Preconception Wellness: Differences in Health by Immigrant Status

Background: A number of studies have documented disparities in health between immigrants and non-immigrants in the United States. We hypothesized that these disparities generalized to lifestyle behaviors during the preconception period of pregnant and non-pregnant women.

Methods: Using the National Health and Nutrition Examination Survey (NHANES) (1999-2004 datasets), we examined health factors of pregnant and non-pregnant, 20-44 year old women (n=3343). Women were sorted by immigrant and pregnancy status: pregnant non-immigrant (i.e., P-NI=596), pregnant immigrant (P-I=230), non-pregnant non-immigrant (NP-NI=1,898), and non-pregnant immigrant (NP-I=619). Logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI) for lifestyle factors.

Results: P-NI women comprised the referent group, as prevalence odds ratios were adjusted for social indicators including health insurance status, age, race, medical conditions, housing characteristics, and acculturation. NP-NI women were more likely to report using alcohol (aPOR, 2.76 95% CI 1.5, 5.10; aPOR), smoking (aPOR, 7.6 95% CI 2.5, 23.2), vigorous physical activity (aPOR, 2.5 95% CI 1.2, 5.3), and less likely to have above-normal folic acid levels (aPOR, 0.3 95% CI 0.2, 0.5). In contrast, immigrant women, regardless of pregnancy status, were no more likely to use alcohol, smoke, exercise or have normal levels of folic acid levels than P-NI women.

Conclusion: These findings support the hypothesis that preconceptional health goals are not being met, that they differ by immigrant status, and that they are influenced by social indicators.