Factors Associated with Rapid Repeat Pregnancy: A Study of Young Low-Income African American Mothers

Background and Purpose:  Having a subsequent pregnancy soon after giving birth is common among adolescent mothers and can contribute to poor infant and maternal outcomes.  Several factors are known to prevent rapid repeat pregnancies, such as use of long-acting reversible contraceptives (LARC), but little is known about how the mother’s experience of parenting and involvement in an intervention focused primarily on parenting, rather than pregnancy prevention, might also impact the likelihood of a repeat pregnancy.  This study examined whether a doula home-visiting parenting intervention and various social, psychological, and parenting factors were related to rapid repeat pregnancy in young, low income mothers.

Methods: Pregnant women (n=248) were recruited from prenatal clinics affiliated with an urban university hospital and randomly assigned to receive either community doula services or routine prenatal care.  Doulas provided home visitation prenatally and for 3 months postpartum, and provided support during childbirth. Home visits focused on the mother-infant relationship, maternal and child health, preparation for childbirth, and early parenting. Mothers were African American, 14 to 21 years old (M=18.3) at the birth, and 94% received Medicaid.  Of the original sample, 184 women were first-time mothers and completed interviews during pregnancy and at 4 and 12 months postpartum.  During interviews, mothers reported on pregnancy intentions, relationships, mental health, contraception, feelings about motherhood, and subsequent pregnancies.  Logistic regression was used to examine predictors of repeat pregnancy within the first postpartum year.

Results:  27% (n=49) of mothers became pregnant again within 12 months of giving birth to their first child. At 4 months postpartum, 44% (n=81) of mothers reported using LARC.  Logistic regression analyses showed that use of LARC was associated with a lower chance of rapid repeat pregnancy (OR=0.25, 95% CI .10 .58).  However, among mothers who were not using LARC, those receiving the doula intervention had a lower chance of subsequent pregnancy in the first year compared to control group mothers (OR=0.32, 95% CI [0.13, 0.82).  Intention to become pregnant with the first child (OR=3.62, 95% CI [1.18, 11.19]) and history of conduct problems (OR=2.92, 95% CI [1.25, 6.78]) were also related to a greater chance of repeat pregnancy, whereas mothers who gave complex, richer descriptions of their transition to motherhood had a lower chance (OR=0.65, 95% CI [0.42, 1.00]).  The mother’s relationship with the father of the baby and support from her parent were not significantly related to repeat pregnancy.

Conclusions and Implications: The current findings support previous work showing that LARC and pregnancy intentions are strong predictors of rapid repeat pregnancy in adolescents, but this study demonstrates that interventions designed to support young mothers during the transition to parenthood may also delay subsequent pregnancy.  Additionally, our finding that mothers who could reflect deeply about becoming a mother were more likely to delay indicates that early parenting experiences may impact future childbearing decisions. Public-health social work interventions for pregnant and parenting adolescents should include support for the developing mother-infant relationship and help mothers focus on their child and parenthood as one avenue to prevent rapid repeat pregnancies.