat depressive symptoms already during pregnancy, particularly among unplanned pregnant women who experience ambivalent feelings. This may help to reduce disparities in child behavior later in life. We did not find evidence that high social support reduces differences in behavior problems between children from intended versus unintended pregnancies. This is surprising, because many studies provided evidence for an association between lack of social support and decreased maternal mental health [ 41 , 42 ]. In our study, postnatal depression and social support were slightly negatively correlated (r=-0.21), suggesting that receiving more social support may be associated with better maternal mental health. Only one recent study focused on the association between perceived social support of mothers and child behavior and found that social support during pregnancy was associated with less mental and behavioural disorders in Finnisch children from birth to the age of 10 [ 43 ]. In our study, however, social support was very weakly correlated with both unintended pregnancy as well as with problem behavior in children (Figure S1 ). One explanation may be that the Social Support List 12 – Interactions (SSL12-I) was originally developed to measure social support in elderly, and may therefore be less applicable in our sample [ 24 , 25 ]. The social support needed after giving birth may include baby sitting or help with taking care of the child, which was not included in the SSL12-I. Strengths of this study were the large sample size, the novel epidemiological design of the study and the longitudinal data which allowed us to study both short- and long-term differences in behavior problems between children from intended versus unintended pregnancies. Another strength of this study is that unintended pregnancy was measured using two questions; whether the pregnancy was planned; and how the women felt about the unplanned pregnancy. Previous studies were often limited by the use of either planned versus unplanned or wanted versus unwanted pregnancy [ 5 ], while it is known that an unintended pregnancy is more complex than just unplanned or just unwanted [ 44 ]. Also, some limitations should be considered. The differences in behavior problems between intended vs. unintended pregnancies were smaller in the complete cases analyses than in the analyses of the full sample. This may indicate the presence of differential missing data by (un)intended pregnancies. Multiple imputation was used to ensure that all participants were included in the analysis to avoid attrition bias. We included all variables from the analyses, as well as many auxiliary variables in the imputation to minimize bias related to differential missingness [ 31 , 32 ]. In order to satisfy the exchangeability assumption, we adjusted for many covariates, including maternal and paternal lifetime psychopathology as a proxy for genetic vulnerability. However, unmeasured confounding of the intervention–outcome model may have led to an overestimation of the change in problem behavior differences between intended and unintended pregnancies. This means that we measured the maximum impact these interventions could have in reducing the difference in child behavior in the main analysis. Finally, the complete case analyses showed less significant findings for the hypothetical intervention on postnatal depression than the analyses on the full sample. This may be explained by both the smaller sample size, and by the smaller difference of behavior problems between intended vs. unintended pregnancies prior to the hypothetical intervention. In conclusion, our study showed that children from unintended pregnancies may encounter more problem behavior than children from intended pregnancies. This difference was observed as early as 1.5 years, and continued to be observed for the next 12 years. Hypothetical preventive interventions targeting postnatal depression may reduce the differences in problem behavior at all ages and in this way combat intergenerational transmission of psychopathology. Therefore, it is important to identify and treat mental health problems of unplanned pregnant women, especially in those with ambivalent feelings, since this may reduce the development of child problem behavior from early childhood to adolescence. Declarations Conflict of interest The authors have no competing interests to declare that are relevant to the content of this article. Acknowledgements We gratefully acknowledge the contribution of the Generation R children and parents, staff, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. We would like to thank Riekje Elema and Meike van ‘t Hof for sharing their knowledge about the program Not Pregnant Now. Financial support The general design of Generation R Study is made possible by financial support from the Erasmus Medical Center and the Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development (ZonMW), the Netherlands Organisation for Scientific Research (NWO), the Ministry of Health, Welfare and Sport and the Ministry of Youth and Families. The current study was made possible by grants from the Netherlands Organization for Health Research and Development (ZonMw Unintended Pregnancy Research Program, grant number 554002008) and the Vital Cities and Citizens initiative. Hanan El Marroun was supported by the Stichting Volksbond Rotterdam, the Netherlands Organization for Scientific Research (NWO) Aspasia grant (No. 015.016.056), and the European Union's Horizon 2020 Research and Innovation Program (HappyMums, Grant agreement 101057390). The funders had no role in the design and conduct of the study or the writing of the report. References Sedgh G, Singh S, Hussain R (2014) Intended and Unintended Pregnancies Worldwide in 2012 and Recent Trends. Stud Fam Plann 45(3):301–314 Picavet C (2012) Zwangerschap en anticonceptie in Nederland. Tijdschrift voor Seksuologie 36(2):121–128 Barrett G, Wellings K (2002) What is a 'planned' pregnancy? Empirical data from a British study. 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Epidemiology, : p. 851–860 Boden JM, Fergusson DM, Horwood LJ (2015) Outcomes for Children and Families Following Unplanned Pregnancy: Findings from a Longitudinal Birth Cohort. Child Indic Res 8(2):389–402 D’Souza S et al (2019) Persistence and change in behavioural problems during early childhood. BMC Pediatr 19(1):259 MacKinnon DP, Lamp SJ (2021) A Unification of Mediator, Confounder, and Collider Effects. Prev Sci 22(8):1185–1193 Abajobir AA et al (2016) A systematic review and meta-analysis of the association between unintended pregnancy and perinatal depression. J Affect Disord 192:56–63 Qiu X et al (2020) Unintended pregnancy and postpartum depression: A meta-analysis of cohort and case-control studies. J Psychosom Res 138:110259 Tokuda N et al (2023) Analyzing the relationship between feelings about pregnancy and mother-infant bonding with the onset of maternal psychological distress after childbirth: The Japan Environment and Children's Study. J Affect Disord 329:531–538 Hutchens BF, Kearney J (2020) Risk Factors for Postpartum Depression: An Umbrella Review. J Midwifery Women's Health 65(1):96–108 Bedaso A et al (2021) The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reproductive Health 18(1):162 Lähdepuro A et al (2023) Positive maternal mental health during pregnancy and mental and behavioral disorders in children: A prospective pregnancy cohort study. J Child Psychol Psychiatry 64(5):807–816 Santelli J et al (2003) The Measurement and Meaning of Unintended Pregnancy. Perspect Sex Reprod Health 35(2):94–101 Tables Table 1: General characteristics of the pregnant mothers. Planned pregnancy (N=5729) Unplanned and wanted from the start (N=1163) Unplanned and initially ambivalent feelings (N=850) Unplanned and prolonged ambivalent feelings (N=114) Missing data on pregnancy intention (N=1765) Age mother Mean (SD) 30.79 (4.76) 27.95 (5.82) 27.22 (5.94) 28.95 (6.11) 29.73 (5.87) N 5729 1163 850 114 1765 Marital Status Married 3116 (55.6%) 368 (32.8%) 262 (31.9%) 43 (38.4%) 378 (51.4%) Cohabiting 2130 (38.0%) 418 (37.3%) 227 (27.6%) 22 (19.6%) 207 (28.2%) Single 358 (6.4%) 335 (29.9%) 332 (40.4%) 47 (42.0%) 150 (20.4%) N 5604 1121 821 112 735 Migration background No 3343 (58.8%) 423 (36.9%) 235 (28.0%) 30 (26.5%) 450 (39.4%) Yes 2338 (41.2%) 722 (63.1%) 603 (72.0%) 83 (73.5%) 693 (60.6%) N 5681 1145 838 113 1143 Educational level mother 1 Low 1160 (20.9%) 397 (35.7%) 359 (44.3%) 46 (42.2%) 268 (33.4%) Mid-Low 1601 (28.8%) 408 (36.7%) 297 (36.6%) 30 (27.5%) 238 (29.7%) Mid-High 1192 (21.5%) 181 (16.3%) 94 (11.6%) 14 (12.8%) 149 (18.6%) High 1603 (28.9%) 126 (11.3%) 61 (7.5%) 19 (17.4%) 147 (18.3%) N 5556 1112 811 109 802 Household income 2 Low 520 (11.9%) 269 (33.1%) 263 (46.8%) 48 (52.7%) 258 (35.4%) Medium 710 (16.2%) 189 (23.2%) 143 (25.4%) 22 (24.2%) 151 (20.7%) High 3143 (71.9%) 355 (43.7%) 156 (27.8%) 21 (23.1%) 320 (43.9%) N 4373 813 562 91 729 Parity 0 3197 (57.1%) 695 (60.6%) 463 (56.1%) 45 (40.5%) 678 (46.8%) 1 1825 (32.6%) 307 (26.8%) 180 (21.8%) 34 (30.6%) 451 (31.1%) 2 467 (8.3%) 113 (9.9%) 138 (16.7%) 21 (18.9%) 230 (15.9%) ≥3 107 (1.9%) 31 (2.7%) 45 (5.4%) 11 (9.9%) 90 (6.2%) N 5596 1146 826 111 1449 1 Highest attained educational level, categorized as: Low (primary school; lower vocational training; intermediate general school; 3 years general secondary school), which typically corresponds to ≤12 years of education; Mid‐low (>3 years general secondary school; intermediate vocational training; 1st year higher vocational training), in general corresponding with 13–15 years of education; Mid‐high (higher vocational training; Bachelor's degree), typically matching with 16 or 17 years of education; And High (higher academic education; PhD), usually indicating 18 years of education or more. 2 Categorized as: Less than €1200/month (social security level); Between €1200 and €2000/month; and More than €2000/month (modal income). Pregnancy intention data was missing for n=1765 participants. Table 2: Changes in behavior differences by a hypothetical intervention on postnatal depression. Internalizing behavior Externalizing behavior Without intervention With postnatal depression intervention Reduction Without intervention With postnatal depression intervention Reduction Age 1.5 years Unplanned and wanted 0.19 (0.13; 0.25) 0.15 (0.10; 0.21) 0.03 (7.5 e-4 ; 0.07) 0.15 (0.09-0.21) 0.13 (0.07; 0.19) 0.02 (-4.6 e-3 ; 0.05) Unplanned and initially ambivalent 0.33 (0.25; 0.40) 0.25 (0.18; 0.31) 0.08 (0.03; 0.13) 0.23 (0.16-0.30) 0.19 (0.12; 0.26) 0.04 (2.2 e-3 ; 0.08) Unplanned and prolonged ambivalent 0.50 (0.30; 0.72) 0.36 (0.17; 