Preconception: Who's at Risk for Pregnancy?

Background: A paucity of research has documented the extent to which women adhere to preconceptional health guidelines for women at risk of becoming pregnant. We hypothesized that factors related to life style choices and clinical practices are associated with pregnancy intention and risk status.

Methods: Using the Behavioral Risk Factor Surveillance System (BRFSS) 2002 and 2004 datasets, we examined risk factors of non-pregnant, 18-44 year old, fertile women (n=62,154), sorting their risk for pregnancy by intention. Risk was sorted by intended pregnancy (n=4,862), unintended high-risk (n=16,113), unintended average-risk (n= 18,183), and unintended low-risk (n= 21,243). Logistic regression was used to estimate prevalence odds ratios (POR) and 95% confidence intervals (CI) for a variety of lifestyle and screening factors.

Results: The referent group included White, non-Hispanic women, aged 21-34, high school graduates, with an income greater than $35,000 and health insurance. Women in the high-risk group were least likely to exercise (adjusted [aPOR], 0.76, 95% CI 0.65, 0.89), take folic acid (aPOR, 0.33, 95% CI 0.13, 0.83) receive treatment for a sexually transmitted disease (STD) (aPOR, 0.56, 95% CI 0.47, 0.66) and use alcohol (aPOR, 0.70, 95% CI 0.62, 0.80). Interestingly, women intending pregnancy received significantly less STD treatment (aPOR, 0.74, 95% CI 0.59, 0.94) while low-risk women received significantly higher rates of STD treatment (aPOR, 1.24, 95% CI 1.07 1.44).

Conclusion: These findings support the hypothesis that preconceptional health goals are not being met and that health status differs by pregnancy intention or risk for an unintended pregnancy.