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

Conclusions

In this study of non-pregnant women from a populationbased cohort of reproductive-age women in Central Pennsylvania, we found no associations between intention for future pregnancy and seven longitudinal health behaviors that may impact pregnancy outcomes in adjusted analyses. These findings differ from data based on retrospective reports which have suggested that women with intended pregnancies report healthier preconception behaviors[3–5] and one cross-sectional study where non-pregnant women intending future pregnancy report healthier behaviors.[6] By using longitudinal data to measure health behaviors, the likelihood of recall bias encountered in retrospective studies is reduced.

Not surprisingly, incident pregnancy was associated with greater folic acid supplementation and reduced binge drinking. It is possible that these favorable changes in behavior did not occur until the pregnancy was recognized, which may be too late for greatest benefit. Of concern, incident pregnancy was not associated with positive longitudinal smoking behavior in our sample. Certainly young women should be a focus of preconception health messaging, since the youngest age group (18–24 years) was less likely to have positive longitudinal behaviors in terms of binge drinking and smoking. It is also of interest that receiving counseling on related health topics did not positively impact longitudinal health behaviors, providing additional evidence that brief counseling in the setting of a health care visit may not be adequate to effectively change the preconception health behaviors studied here.

The findings in this study are worth noting for several reasons. Since women in this sample who intend pregnancy were more likely to become pregnant than those not intending pregnancy,[7] this is a relevant sample to study in terms of health behaviors that are related to future pregnancy. There are a number of unanswered questions, however. For example, what does a woman mean when she states she is considering a future pregnancy? Are there concomitant changes in behavior? There is likely some change in behavior (e.g., frequency of sexual intercourse, birth control use) that results in increased likelihood of pregnancy, but does intent lead to other behavioral changes as well? From these results, intent does not seem to be correlated with a change in health behaviors that may impact pregnancy outcomes. These findings support the need for promotion of better preconception care, as has been recommended by the CDC.[1] Further work is needed to evaluate what women know about preconception health behaviors and what interventions may be effective in producing behavioral change in the preconception period.

Our study has several limitations. Report of health behaviors were collected at two time points: the baseline and 2-year follow-up surveys. We use the data from these two time points to represent health behaviors during the 2 year period, but we do not actually know if the behaviors reported were sustained throughout the study period, or if there was a change in behavior, when that change may have occurred. We use self-reported data which may result in women reporting more socially desirable behaviors, although the percentages reporting unhealthy behaviors in this sample are similar to or higher than other samples.

Although our sample was highly representative of the target Central Pennsylvania population, this population is largely non-Hispanic white and does not include adolescents. Therefore, our findings may not be representative of more diverse populations.

In summary, our study confirms the need for improved preconception health promotion. We did not see evidence that women intending pregnancy were more likely to engage in positive longitudinal health behaviors. Policy makers, researchers, and health care providers should further investigate methods for effectively translating preconception health recommendations into clinical care and practice as this represents an area of great potential for improvement of pregnancy outcomes.

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