0.58) 0.14 (-0.02; 0.32) 0.39 (0.22-0.57) 0.29 (0.09; 0.49) 0.11 (-0.03; 0.25) Age 3 years Unplanned and wanted 0.16 (0.11; 0.22) 0.14 (0.09; 0.20) 0.02 (-0.01; 0.05) 0.15 (0.10-0.21) 0.14 (0.08; 0.20) 0.02 (-0.01; 0.05 Unplanned and initially ambivalent 0.25 (0.18; 0.32) 0.21 (0.14; 0.28) 0.04 (1.2 e-3 ; 0.09) 0.23 (0.16-0.30) 0.19 (0.12; 0.26) 0.04 (-3.1 e-3 ; 0.08) Unplanned and prolonged ambivalent 0.67 (0.46; 0.89) 0.57 (0.35; 0.82) 0.10 (-0.07; 0.27) 0.59 (0.40-0.78) 0.50 (0.39; 0.72) 0.09 (-0.06; 0.25) Age 6 years Unplanned and wanted 0.13 (0.08; 0.19) 0.11 (0.05; 0.17) 0.02 (-0.01; 0.06) 0.16 (0.10; 0.22) 0.14 (0.08; 0.20) 0.02 (-0.01; 0.05) Unplanned and initially ambivalent 0.23 (0.16; 0.30) 0.15 (0.09; 0.22) 0.07 (0.03; 0.12) 0.20 (0.13; 0.27) 0.15 (0.08; 0.20) 0.06 (0.02; 0.10) Unplanned and prolonged ambivalent 0.29 (0.10; 0.49) 0.17 (0.01; 0.37) 0.12 (-0.03; 0.29) 0.34 (0.15; 0.53) 0.23 (0.05; 0.43) 0.10 (-0.05; 0.10) Age 9 years Unplanned and wanted 0.12 (0.06; 0.18) 0.09 (0.03; 0.15) 0.03 (-4.9 e-3 ; 0.06) 0.13 (0.07; 0.19) 0.11 (0.05; 0.17) 0.02 (-0.01; 0.05) Unplanned and initially ambivalent 0.21 (0.14; 0.28) 0.16 (0.08; 0.23) 0.05 (0.01; 0.09) 0.27 (0.20; 0.35) 0.23 (0.16; 0.31) 0.04 (-4.2 e-3 ; 0.09) Unplanned and prolonged ambivalent 0.55 (0.34; 0.76) 0.39 (0.17; 0.63) 0.16 (-0.01; 0.33) 0.50 (0.30; 0.72) 0.40 (0.18; 0.64) 0.10 (-0.06; 0.27) Age 13 years Unplanned and wanted 0.13 (0.08; 0.19) 0.11 (0.05; 0.17) 0.02 (-0.01; 0.05) 0.16 (0.10; 0.22) 0.13 (0.07; 0.19) 0.02 (-0.01; 0.06) Unplanned and initially ambivalent 0.22 (0.15; 0.29) 0.16 (0.09; 0.24) 0.05 (0.01; 0.10) 0.22 (0.15; 0.30) 0.19 (0.12; 0.27) 0.03 (-0.01; 0.07) Unplanned and prolonged ambivalent 0.36 (0.18; 0.56) 0.24 (0.04; 0.45) 0.13 (-0.02; 0.29) 0.38 (0.19; 0.60) 0.30 (0.09; 0.54) 0.08 (-0.08; 0.25) Difference without the intervention: The absolute difference in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets. Difference with the postnatal depression intervention: The absolute difference in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets after setting the intervention to ‘no postnatal depression’. Reduction in difference: The absolute change from the difference without and with intervention in in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets. The 95% confidence intervals were calculated by bootstrapping with 1000 iterations. Table 3: Changes in behavior differences by a hypothetical intervention on social support. Internalizing behavior Externalizing behavior Without intervention With social support intervention Reduction Without intervention With social support intervention Reduction Age 1.5 years Unplanned and wanted 0.19 (0.13; 0.25) 0.17 (0.11; 0.24) 0.01 (-0.03; 0.06) 0.15 (0.09-0.21) 0.14 (0.07; 0.21) 0.01 (-0.04; 0.06) Unplanned and initially ambivalent 0.33 (0.25; 0.40) 0.31 (0.22; 0.40) 0.01 (-0.05; 0.08) 0.23 (0.16-0.30) 0.24 (0.15; 0.33) -0.01 (-0.07; 0.05) Unplanned and prolonged ambivalent 0.50 (0.30; 0.72) 0.44 (0.18; 0.73) 0.06 (-0.15; 0.28) 0.39 (0.22-0.57) 0.41 (0.17; 0.67) -0.02 (-0.21; 0.17) Age 3 years Unplanned and wanted 0.16 (0.11; 0.22) 0.15 (0.08; 0.22) 0.01 (-0.03; 0.06) 0.15 (0.10-0.21) 0.14 (0.07; 0.21) 0.01 (-0.03; 0.06) Unplanned and initially ambivalent 0.25 (0.18; 0.32) 0.24 (0.16; 0.33) 0.01 (-0.05; 0.07) 0.23 (0.16-0.30) 0.23 (0.14; 0.32) 0.00 (-0.06; 0.06) Unplanned and prolonged ambivalent 0.67 (0.46; 0.89) 0.66 (0.39; 0.95) 0.01 (-0.21; 0.24) 0.59 (0.40-0.78) 0.60 (0.34; 0.88) -0.01 (0.19; 0.22) Age 6 years Unplanned and wanted 0.13 (0.08; 0.19) 0.12 (0.05; 0.19) 0.01 (-0.03; 0.06) 0.16 (0.10; 0.22) 0.15 (0.08; 0.22) 0.01 (-0.04; 0.06) Unplanned and initially ambivalent 0.23 (0.16; 0.30) 0.22 (0.13; 0.31) 0.01 (-0.05; 0.08) 0.20 (0.13; 0.27) 0.20 (0.11; 0.29) 0.00 (-0.06; 0.07) Unplanned and prolonged ambivalent 0.29 (0.10; 0.49) 0.28 (0.03; 0.55) 0.01 (-0.19; 0.22) 0.34 (0.15; 0.53) 0.32 (0.08; 0.59) 0.01 (-0.19; 0.21) Age 9 years Unplanned and wanted 0.12 (0.06; 0.18) 0.12 (0.05; 0.19) 0.00 (-0.05; 0.05) 0.13 (0.07; 0.19) 0.14 (0.07; 0.22) -0.01 (-0.06; 0.04) Unplanned and initially ambivalent 0.21 (0.14; 0.28) 0.21 (0.12; 0.30) 0.00 (-0.07; 0.06) 0.27 (0.20; 0.35) 0.27 (0.18; 0.37) 0.00 (-0.06; 0.07) Unplanned and prolonged ambivalent 0.55 (0.34; 0.76) 0.52 (0.23; 0.82) 0.03 (-0.19; 0.25) 0.50 (0.30; 0.72) 0.51 (0.22; 0.82) -0.01 (-0.24; 0.21) Age 13 years Unplanned and wanted 0.13 (0.08; 0.19) 0.12 (0.05; 0.20) 0.01 (-0.04; 0.06) 0.16 (0.10; 0.22) 0.15 (0.08; 0.23) 0.00 (-0.05; 0.05) Unplanned and initially ambivalent 0.22 (0.15; 0.29) 0.21 (0.12; 0.30) 0.01 (-0.05; 0.07) 0.22 (0.15; 0.30) 0.21 (0.12; 0.31) 0.01 (-0.05; 0.08) Unplanned and prolonged ambivalent 0.36 (0.18; 0.56) 0.33 (0.07; 0.61) 0.03 (-0.17; 0.24) 0.38 (0.19; 0.60) 0.38 (0.11; 0.69) 0.00 (-0.22; 0.22) Difference without the intervention: The absolute difference in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets. Difference with the social support intervention: The absolute difference in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets after setting the intervention to ‘sufficient social support’. Reduction in difference: The absolute change from the difference without and with intervention in in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets. The 95% confidence intervals were calculated by bootstrapping with 1000 iterations. Additional Declarations No competing interests reported. Supplementary Files SupplementsUPchildbehaviour28122023.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 14 Apr, 2024 Reviews received at journal 10 Mar, 2024 Reviews received at journal 04 Mar, 2024 Reviewers agreed at journal 17 Feb, 2024 Reviewers agreed at journal 16 Feb, 2024 Reviewers invited by journal 22 Jan, 2024 Editor assigned by journal 30 Dec, 2023 Submission checks completed at journal 29 Dec, 2023 First submitted to journal 28 Dec, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Lambregtse-van den Berg","email":"","orcid":"","institution":"Erasmus University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Mijke","middleName":"P. Lambregtse-van den","lastName":"Berg","suffix":""},{"id":264486420,"identity":"e4c6dacc-b9f0-4c48-a50b-4f9986af0fad","order_by":4,"name":"Manon H.J. Hillegers","email":"","orcid":"","institution":"Erasmus University Medical Center- Sophia Childrens hospital","correspondingAuthor":false,"prefix":"","firstName":"Manon","middleName":"H.J.","lastName":"Hillegers","suffix":""},{"id":264486421,"identity":"f6259df7-809f-40d7-a24e-c65c9de99350","order_by":5,"name":"Hanan El Marroun","email":"","orcid":"","institution":"Erasmus University","correspondingAuthor":false,"prefix":"","firstName":"Hanan","middleName":"El","lastName":"Marroun","suffix":""},{"id":264486422,"identity":"63e69d2f-bef7-40d1-a95b-bb2bdfa02e36","order_by":6,"name":"Pauline W. Jansen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYLACCTDJfABIHIAKFRClhS0BSYsBUXbxGBCnxRyk0qLmjj2/dM/Hhz/+3GHgl8h9wFyAR4tlA1CLxLFniTPnnN1szNv2jEFyRroB8ww8WgwO8G5gkGA7nGBwI3ebNGPDYQaDG2kMzDwEtfw7bG9/I+f5zx9/DjPYE6VFsu0w4waJHDYGHjagLRIEtFg28384INl3OHHGjTRjaaBfeCTOPGM4jE+LOXtb4mOJb4ft+WckP/wIDDE5/vY0xsc8FXgcxszAcFgCSYAHRBzArQESZYwf8KkYBaNgFIyCUQAA9mJLqqnwLesAAAAASUVORK5CYII=","orcid":"","institution":"Erasmus University","correspondingAuthor":true,"prefix":"","firstName":"Pauline","middleName":"W.","lastName":"Jansen","suffix":""}],"badges":[],"createdAt":"2023-12-28 12:29:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3816656/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3816656/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49127530,"identity":"97fec08c-df38-427c-8921-4abacf07bbf1","added_by":"auto","created_at":"2024-01-03 15:00:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25453,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of the differences in internalizing problem behavior before the hypothetical intervention (dark blue), after the hypothetical intervention on postnatal depression (green), and after the hypothetical intervention on social support (light blue) between children from planned pregnancies (reference) and children from unplanned and wanted pregnancies, unplanned pregnancies with initially ambivalent feelings and unplanned pregnancies with prolonged ambivalent feelings ages 1.5, 3, 6, 9 and 13 years. The beta-coefficients are indicated with a black dot, and the 95% confidence intervals are indicated by the width of the error bars.\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3816656/v1/e021a5c51430f6829f66b8bd.png"},{"id":49127531,"identity":"77e03aec-078a-4679-b4fb-861025801cf8","added_by":"auto","created_at":"2024-01-03 15:00:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25339,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of the differences in externalizing problem behavior before the hypothetical intervention (dark blue), after the hypothetical intervention on postnatal depression (green), and after the hypothetical intervention on social support (light blue) between children from planned pregnancies (reference) and children from unplanned and wanted pregnancies, unplanned pregnancies with initially ambivalent feelings and unplanned pregnancies with prolonged ambivalent feelings ages 1.5, 3, 6, 9 and 13 years.. The beta-coefficients are indicated with a black dot, and the 95% confidence intervals are indicated by the width of the error bars.\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3816656/v1/d0f92c35aa543aca71c2f77c.png"},{"id":49128772,"identity":"c8082e3f-c02c-4572-af33-a48f7dad0054","added_by":"auto","created_at":"2024-01-03 15:08:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":558708,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3816656/v1/0ff3bb83-8b43-4e3c-881d-62562227abbc.pdf"},{"id":49127532,"identity":"6eedfff9-957a-440f-853d-6b67d9e4c9f4","added_by":"auto","created_at":"2024-01-03 15:00:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":63237,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementsUPchildbehaviour28122023.docx","url":"https://assets-eu.researchsquare.com/files/rs-3816656/v1/76b953466ee42af9c68b04e4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reducing behavior problems in children born after an unintended pregnancy: A hypothetical intervention study in the population-based Generation R cohort","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUnintended pregnancies are very common all around the world. The highest rates of unintended pregnancies have been found in Latin America and the Caribbean (56%), whereas lower rates are reported in Western Europe (34%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The Netherlands has a relatively low rate of unintended pregnancies as compared to other countries, yet 18% of the pregnancies are unintended [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Whether a pregnancy is unintended or unplanned is complex to determine as feelings towards the pregnancy may change over time [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In this study, pregnant women reported during the first trimester of the pregnancy whether the pregnancy was planned or not, and in case of an unplanned pregnancy, how they felt about the pregnancy.