title: Effect of multiple previous miscarriages on health behaviors and health care utilization during subsequent pregnancy.
abstract: BACKGROUND
  Women with a history of miscarriage report feeling emotionally guarded during a subsequent pregnancy and may be at increased risk for pregnancy-related anxiety and greater health care utilization compared with women without a history of miscarriage. However, these behaviors have not been studied in women with a history of multiple miscarriages.
  
  
  METHODS
  We examined the effect of a history of multiple miscarriages on health behaviors and health care utilization in 2,854 women ages 18 to 36 years expecting their first live-born baby. Self-reported health behaviors and use of health care resources during pregnancy were compared for women with a history of two or more miscarriages and women with one or no miscarriages.
  
  
  RESULTS
  Women with a history of multiple miscarriages were more than four times as likely to smoke during pregnancy (adjusted odds ratio [aOR], 4.69; 95% CI, 2.63-8.38) compared with women without a history of multiple miscarriages. They initiated prenatal care earlier (7.0 vs. 8.2 weeks gestation), had higher odds of third trimester emergency department visit (aOR, 2.21; 95% CI, 1.24-3.94), higher odds of hospitalization during pregnancy (aOR, 1.66; 95% CI, 1.01-2.73), and twice the mean number of third trimester emergency department visits and hospitalizations during pregnancy.
  
  
  CONCLUSIONS
  Women with a history of multiple miscarriages may be more likely to smoke and may demonstrate increased health care utilization during a subsequent pregnancy. Compassionate, individualized, and supportive counseling by providers may address smoking and other health behaviors as well as increased health care utilization.
authors: College of Nursing, The Pennsylvania State University, University Park, Pennsylvania; Department of Public Health Science, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania. Electronic address: cbickingkinsey@gmail.com.
authors: Cara
authors: C
authors: Bicking Kinsey
authors: College of Nursing, The Pennsylvania State University, University Park, Pennsylvania; Department of Public Health Science, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
authors: Kesha
authors: K
authors: Baptiste-Roberts
authors: Department of Public Health Science, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
authors: Junjia
authors: J
authors: Zhu
authors: Department of Public Health Sciences and Obstetrics and Gynecology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
authors: Kristen H
authors: KH
authors: Kjerulff
mesh_terms: D000022:Abortion, Spontaneous / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D005260:Female; D005865:Gestational Age; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010414:Pennsylvania / Q000453:epidemiology; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D017584:Reproductive History; D057566:Self Report; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult