Are pregnancy feelings associated with less than adequate prenatal care utilization?

Background: Prenatal care services are generally available to women in Minnesota, but about one-third receives late, or fewer than recommended, visits. While logistical barriers to care are understood, attitudinal barriers are studied less often. We examined the associations of pregnancy happiness and intention with prenatal care adequacy. Methods: We examined data from 6,097 women who participated in Minnesota's Pregnancy Risk Assessment Monitoring System survey in 2002-2005. Women were surveyed, by telephone or mail, between 2-6 months after they delivered a live infant. We conducted weighted multivariate logistic regression to examine the associations between pregnancy happiness and pregnancy intention with less than adequate prenatal care (i.e., intermediate, inadequate, or no care, per Kotelchuck's index). Results: Thirty-four percent of women reported less than adequate prenatal care. Happiness about pregnancy and intended pregnancy were significantly associated with many known demographic, health, and behavioral correlates of prenatal care adequacy. Women who are defined as “high risk” for poor care in the literature were most likely to report unintended pregnancies and pregnancies about which they were unhappy. In adjusted analyses, pregnancy unhappiness was not associated with less than adequate care, but women who reported unintended pregnancies were 1.3 times more likely to report inadequate care. Conclusions: We found that unintended pregnancies and negative pregnancy feelings were highest among demographically high risk women and it appears that pregnancy intention adds to their risk of less than adequate prenatal care.