\u003c/p\u003e \u003cp\u003eUnintended pregnancies are associated with poorer mental health in children. Research has shown that children born from an unintended pregnancy are more likely to display behavior problems at 5 and 7 years [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], aggression and externalizing problems at 14 years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and a lower self-esteem and more depressive symptoms in their 20s [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A causal relationship is debatable, as many maternal factors (e.g. lower socioeconomic position and history of psychopathology) that are associated with later child problem behavior may already be present prior to the unintended pregnancy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, even though potentially explained by other underlying factors, children born from an unintended pregnancy still have a different starting point in life as compared to children from an intended pregnancy.\u003c/p\u003e \u003cp\u003eKnowledge on which pathways drive the difference in child behavioral outcomes of intended versus unintended pregnancies is largely lacking. Two potential pathways are via maternal psychiatric problems (e.g. postnatal depression) and psychosocial problems (e.g. lack of social support), because they are both more common among women with unintended pregnancies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], are associated with child problem behavior [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and thus may mediate the association between unintended pregnancy and child problem behavior [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Ideally, one would study these pathways using randomized controlled trials. However, besides unethical, it is also impossible to randomize women into intended versus unintended pregnancies. Therefore, our aim is to study these pathways by emulating hypothetical interventions on postnatal depression and social support using an observational population-based birth cohort [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we examined differences in child behavior between children born from an intended versus unintended pregnancy, and aim to identify mechanisms contributing to these differences. We used a statistical technique called G-estimation to determine the difference in problem behavior across childhood and early adolescence that is associated with (un)intended pregnancies. Then, we estimated how much the difference in child problem behavior would be reduced if we had intervened on reducing postnatal depression symptoms and increasing social support. Our hypothesis is that the absence of postnatal depression and the presence of high social support reduces differences in child problem behavior resulting from (un)intended pregnancies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis study is embedded in the Generation R Study, a multiethnic population-based prospective cohort from fetal life onwards. The study is designed to identify early environmental and genetic determinants of growth, development, and health. The cohort has previously been described in detail [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Briefly, all pregnant women who resided in Rotterdam at the time of their delivery and with a due date between April 2002 and January 2006 were invited to participate. Enrollment was aimed in early pregnancy (gestational age\u0026thinsp;\u0026lt;\u0026thinsp;18 weeks), but was possible until birth of the child. In total, 9778 (response rate 61%) women were enrolled in Generation R, of whom 9621 were included in the analyses, see paragraph below. The study has been approved by the Medical Ethics Committee of Erasmus MC in Rotterdam, the Netherlands, and is conducted in accordance with the Declaration of Helsinki of the World Medical Association. Written informed consent was obtained from all parents and children (if older than 12). This project was pre-registered at Open Science Framework (doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17605/OSF.IO/G86SF\u003c/span\u003e\u003cspan address=\"10.17605/OSF.IO/G86SF\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eUnintended pregnancy\u003c/h2\u003e \u003cp\u003ePregnancy intention was measured using a self-report questionnaire at inclusion of the study. Women reported whether their pregnancy was planned or not. This variable was compared with pre-pregnancy folic acid use and contraceptive use at conception. We excluded those who reported both an unplanned pregnancy and pre-pregnancy folic acid intake (n\u0026thinsp;=\u0026thinsp;104) and those who reported a planned pregnancy and contraceptive use at conception (n\u0026thinsp;=\u0026thinsp;173), leaving n\u0026thinsp;=\u0026thinsp;9621 participants for analyses (n\u0026thinsp;=\u0026thinsp;1765 participants with missing data on pregnancy intention were imputed). In case of an unplanned pregnancy, women reported how they felt about the pregnancy using the following four answering categories: \u0026ldquo;pleased from the start\u0026rdquo;; \u0026ldquo;initially mixed feelings\u0026rdquo;; \u0026ldquo;still mixed feelings\u0026rdquo;; or \u0026ldquo;mostly unhappy about the pregnancy\u0026rdquo;. Few women reported having \u0026ldquo;still mixed feelings\u0026rdquo; or \u0026ldquo;mostly unhappy\u0026rdquo;, which we combined into prolonged ambivalent feelings. Pregnancy intention was categorized into \u0026ldquo;planned\u0026rdquo;, \u0026ldquo;unplanned and wanted from the start\u0026rdquo;, \u0026ldquo;unplanned and initially ambivalent feelings\u0026rdquo;, and \u0026ldquo;unplanned and prolonged ambivalent feelings\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eChild internalizing and externalizing problem behavior\u003c/h2\u003e \u003cp\u003eThe validated Child Behavior Checklist (CBCL/1\u0026frac12;\u0026ndash;5 and CBCL/6\u0026ndash;18) was completed by the main caregiver of the child at ages of 1.5, 3, 6, 9 and 13 years [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The CBCL consists of 99 items (CBCL/1\u0026frac12;\u0026ndash;5) or 118 items (CBCL/6\u0026ndash;18) and assesses behavioral and emotional problems in the preceding 2 (CBCL/1\u0026frac12;\u0026ndash;5) or 6 (CBCL/6\u0026ndash;18) months. Items of the CBCL/1\u0026frac12;\u0026ndash;5 and CBCL/6\u0026ndash;18 were comparable and scored on a 3-point Likert scale (0\u0026thinsp;=\u0026thinsp;not true, 1\u0026thinsp;=\u0026thinsp;somewhat or sometimes true, and 2\u0026thinsp;=\u0026thinsp;very true or often true). Mean scale scores for internalizing (anxious/depressed, withdrawn/depressed and somatic complaints) and externalizing (rule-breaking behavior, and aggressive behavior) behavior were computed and converted to standardized T-scores per wave. Cronbach\u0026rsquo;s alpha at the different time points were calculated and are shown in supplemental table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Sensitivity analyses were performed with similar scores, but based on self-report by the children. At age 9 years, children were asked to complete the Brief Problem Monitor which is a validated, 19-item abbreviated version of the Youth Self Report (YSR) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. At age 13 years, children completed the full YSR containing 110 items [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003ePostpartum psychiatric symptoms\u003c/h2\u003e \u003cp\u003ePostpartum psychiatric symptoms were measured 2 months after delivery with the Edinburgh Postnatal Depression Scale (EPDS). This validated self-report questionnaire includes 10 items assessing symptoms of postpartum depression in the previous week, rated on a 4-point scale from 0 (no, not at all) to 3 (yes, quite often) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A sum score ranging from 0 to 30 was calculated with higher scores indicating more depressive symptoms. Women with a score of more than 12 were classified as having postpartum depression. This cut-off score had a sensitivity of over 80% and specificity of 95% in diagnosing postnatal depression in a clinical population [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eSocial Support\u003c/h2\u003e \u003cp\u003eSocial support was measured 6 months after delivery using the Social Support List 12 \u0026ndash; Interactions (SSL12-I), a validated 12-item abbreviated version of the full Social Support List \u0026ndash; Interactions [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Women were asked to indicate whether people around them are nice to them (e.g. give them compliments, invite them to join a party or dinner) or would help them (e.g. provide help in case of illness or moving houses, provide good advice), rated on a 4-point scale from 1 (seldom or never) to 4 (very often). A sum score ranging from 12 to 48 was calculated with higher scores indicating more social support. Women in the lowest tertile were classified as having low social support.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eCovariates\u003c/h2\u003e \u003cp\u003eThe following variables were included as covariates and were measured during pregnancy or at birth: maternal age, migration background, socioeconomic factors (maternal education and household income), marital status, maternal and paternal lifetime psychopathology, substance use (drugs, smoking, alcohol) and gestational age at birth [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003ePrior to analyses, multiple imputations were performed to replace the missing values in child behavior, unintended pregnancy, postnatal depression, social support and the covariates using MICE package [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. We created 30 imputed datasets with 100 iterations. Performing multiple imputation on the variables of interest is recommended to minimize attrition bias, in particular when auxiliary variables are available [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Besides our variables of interest and covariates, we used the following variables as predictors for imputation because they have been related to pregnancy intention and/or child behavior problems and contain only a small amount of missing data: four digit zip code at birth, parity, maternal pre-pregnancy body mass index, folic acid intake, number of sexual partners in the year prior to pregnancy; and child ethnicity, birth weight and Apgar score after 5 minutes. These variables were all self-reported, except for birthweight and Apgar score.