title: Racial and ethnic disparities in preconception risk factors and preconception care.
abstract: OBJECTIVE
  At-risk drinking, cigarette smoking, obesity, diabetes, and frequent mental distress, as well as their co-occurrence in childbearing aged women, are risk factors for adverse pregnancy outcomes. This study estimated the prevalence of these five risk factors individually and in combination among nonpregnant women aged 18-44 years by demographic and psychosocial characteristics, with a focus on racial and ethnic disparities.
  
  
  METHODS
  Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) on nonpregnant women aged 18-44 years (n=54,612) were used to estimate the prevalences of five risk factors, pairs of co-occurring risk factors, and multiple risk factors for poor pregnancy outcomes.
  
  
  RESULTS
  The majority of women had at least one risk factor, and 18.7% had two or more risk factors. Having two or more risk factors was highest among women who were American Indian and Alaska Native (34.4%), had less than a high school education (28.7%), were unable to work (50.1%), were unmarried (23.3%), and reported sometimes, rarely, or never receiving sufficient social and emotional support (32.8%). The most prevalent pair of co-occurring risk factors was at-risk drinking and smoking (5.7%).
  
  
  CONCLUSIONS
  The high proportion of women of childbearing age with preconception risk factors highlights the need for preconception care. The common occurrence of multiple risk factors suggests the importance of developing screening tools and interventions that address risk factors that can lead to poor pregnancy outcomes. Increased attention should be given to high-risk subgroups.
authors.affiliation: Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cdenny@cdc.gov
authors.forename: Clark H
authors.initials: CH
authors.lastname: Denny
authors.forename: R Louise
authors.initials: RL
authors.lastname: Floyd
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Green
authors.forename: Donald K
authors.initials: DK
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000208:ethnology / Q000523:psychology; D040343:Behavioral Risk Factor Surveillance System; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D001523:Mental Disorders; D009765:Obesity / Q000208:ethnology / Q000523:psychology; D016742:Preconception Care / Q000592:standards*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012907:Smoking / Q000208:ethnology / Q000523:psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology