Pregnancy Intention and Health Behaviors: Results from the Central Pennsylvania Women's Health Study Cohort

Cynthia H. Chuang; Carol S. Weisman; Marianne M. Hillemeier; Eleanor Bimla Schwarz; Fabian T. Camacho; Anne-Marie Dyer

Disclosures

Matern Child Health J. ;14(4):501-510. 

In This Article

Abstract and Introduction

Abstract

Objective Our objective was to determine whether intention for future pregnancy affects selected preconception health behaviors that may impact pregnancy outcomes.
Methods Analyses are based on data from a population-based cohort study of women ages 18–45 residing in Central Pennsylvania. A subsample of 847 nonpregnant women with reproductive capacity comprise the analytic sample. We determined the associations between intention for future pregnancy and the pattern in the following health behaviors over a 2-year period: nutrition (fruit and vegetable consumption), folic acid supplementation, physical activity, binge drinking, smoking, and vaginal douching. Multivariable analyses controlled for pregnancy-related variables, health status, health care utilization, and sociodemographic variables.
Results At baseline, 9% of women were considering pregnancy in the next year, 37% of women were considering pregnancy some other time in the future, and 53% of women were not considering future pregnancy. In multivariable analyses, there were no associations between intention for future pregnancy and maintaining healthy behavior or improving behavior for any of the seven longitudinal health behaviors studied.
Conclusions The importance of nutrition, folic acid supplementation, physical activity, avoiding binge drinking, not smoking, and avoiding vaginal douching in the preconception period needs to be emphasized by health care providers and policy makers.

Introduction

Health-related behaviors prior to conception impact pregnancy outcomes; this has been a major impetus behind the promotion of preconception care. The Centers for Disease Control (CDC) has defined preconception care as "set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management".[1] While women are likely to adopt healthier behaviors after pregnancy is recognized,[2] waiting until a pregnancy is identified to improve health behaviors may be too late to reduce some adverse birth outcomes.

Research is limited on whether women who intend to become pregnant adopt healthier preconception behaviors. While some research shows high prevalence of unhealthy behaviors in the preconception period,[2] there is also evidence that women with intended pregnancies are more likely to engage in health promoting behaviors prior to conception, such as smoking reduction, folic acid supplementation, and less binge drinking.[3–5] These were studies of women who were pregnant or post-partum; thus, report of both intent for pregnancy and preconception health behaviors was assessed retrospectively and is subject to recall bias. A study of non-pregnant women by Green-Raleigh et al. investigated the association between pregnancy planning status and health behaviors in a cross-sectional telephone survey of women enrolled in a staff-model HMO in California. Compared with women not planning pregnancy, women planning pregnancy within the next year were more likely to report some healthier behaviors (less smoking, more regular multivitamin use, more likely to have a health care visit in the past year), but there was no difference in alcohol use.[6] Their study was unique in that it collected intention and behavior data before conception, rather than retrospectively. However, it is unclear whether these findings truly reflect that women intending their pregnancies are actively improving their health prior to conception, or whether women who are more likely to have intended pregnancies are also more likely to have healthier behaviors to begin with. These uncertainties can be better clarified if intention status and health behaviors are measured prospectively and longitudinally.

Using a unique longitudinal data set, we examined whether pregnancy intention measured at baseline predicted maintenance of healthy behaviors or improved health behaviors during a 2-year follow-up period. Previous research using this data source found that baseline pregnancy intention was strongly associated with incident pregnancy during the follow-up period,[7] suggesting that women intending future pregnancy at baseline might be motivated to engage in healthier behaviors in order to improve their pregnancy experiences and outcomes. We hypothesize that among non-pregnant women, intention for future pregnancy will be associated with healthier longitudinal behaviors, such as fruit and vegetable intake, physical activity, folic acid supplementation, reduced binge drinking, tobacco abstinence, and avoidance of vaginal douching.

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