\u003c/p\u003e \u003cp\u003eThough our method shares some similarities with mediation analyses, it does not estimate the controlled or natural direct or indirect effects, which target the effect of changing the \u0026lsquo;exposure\u0026rsquo; while fixing the value of the mediator [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Changing the \u0026lsquo;exposure\u0026rsquo; (unintended pregnancy) would be very complicated, if not impossible, because the counterfactual of an unintended pregnancy is either an intended pregnancy or no pregnancy at all. In practice, it would only be possible to prevent unintended pregnancies. Hence, the prevention of unintended pregnancies (no pregnancy) would result in an absence of the outcome (childhood behavior). Therefore, we examined whether hypothetical interventions on postnatal depression and social support may improve internalizing and externalizing problems in children of unintended pregnancies and thereby have the potential to reduce the differences in behavioral outcomes between children of intended and unintended pregnancies. This modelling approach is called G-estimation [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a first step we estimated the observed difference in problem behavior, and the association between postnatal depression, social support and problem behavior based on the observed data. Second, we hypothetically \u0026lsquo;intervened\u0026rsquo; on postnatal depression and social support by setting all participants to \u0026lsquo;no postnatal depression\u0026rsquo; and \u0026lsquo;high social support\u0026rsquo;. Third, we used the intervention models of the second step to estimate the difference in problem behavior after the \u0026lsquo;hypothetical intervention\u0026rsquo; was implemented. The epidemiological design requires three causal assumptions: exchangeability, positivity and consistency. Exchangeability means no residual confounding or selection bias in the relationship of postnatal depression and social support with child behavior. We therefore adjusted for the earlier mentioned covariates [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Positivity indicates enough variation in postnatal depression and social support by levels of the covariates, which is likely satisfied given the sample size of the study population and there are no known structural reasons why positivity would be violated. Consistency requires well defined interventions, which might be violated because postnatal depression and lack of social support can be intervened on in different ways possibly resulting in different causal effects. This should be kept in mind when interpreting the results.\u003c/p\u003e \u003cp\u003eFirst, differences in internalizing and externalizing problems between pregnancy intention groups were estimated using linear regression models adjusted for child age and sex. Second, the associations of (1) postnatal depression, and (2) social support with internalizing and externalizing problems were estimated using linear regression analyses adjusted for the earlier mentioned covariates [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This model was subsequently used to obtain the estimated child behavioral outcomes if the intervention was set to \u0026lsquo;no postnatal depression\u0026rsquo; or \u0026lsquo;high social support\u0026rsquo;. By comparing child behavior with and without the hypothetical intervention, the reduction in the differences in child behavior was estimated [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. All analyses were run for internalizing and externalizing problems at ages 1.5, 3, 6, 9 and 13 years separately. Bootstrapping with 1000 iterations was used to calculate the 95% confidence intervals. Several sensitivity analyses were performed. Firstly, we used child self-reported internalizing and externalizing problems from the BPM at age 9 years and the YSR at age 13 years to determine whether reporting bias may have influenced our results. Secondly, in women who participated in the study with multiple pregnancies and/or women who gave birth to twins, a random child was excluded (analytical sample N\u0026thinsp;=\u0026thinsp;9621). Finally, complete case analyses were performed by excluding dyads with missing data on unintended pregnancy, postnatal depression, social support or all child behavior questionnaires (N\u0026thinsp;=\u0026thinsp;4244 for analyses with postnatal depression, and N\u0026thinsp;=\u0026thinsp;3484 for analyses with social support). All analyses were conducted in IBM SPSS version 28 and R statistical software version 4.2.1.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mothers were on average 29.9 (SD\u0026thinsp;=\u0026thinsp;5.4) years old and 72.9% of them had a planned pregnancy, 14.8% had a wanted unplanned pregnancy, 10.8% had an unplanned pregnancy with initially ambivalent feelings and 1.5% had an unplanned pregnancy with prolonged ambivalent feelings. Most mothers were married (49.6%) or cohabiting (25.8%), had a low (26.6%) or mid-low (30.7%) educational level and around half of them (49.8%) had a migration background. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the characteristics of the mothers per pregnancy intention group, and figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e shows the correlations between all variables of interest.\u003c/p\u003e \u003cp\u003eAt all ages, children from unplanned pregnancies had more internalizing and externalizing problems as compared to children from planned pregnancies (Figs.\u0026nbsp;1 and 2; Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The difference was largest for children from unplanned pregnancies with prolonged ambivalent feelings and smallest for children from wanted unplanned pregnancies. For example, at age 1.5 years, children from wanted unplanned pregnancies had β\u0026thinsp;=\u0026thinsp;0.19 (95% CI\u0026thinsp;=\u0026thinsp;0.13; 0.25) more internalizing and β\u0026thinsp;=\u0026thinsp;0.15 (95% CI\u0026thinsp;=\u0026thinsp;0.09; 0.21) more externalizing problems; children from an unplanned pregnancy with initially ambivalent feelings had β\u0026thinsp;=\u0026thinsp;0.33 (95% CI\u0026thinsp;=\u0026thinsp;0.25; 0.40) more internalizing and β\u0026thinsp;=\u0026thinsp;0.23 (95% CI\u0026thinsp;=\u0026thinsp;0.16; 0.30) more externalizing problems; and children from an unplanned pregnancy with prolonged ambivalent feelings had β\u0026thinsp;=\u0026thinsp;0.50 (95% CI\u0026thinsp;=\u0026thinsp;0.30; 0.72) more internalizing and β\u0026thinsp;=\u0026thinsp;0.39 (95% CI\u0026thinsp;=\u0026thinsp;0.22; 0.57) more externalizing problems as compared to children from planned pregnancies.\u003c/p\u003e \u003cp\u003eHypothetical interventions on postnatal depression reduced the differences in offspring internalizing and externalizing problems to some extent, with largest reductions seen for unplanned pregnancies with prolonged ambivalent feelings (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). For example, at age 1.5 years, the reduction of planned vs. unplanned and wanted pregnancies was β\u0026thinsp;=\u0026thinsp;0.03 (95% CI\u0026thinsp;=\u0026thinsp;0.00; 0.07) for internalizing and β\u0026thinsp;=\u0026thinsp;0.02 (95% CI=-4.6e-3; 0.05) for externalizing problems. The reduction of planned vs. unplanned pregnancies with initially ambivalent feelings was β\u0026thinsp;=\u0026thinsp;0.08 (95% CI\u0026thinsp;=\u0026thinsp;0.03; 0.13) for internalizing and β\u0026thinsp;=\u0026thinsp;0.04 (95% CI\u0026thinsp;=\u0026thinsp;2.2e-3; 0.08) for externalizing problems. The reduction of planned vs. unplanned pregnancies with prolonged ambivalent feelings was β\u0026thinsp;=\u0026thinsp;0.14 (95% CI=-0.02; 0.32) for internalizing and β\u0026thinsp;=\u0026thinsp;0.04 (95% CI=-0.03; 0.25) for externalizing problems. Reductions were quite comparable across ages. Hypothetical interventions on social support did not result in significant changes in differences in internalizing problems and externalizing problems between the different pregnancy intention groups at all ages (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSensitivity analyses using child self-reported internalizing and externalizing problems (n\u0026thinsp;=\u0026thinsp;9260) and excluding a random child in case women participated in the study with multiple children (n\u0026thinsp;=\u0026thinsp;8892) both showed similar results (Supplemental Tables\u0026nbsp;2\u0026ndash;5). Complete case analyses excluding dyads with missing data on unintended pregnancy, postnatal depression, social support or child behavior questionnaires (leaving n\u0026thinsp;=\u0026thinsp;4034 for postnatal depression and n\u0026thinsp;=\u0026thinsp;3484 for social support) showed a smaller difference in internalizing and externalizing problems between planned and unplanned pregnancies. The hypothetical intervention on postnatal depression showed smaller and non-significant reductions in the differences, while the hypothetical intervention on social support showed non-significant increases in the differences with very wide confidence intervals (Supplemental Tables\u0026nbsp;6 and 7).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study showed that children from unintended pregnancies had more internalizing and externalizing problems as compared to children from intended pregnancies across the childhood years into early adolescence. Problem behavior in the children was higher when the mother had more ambivalent feelings towards the unplanned pregnancy. Hypothetical interventions on postnatal depression reduced the differences between intended and unintended pregnancies by 0.02 (95% CI= -0.01; 0.05) to 0.16 standard deviation (95% CI=-0.01; 0.33) for internalizing problems; and 0.02 (95% CI=-0.01;0.05) to 0.11 standard deviation (95% CI=-0.03; 0.25) for externalizing problems. These are substantial changes at a population level in a relatively healthy cohort. Surprisingly, the results suggested that a hypothetical intervention on social support would not result in any reductions in internalizing and externalizing problems in the offspring.