title: Exploring health by reproductive status: an epidemiological analysis of preconception health.
abstract: BACKGROUND
  Recently published preconception health guidelines promote maternal health, yet adherence to those guidelines has not been documented. We hypothesized that pregnant women engaged in a healthier lifestyle than nonpregnant women, although this may vary by pregnancy intention and birth control method.
  
  
  METHODS
  We performed secondary analysis of cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) (2002 and 2004 datasets). The data are collected in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam through a telephone survey of 350,000 adults annually. Subjects were a representative sample of noninstitutionalized, 18-44-year-old, fertile women (n = 66,152). Based on pregnancy risk, women were grouped into one of five categories: pregnant, intending pregnancy (IP), unintended pregnancy high risk (HR), moderate risk (MR), and low risk (LR). Logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI) for behavioral characteristics using pregnant women as the referent group.
  
  
  RESULTS
  IP, HR, MR, and LR women were more likely to drink any alcohol (aPOR 10.85, aPOR 8.39, aPOR 11.90, aPOR 11.98, respectively), binge drink (aPOR 7.07, aPOR 6.24, aPOR 7.27, aPOR 7.17, respectively), heavy drink (aPOR 6.90, aPOR 5.67, aPOR 7.48, aPOR 5.89, respectively), and smoke (aPOR 2.89, aPOR 2.69, aPOR 2.40, aPOR 2.09, respectively). Interestingly, IP, HR, MR, and LR women were more likely to engage in leisure activity (aPOR 1.37, aPOR 1.19, aPOR 1.57, aPOR 1.17, respectively). HR, MR, and LR women were less likely to consume folic acid (aPOR 0.14, aPOR 0.21, aPOR 0.29, respectively), whereas women intending a pregnancy were equally likely to consume folic acid (aPOR 0.77 CI 0.30, 2.0), although the response rate for folic acid was low.
  
  
  CONCLUSIONS
  Preconceptional health goals are not being met. Pregnancy risk, as delineated by contraceptive use, can inform interventions designed to prevent adversely exposed pregnancies.
authors.affiliation: Family and Community Medicine, St. Louis University School of Medicine, St. Louis, MO 63104, USA. pxaveriu@slu.edu
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Xaverius
authors.forename: Leigh E
authors.initials: LE
authors.lastname: Tenkku
authors.forename: Joanne
authors.initials: J
authors.lastname: Salas
authors.forename: Daniel
authors.initials: D
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D004219:District of Columbia; D005260:Female; D006141:Guam; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008019:Life Style; D017410:Practice Guidelines as Topic; D016742:Preconception Care; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D015995:Prevalence; D011647:Puerto Rico; D043762:Reproductive Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012309:Risk-Taking; D014481:United States; D014767:United States Virgin Islands; D016387:Women's Health; D055815:Young Adult