Environmental exposures, pregnancy intention, and behavioral choice

Background: Adverse birth outcomes are associated with unwanted pregnancies (UWP) and exposure to environmental contaminants. Maternal behavioral choices affect exposures and may be affected by pregnancy intention. Objective: Examine associations between environmental exposures and behavioral choices among women in different pregnancy intention categories. Methods: We examine how pregnancy intention impacts prenatal behavior and among 1518 women (1188 non-Hispanic black; 330 non Hispanic white; oversampling of NHB intended) enrolled in a prospective cohort study. Psychosocial and behavioral correlates were obtained through prenatal surveys; pregnancy outcomes were collected from medical records. Environmental contaminants were measured in maternal blood samples collected at delivery. Multivariable, multinomial analyses were run controlling for demographics. Results: Behavioral choices varied with pregnancy intention. UWP were more likely to report smoking (28%, 19%, 13%, UWP, Mistimed, Wanted, respectively, p<.001) and were at higher odds of being exposed to ETS (OR = 1.72, 95% CI (1.1, 2.8)) than women with wanted pregnancies. UWP were more likely to report a history of drug use (OR = 1.9, 95% CI (1.1, 3.4)) that continued during pregnancy (p<.01). Women with wanted pregnancies were more likely to have detectable mercury (ng/mL), indicating they consumed more fish prenatally (p<.01). Conclusions: Pregnancy intention was strongly correlated with behavioral choices linked to environmental exposures related to birth outcomes. We speculate that the exposures interact with the social environment and maternal health. The combination of an increased likelihood of exposure to environmental contaminants, an at-risk profile, and an unintended pregnancy may jeopardize maternal and infant health.