\u003c/p\u003e \u003cp\u003ePrevious studies were in line with our findings and demonstrated more internalizing and externalizing problems in children from women with unplanned or unwanted pregnancy as compared to planned pregnancies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Only few studies focused on the potential pathways behind this association. In 14-year-old Australian children, the association between (un)planned pregnancy and internalizing and externalizing problems was reduced by 50% after adjustment for potential confounders (mother's age, mother's marital status, mother's anxiety, depression and smoking at first clinic visit). Additional adjustment for mother\u0026rsquo;s attitudes towards caring for a baby at 6 months did not change the results [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In children aged 5 and 7 years from the United Kingdom, child behavior was measured using the Strengths and Difficulties Questionnaire. Children from unplanned and mistimed pregnancies had more difficulties than children from planned pregnancies. Again, the association was reduced by 50% after adjustment for pregnancy and postnatal factors, such as gestational age, alcohol drinking, smoking, breastfeeding, maternal mental health, attachment and parenting [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These studies suggest that predisposing or coinciding factors may result in behavioral problems in children from unintended pregnancies. The statistical design of these studies hamper causal interpretation, because of violating the exchangebility assumption due to adjustment for potential colliders (postnatal factors) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. We therefore applied G-estimation, that has the advantage to provide estimates under less restrictive identification conditions. Our results provided more solid evidence that hypothetically intervening on postnatal depression also reduced the association between (un)planned pregnancy and internalizing and externalizing problem behavior by 14\u0026ndash;36%.\u003c/p\u003e \u003cp\u003eOur findings suggest that preventing postnatal depression may be promising to reduce differences in behavior problems between children from intended versus unintended pregnancies, in particular when ambivalent feelings towards the pregnancy are present. Some studies have shown that mothers who had an unintended pregnancy more often suffered from postnatal depression [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A recent study also showed that ambivalent feelings towards the pregnancy were associated with psychological distress in mothers within the first year after childbirth [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, one of the strongest predictors for postnatal depression is prenatal depression [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Therefore, it is very important to screen and treat depressive symptoms already during pregnancy, particularly among unplanned pregnant women who experience ambivalent feelings. This may help to reduce disparities in child behavior later in life.\u003c/p\u003e \u003cp\u003eWe did not find evidence that high social support reduces differences in behavior problems between children from intended versus unintended pregnancies. This is surprising, because many studies provided evidence for an association between lack of social support and decreased maternal mental health [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In our study, postnatal depression and social support were slightly negatively correlated (r=-0.21), suggesting that receiving more social support may be associated with better maternal mental health. Only one recent study focused on the association between perceived social support of mothers and child behavior and found that social support during pregnancy was associated with less mental and behavioural disorders in Finnisch children from birth to the age of 10 [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In our study, however, social support was very weakly correlated with both unintended pregnancy as well as with problem behavior in children (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). One explanation may be that the Social Support List 12 \u0026ndash; Interactions (SSL12-I) was originally developed to measure social support in elderly, and may therefore be less applicable in our sample [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The social support needed after giving birth may include baby sitting or help with taking care of the child, which was not included in the SSL12-I.\u003c/p\u003e \u003cp\u003eStrengths of this study were the large sample size, the novel epidemiological design of the study and the longitudinal data which allowed us to study both short- and long-term differences in behavior problems between children from intended versus unintended pregnancies. Another strength of this study is that unintended pregnancy was measured using two questions; whether the pregnancy was planned; and how the women felt about the unplanned pregnancy. Previous studies were often limited by the use of either planned versus unplanned or wanted versus unwanted pregnancy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], while it is known that an unintended pregnancy is more complex than just unplanned or just unwanted [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlso, some limitations should be considered. The differences in behavior problems between intended vs. unintended pregnancies were smaller in the complete cases analyses than in the analyses of the full sample. This may indicate the presence of differential missing data by (un)intended pregnancies. Multiple imputation was used to ensure that all participants were included in the analysis to avoid attrition bias. We included all variables from the analyses, as well as many auxiliary variables in the imputation to minimize bias related to differential missingness [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In order to satisfy the exchangeability assumption, we adjusted for many covariates, including maternal and paternal lifetime psychopathology as a proxy for genetic vulnerability. However, unmeasured confounding of the intervention\u0026ndash;outcome model may have led to an overestimation of the change in problem behavior differences between intended and unintended pregnancies. This means that we measured the maximum impact these interventions could have in reducing the difference in child behavior in the main analysis. Finally, the complete case analyses showed less significant findings for the hypothetical intervention on postnatal depression than the analyses on the full sample. This may be explained by both the smaller sample size, and by the smaller difference of behavior problems between intended vs. unintended pregnancies prior to the hypothetical intervention.\u003c/p\u003e \u003cp\u003eIn conclusion, our study showed that children from unintended pregnancies may encounter more problem behavior than children from intended pregnancies. This difference was observed as early as 1.5 years, and continued to be observed for the next 12 years. Hypothetical preventive interventions targeting postnatal depression may reduce the differences in problem behavior at all ages and in this way combat intergenerational transmission of psychopathology. Therefore, it is important to identify and treat mental health problems of unplanned pregnant women, especially in those with ambivalent feelings, since this may reduce the development of child problem behavior from early childhood to adolescence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge the contribution of the Generation R children and parents, staff, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. We would like to thank Riekje Elema and Meike van \u0026lsquo;t Hof for sharing their knowledge about the program Not Pregnant Now.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe general design of Generation R Study is made possible by financial support from the Erasmus Medical Center and the Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development (ZonMW), the Netherlands Organisation for Scientific Research (NWO), the Ministry of Health, Welfare and Sport and the Ministry of Youth and Families. The current study was made possible by grants from the Netherlands Organization for Health Research and Development (ZonMw Unintended Pregnancy Research Program, grant number 554002008) and the Vital Cities and Citizens initiative. Hanan El Marroun was supported by the Stichting Volksbond Rotterdam, the Netherlands Organization for Scientific Research (NWO) Aspasia grant (No. 015.016.056), and the European Union\u0026apos;s Horizon 2020 Research and Innovation Program (HappyMums, Grant agreement 101057390). The funders had no role in the design and conduct of the study or the writing of the report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSedgh G, Singh S, Hussain R (2014) Intended and Unintended Pregnancies Worldwide in 2012 and Recent Trends. Stud Fam Plann 45(3):301\u0026ndash;314\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePicavet C (2012) Zwangerschap en anticonceptie in Nederland. Tijdschrift voor Seksuologie 36(2):121\u0026ndash;128\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrett G, Wellings K (2002) What is a 'planned' pregnancy? Empirical data from a British study. Soc Sci Med 55(4):545\u0026ndash;557\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarson C et al (2013) \u003cem\u003eEffects of pregnancy planning, fertility, and assisted reproductive treatment on child behavioral problems at 5 and 7 years: evidence from the Millennium Cohort Study.\u003c/em\u003e Fertility and Sterility, 99(2): p.\u0026nbsp;456\u0026ndash;463\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayatbakhsh MR et al (2011) A longitudinal study of child mental health and problem behaviours at 14years of age following unplanned pregnancy. Psychiatry Res 185(1):200\u0026ndash;204\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAxinn WG, Barber JS, Thornton A (1998) The long-term impact of parents' childbearing decisions on children's self-esteem. Demography 35(4):435\u0026ndash;443\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu JH (2017) Unintended birth and children\u0026rsquo;s long-term mental health. 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Eur J Epidemiol 31(12):1243\u0026ndash;1264\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eManual for the ASEBA preschool forms and profiles\u003c/em\u003e. Vol.\u0026nbsp;30. 