Attitudes and Decision-making After Pregnancy Testing Study

The ADAPT Study is a longitudinal observational cohort study. The study has four components,
each corresponding to a study aim: 1) Underlying Cohort (Aim 1); 2) Pregnancy and Match
Cohort, Study A (Aim 2); 3) Pregnancy and Match Cohort, Study B1 (Aim 3a); and 4) Pregnancy
and Match Cohort, Study B2 (Aim 3b).

This ADAPT study will recruit an "Underlying Cohort" (UC) of approximately 2,200 English or
Spanish-speaking women, ages 15-34, who are not pregnant (or are terminating a pregnancy) and
who are seeking care at designated primary and reproductive health care facilities in four
states (see Eligibility Criteria). Participants will be followed up to a year as a part of
the UC. At the UC baseline and follow-up surveys conducted every 6 weeks, participants will
complete a psychometrically validated measure of prospective preferences and feelings about a
potential pregnancy, the Desire to Avoid Pregnancy (DAP) scale. Analyses of UC data will
examine the degree to which DAP scores change over time, as well as the relationships between
DAP score and contraceptive use, pregnancy, feelings about incident pregnancies after they
occur, collected at follow-up surveys.

Participants experiencing new pregnancies during the one-year UC will be transferred into a
new cohort, the Pregnancy and Match Cohort (PMC), and will be followed for two years. In the
PMC, participants will complete 8 surveys at: PMC baseline (right after reporting a new
pregnancy), 6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months.
Surveys will capture the pregnancy options participants consider (raising child, abortion,
adoption), health care and services participants seek (prenatal, abortion, adoption),
services obtained and pregnancy outcome. Analyses will examine the factors influencing
decision-making and ability to obtain desired care/services, including state sociopolitical
environment around reproductive health.

PMC participants will also be a part of PMC-Study B1, in which they will be followed through
the course of their pregnancies and childbirth to investigate health, well-being, and
socioeconomic outcomes. All PMC surveys will include measures of stress and mental health;
well-being; socioeconomics and employment; educational goals and attainment; alcohol, tobacco
and drug use; physical health; and intimate partner violence so that individual trajectories
of these outcomes will be available over time. Surveys administered after the birth of a
child will also assess birth, maternal and child outcomes, including prematurity, low birth
weight, breast-feeding, post-partum depression, maternal bonding, and child development.
Study B1 will investigate how these outcomes differ based on the woman's prospective
preference about the pregnancy, as well as her attitudes and feelings about it upon
discovery. Analyses will compare outcomes among women giving birth by pregnancy preferences
level; separately, analyses will also include the women who experienced miscarriage or
terminated pregnancies. The hypothesis is that women with higher DAP scores will experience
poorer outcomes after pregnancy and birth than those with higher DAP scores.

Finally, PMC-Study B2 will examine the effect of pregnancy itself on health and well-being
outcomes. Throughout the UC as new pregnancies occur, a cohort, frequency matched on
pregnancy preference score and time at risk of pregnancy, will also be followed as part of
the PMC. Non-pregnant matches who experience pregnancy within a year of enrollment will
themselves enter the pregnancy cohort and be assigned a non-pregnant match for the remainder
of their time in the PMC. Analyses will compare the health, well-being, and socioeconomic
outcomes of women with new pregnancies (and, separately, new births) to those the
non-pregnant group to assess the effect of pregnancy itself on women. Analyses will account
for the interaction between pregnancy preferences and pregnancy. The hypothesis is that
experiencing a less preferred pregnancy (higher DAP score) will result in poorer health
outcomes than avoiding a less preferred pregnancy.

Research activities will be conducted and coordinated by trained University of California,
San Francisco (UCSF) research associates. Staff members at recruitment sites will not be
engaged in the research. Data collection will involve completing confidential
self-administered surveys using secure electronic systems (i.e., Qualtrics) or phone
interviews over the course of the study. Participants will be followed for up to one year in
the UC; those who transfer to the PMC will be followed for between 2-3 years overall.
Participants will be remunerated with gift cards after each survey.

Inclusion Criteria:

- Aged 15 to 34

- Is presenting for services at the participating recruitment site

- Speaks and reads English or Spanish

- Sexually active (has had sex in the last 3 months with a man/someone with sperm)

- Has a uterus (assigned female at birth)

- Resides in a study state or one directly bordering a study state

- Has access to a phone, internet, or smartphone

- Willing to be contacted by research team for 1-3 years by phone and either email or
mail

Exclusion Criteria:

- Reports current pregnancy (unless having or initiating an abortion on the day of
enrollment)

- Is sterilized or using an intrauterine device or transdermal implant at enrollment