Orr, S. T., James, S. A., & Reiter, J. P. (2008). Annals of Epidemiology, 18, 545-551.
Women's behaviors during pregnancy have been shown to affect the outcome of pregnancy. Previous studies suggested that intendedness of pregnancy is associated with maternal behaviors during pregnancy, although interpretation of results is limited by the retrospective or cross-sectional designs of these studies. These investigators undertook a prospective study to examine the relationship between intendedness of pregnancy and harmful maternal behaviors using a sample of 913 black women in Baltimore, Maryland. Women were enrolled in the study at their first prenatal visit and were asked whether they wanted to be pregnant sooner or now (labeled intended or wanted pregnancy), wanted to be pregnant later (labeled mistimed pregnancy), or did not want to be pregnant now or at any time in the future (labeled unwanted pregnancy).
Data on behavioral risk factors were abstracted from the health records and included results of urine screening for drug use. Eleven percent of women indicated that they had experienced an unwanted pregnancy (n=97). The use of alcohol, drugs, and smoking was significantly greater among women with unwanted pregnancies compared to those with mistimed or wanted pregnancies. For example, 20% of women with unwanted pregnancies used alcohol compared with 4% with mistimed pregnancies; 33% used illicit drugs compared to 10% with mistimed pregnancies, and 47% smoked cigarettes compared to 15% with mistimed pregnancies. Among women with unwanted pregnancies, 45% initiated prenatal care during the third trimester, which was significantly higher than women with wanted (8.3%) or mistimed pregnancies (14.6%). These results suggest that facilitating wanted pregnancies could lead to enhanced pregnancy outcomes. Nurses need to provide a range of health-promoting services to women of reproductive age to prevent unwanted pregnancy, including access to effective contraception. Strategies to enhance early initiation of prenatal care are also needed to ensure that harmful behaviors of women are addressed in a timely manner.
Commentary by
Maureen Heaman