2000: Burlington, VT: University of Vermont, Research center for children,youth \u0026amp;#8230\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAchenbach TM (2001) Manual for ASEBA school-age forms \u0026amp; profiles. University of Vermont, Research Center for Children, Youth \u0026amp; Families\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAchenbach TM et al (2011) Manual for the ASEBA brief problem monitor (BPM). ASEBA, Burlington, VT, p 33\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAchenbach TM (2001) Manual for the youth self-report and 2001 profile. University of Vermont, Burlington, VT\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J psychiatry 150(6):782\u0026ndash;786\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePop VJ, Komproe IH, Van Son MJ (1992) Characteristics of the Edinburgh post natal depression scale in The Netherlands. J Affect Disord 26(2):105\u0026ndash;110\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlom EA et al (2010) Perinatal complications increase the risk of postpartum depression. The Generation R Study. BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology 117(11):1390\u0026ndash;1398\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurray L, Carothers AD (1990) The validation of the Edinburgh Post-natal Depression Scale on a community sample. Br J Psychiatry 157(2):288\u0026ndash;290\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKempen G, Van Eijk LM (1995) The psychometric properties of the SSL12-I, a short scale for measuring social support in the elderly. Soc Indic Res 35(3):303\u0026ndash;312\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eHet meten van de sociale steun met de sociale steunlijst-interacties (SSL-I) en sociale steunlijst-discrepanties (SSL-D): een handleiding\u003c/em\u003e. 1993: Noordelijk Centrum voor Gezondheidsvraagstukken (NCGv), Rijksuniversiteit\u0026amp;#8230\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarneiro A, Dias P, Soares I (2016) Risk Factors for Internalizing and Externalizing Problems in the Preschool Years: Systematic Literature Review Based on the Child Behavior Checklist 1\u0026frac12;\u0026ndash;5. J Child Fam stud 25(10):2941\u0026ndash;2953\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuintivano J, Manuck T, Meltzer-Brody S (2018) Predictors of Postpartum Depression: A Comprehensive Review of the Last Decade of Evidence. Clin Obstet Gynecol 61(3):591\u0026ndash;603\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePentecost R, Latendresse G, Smid M (2021) Scoping Review of the Associations Between Perinatal Substance Use and Perinatal Depression and Anxiety. J Obstetric Gynecologic Neonatal Nurs 50(4):382\u0026ndash;391\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Marroun H et al (2012) Post-term birth and the risk of behavioural and emotional problems in early childhood. Int J Epidemiol 41(3):773\u0026ndash;781\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Buuren S (2011) Groothuis-Oudshoorn, \u003cem\u003emice: Multivariate Imputation by Chained Equations in R\u003c/em\u003e. J Stat Softw 45(3):1\u0026ndash;67\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustin PC et al (2021) Missing data in clinical research: a tutorial on multiple imputation. Can J Cardiol 37(9):1322\u0026ndash;1331\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Ginkel JR et al (2020) Rebutting Existing Misconceptions About Multiple Imputation as a Method for Handling Missing Data. J Pers Assess 102(3):297\u0026ndash;308\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaimi AI, Cole SR, Kennedy EH (2017) An introduction to g methods. Int J Epidemiol 46(2):756\u0026ndash;762\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVansteelandt S (2009) \u003cem\u003eEstimating direct effects in cohort and case\u0026ndash;control studies\u003c/em\u003e. Epidemiology, : p. 851\u0026ndash;860\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoden JM, Fergusson DM, Horwood LJ (2015) Outcomes for Children and Families Following Unplanned Pregnancy: Findings from a Longitudinal Birth Cohort. Child Indic Res 8(2):389\u0026ndash;402\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026rsquo;Souza S et al (2019) Persistence and change in behavioural problems during early childhood. BMC Pediatr 19(1):259\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacKinnon DP, Lamp SJ (2021) A Unification of Mediator, Confounder, and Collider Effects. Prev Sci 22(8):1185\u0026ndash;1193\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbajobir AA et al (2016) A systematic review and meta-analysis of the association between unintended pregnancy and perinatal depression. J Affect Disord 192:56\u0026ndash;63\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiu X et al (2020) Unintended pregnancy and postpartum depression: A meta-analysis of cohort and case-control studies. J Psychosom Res 138:110259\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTokuda N et al (2023) Analyzing the relationship between feelings about pregnancy and mother-infant bonding with the onset of maternal psychological distress after childbirth: The Japan Environment and Children's Study. J Affect Disord 329:531\u0026ndash;538\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHutchens BF, Kearney J (2020) Risk Factors for Postpartum Depression: An Umbrella Review. J Midwifery Women's Health 65(1):96\u0026ndash;108\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBedaso A et al (2021) The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reproductive Health 18(1):162\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026auml;hdepuro A et al (2023) Positive maternal mental health during pregnancy and mental and behavioral disorders in children: A prospective pregnancy cohort study. J Child Psychol Psychiatry 64(5):807\u0026ndash;816\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantelli J et al (2003) The Measurement and Meaning of Unintended Pregnancy. Perspect Sex Reprod Health 35(2):94\u0026ndash;101\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: General characteristics of the pregnant mothers.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"bottom\"\u003e\n \u003cp\u003ePlanned pregnancy\u003c/p\u003e\n \u003cp\u003e(N=5729)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003eUnplanned and wanted from the start\u003c/p\u003e\n \u003cp\u003e(N=1163)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"bottom\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent feelings\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=850)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent feelings\u003c/p\u003e\n \u003cp\u003e(N=114)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003eMissing data on pregnancy intention (N=1765)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge mother\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e30.79 (4.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e27.95 (5.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e27.22 (5.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e28.95 (6.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e29.73 (5.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e5729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1765\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e3116 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e368 (32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e262 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e43 (38.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e378 (51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e2130 (38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e418 (37.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e227 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e22 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e207 (28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e358 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e335 (29.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e332 (40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e47 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e150 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e5604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e735\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMigration background\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e3343 (58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e423 (36.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e235 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e30 (26.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e450 (39.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e2338 (41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e722 (63.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e603 (72.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e83 (73.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e693 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e5681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level mother\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e1160 (20.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e397 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e359 (44.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e46 (42.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e268 (33.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mid-Low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e1601 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e408 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e297 (36.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e30 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e238 (29.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mid-High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e1192 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e181 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e94 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e14 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e149 (18.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e1603 (28.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e126 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e61 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e19 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e147 (18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e5556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e811\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e802\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold income\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e520 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e269 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e263 (46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e48 (52.