Timing of Pregnancy Recognition in the United States: A Scoping Review.

PURPOSE: Health care provided during pregnancy is often time bound. However, much of pregnancy research is conducted among participants who identify themselves as being pregnant or focuses on time to pregnancy among those trying to conceive, overlooking the experience of coming to recognize one's pregnancy. We aimed to scope what is known in the literature about the timing of pregnancy recognition in the United States and the factors associated with it. METHODS: A scoping review was conducted according to the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Medline, CINAHL, and Embase were searched for peer-reviewed articles published after 2000 reporting an outcome related to the timing of pregnancy recognition or associated factors in the United States. Search results were uploaded to Covidence for review management. RESULTS: The search identified 2,093 studies, of which 30 met the inclusion criteria. Across the included literature, the average gestational duration at which pregnancies were recognized ranged from 4.0 to 6.3 weeks. Studies identified several associations with the timing of pregnancy recognition, including pregnancy intention, perceived risk of pregnancy, pregnancy-related knowledge, previous pregnancy experiences, pregnancy signs and symptoms, access to confirmation technologies, and comorbidities. Sociodemographic characteristics including age, race and ethnicity, relationship status, and financial resources may further shape the timing of pregnancy recognition. CONCLUSION: This scoping review highlights the considerable variation in when pregnant people in the United States first identify their pregnancy and associated factors. The variations in pregnancy recognition timing found in this scoping review have subsequent implications for disparities in pregnancy care, both for pregnancies ending in termination and those continuing to birth.