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e258 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Medium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e710 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e189 (23.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e143 (25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e22 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e151 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e3143 (71.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e355 (43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e156 (27.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e21 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e320 (43.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e4373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e3197 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e695 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e463 (56.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e45 (40.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e678 (46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e1825 (32.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e307 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e180 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e34 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e451 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e467 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e113 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e138 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e21 (18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e230 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e107 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e31 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e45 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e11 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e90 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.306122448979592%\" valign=\"top\"\u003e\n \u003cp\u003e5596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1449\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eHighest attained educational level, categorized as: Low (primary school; lower vocational training; intermediate general school; 3 years general secondary school), which typically corresponds to \u0026le;12 years of education; Mid‐low (\u0026gt;3 years general secondary school; intermediate vocational training; 1st year higher vocational training), in general corresponding with 13\u0026ndash;15 years of education; Mid‐high (higher vocational training; Bachelor\u0026apos;s degree), typically matching with 16 or 17 years of education; And High (higher academic education; PhD), usually indicating 18 years of education or more.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Categorized as: Less than \u0026euro;1200/month (social security level); Between \u0026euro;1200 and \u0026euro;2000/month; and More than \u0026euro;2000/month (modal income).\u003c/p\u003e\n\u003cp\u003ePregnancy intention data was missing for n=1765 participants.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Changes in behavior differences by a hypothetical intervention on postnatal depression.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInternalizing behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExternalizing behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith postnatal depression intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReduction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith postnatal depression intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReduction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 1.5 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.19 (0.13; 0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.10; 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.03 (7.5\u003csup\u003ee-4\u003c/sup\u003e; 0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.09-0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (0.07; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-4.6\u003csup\u003ee-3\u003c/sup\u003e; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.33 (0.25; 0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.25 (0.18; 0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.08 (0.03; 0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.16-0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.19 (0.12; 0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.04 (2.2\u003csup\u003ee-3\u003c/sup\u003e; 0.08)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.50 (0.30; 0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.36 (0.17; 0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 (-0.02; 0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.39 (0.22-0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.29 (0.09; 0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.11 (-0.03; 0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 3 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (0.11; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 (0.09; 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-0.01; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.10-0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 (0.08; 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-0.01; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.25 (0.18; 0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.21 (0.14; 0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.04 (1.2\u003csup\u003ee-3\u003c/sup\u003e; 0.09)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.16-0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.19 (0.12; 0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.04 (-3.1\u003csup\u003ee-3\u003c/sup\u003e; 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.67 (0.46; 0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.57 (0.35; 0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.10 (-0.07; 0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.59 (0.40-0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.50 (0.39; 0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 (-0.06; 0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 6 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (0.08; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.11 (0.05; 0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-0.01; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (0.10; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 (0.08; 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-0.01; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.16; 0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.09; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.07 (0.03; 0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.20 (0.13; 0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.08; 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.06 (0.02; 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.29 (0.10; 0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.17 (0.01; 0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (-0.03; 0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.34 (0.15; 0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.05; 0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.10 (-0.05; 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 9 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (0.06; 0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 (0.03; 0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.03 (-4.9\u003csup\u003ee-3\u003c/sup\u003e; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (0.07; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.11 (0.05; 0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-0.01; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.21 (0.14; 0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (0.08; 0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.05 (0.01; 0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.27 (0.20; 0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.16; 0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.04 (-4.2\u003csup\u003ee-3\u003c/sup\u003e; 0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.55 (0.34; 0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.39 (0.17; 0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (-0.01; 0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.50 (0.30; 0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.40 (0.18; 0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.10 (-0.06; 0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 13 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (0.08; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.11 (0.05; 0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-0.01; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (0.10; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (0.07; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (-0.01; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.22 (0.15; 0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (0.09; 0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.05 (0.01; 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.22 (0.15; 0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.19 (0.12; 0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.03 (-0.01; 0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.36 (0.18; 0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.24 (0.04; 0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (-0.02; 0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.38 (0.19; 0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.30 (0.09; 0.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.08 (-0.08; 0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDifference without the intervention: The absolute difference in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets.\u003c/p\u003e\n\u003cp\u003eDifference with the postnatal depression intervention: The absolute difference in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets after setting the intervention to \u0026lsquo;no postnatal depression\u0026rsquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReduction in difference: The absolute change from the difference without and with intervention in in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets.\u003c/p\u003e\n\u003cp\u003eThe 95% confidence intervals were calculated by bootstrapping with 1000 iterations.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Changes in behavior differences by a hypothetical intervention on social support.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInternalizing behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExternalizing behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith social support intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReduction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith social support intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReduction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 1.5 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.19 (0.13; 0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.17 (0.11; 0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.03; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.09-0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 (0.07; 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.04; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.33 (0.25; 0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.31 (0.22; 0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.05; 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.16-0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.24 (0.15; 0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e-0.01 (-0.07; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.50 (0.30; 0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.44 (0.18; 0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.06 (-0.15; 0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.39 (0.22-0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.41 (0.17; 0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e-0.02 (-0.21; 0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eyears\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (0.11; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.08; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.03; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.10-0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 (0.07; 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.03; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and\u0026nbsp;initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.25 (0.18; 0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.24 (0.16; 0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.05; 0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.16-0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.14; 0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.00 (-0.06; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.67 (0.46; 0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.66 (0.39; 0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.21; 0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.59 (0.40-0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.60 (0.34; 0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e-0.01 (0.19; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 6 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (0.08; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (0.05; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.03; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (0.10; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.08; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.04; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.16; 0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.22 (0.13; 0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.05; 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.20 (0.13; 0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.20 (0.11; 0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.00 (-0.06; 0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.29 (0.10; 0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.28 (0.03; 0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.19; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.34 (0.15; 0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.32 (0.08; 0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.19; 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 9 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (0.06; 0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (0.05; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.00 (-0.05; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (0.07; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.14 (0.07; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e-0.01 (-0.06; 0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.21 (0.14; 0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.21 (0.12; 0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.00 (-0.07; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.27 (0.20; 0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.27 (0.18; 0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.00 (-0.06; 0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.55 (0.34; 0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.52 (0.23; 0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.03 (-0.19; 0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.50 (0.30; 0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.51 (0.22; 0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e-0.01 (-0.24; 0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge 13 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and wanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.13 (0.08; 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.12 (0.05; 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.04; 0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.16 (0.10; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.08; 0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.00 (-0.05; 0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and initially ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.22 (0.15; 0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.21 (0.12; 0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.05; 0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.22 (0.15; 0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.21 (0.12; 0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.01 (-0.05; 0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eUnplanned and prolonged ambivalent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.36 (0.18; 0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.33 (0.07; 0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.03 (-0.17; 0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.38 (0.19; 0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.38 (0.11; 0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\" valign=\"top\"\u003e\n \u003cp\u003e0.00 (-0.22; 0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDifference without the intervention: The absolute difference in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets.\u003c/p\u003e\n\u003cp\u003eDifference with the social support intervention: The absolute difference in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets after setting the intervention to \u0026lsquo;sufficient social support\u0026rsquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReduction in difference: The absolute change from the difference without and with intervention in in internalizing and externalizing problem behaviour between the intention groups with planned pregnancy as reference and 95% confidence interval in between brackets.\u003c/p\u003e\n\u003cp\u003eThe 95% confidence intervals were calculated by bootstrapping with 1000 iterations.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"social-psychiatry-and-psychiatric-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sppe","sideBox":"Learn more about [Social Psychiatry and Psychiatric Epidemiology](http://link.springer.com/journal/127)","snPcode":"127","submissionUrl":"https://submission.nature.com/new-submission/127/3","title":"Social Psychiatry and Psychiatric Epidemiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Unintended Pregnancy, Postnatal Depression, Social Support, Problem Behavior, Hypothetical Intervention","lastPublishedDoi":"10.21203/rs.3.rs-3816656/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3816656/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives:\u003c/h2\u003e \u003cp\u003eTo 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.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eData from the Generation R Study were used, a population-based birth cohort in Rotterdam, the Netherlands (N\u0026thinsp;=\u0026thinsp;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 \u0026lsquo;no postnatal depression\u0026rsquo; or \u0026lsquo;high social support\u0026rsquo;.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eMost 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.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eChildren 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.\u003c/p\u003e","manuscriptTitle":"Reducing behavior problems in children born after an unintended pregnancy: A hypothetical intervention study in the population-based Generation R cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-03 15:00:53","doi":"10.21203/rs.3.rs-3816656/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-14T18:36:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-10T17:00:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-04T13:23:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6d683e53-efa4-49ee-b99c-b3247cdf07b1","date":"2024-02-17T10:31:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52916c7a-0f8e-476b-86b8-4b0e34889bb2","date":"2024-02-16T15:30:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-01-22T14:59:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-12-30T15:04:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-12-29T14:58:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Social Psychiatry and Psychiatric Epidemiology","date":"2023-12-28T12:27:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"social-psychiatry-and-psychiatric-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sppe","sideBox":"Learn more about [Social Psychiatry and Psychiatric Epidemiology](http://link.springer.com/journal/127)","snPcode":"127","submissionUrl":"https://submission.nature.com/new-submission/127/3","title":"Social Psychiatry and Psychiatric Epidemiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2196b9f9-15ab-4dbc-ab63-805c73f108e4","owner":[],"postedDate":"January 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-17T22:38:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-03 15:00:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3816656","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3816656","identity":"rs-3816656","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}