Pregnancy Planning and Lifestyle Behaviors Among Nonpregnant Childbearing Age Women Southern Califor

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Pregnancy Planning and Lifestyle Behaviors Among
Nonpregnant Childbearing Age Women Southern
California, 19982000Kathleen Green Raleigh
PhD, MSPrevention Research Team, Division of
Birth Defects and Developmental Disabilities,
NCBDDD
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Background

• Maternal behaviors before and at time of
  conception important for infant development, for
  example
• 400 mcg of folic acid taken daily during the
  periconceptional period prevents birth defects
• tobacco use and late prenatal care increases
• the risk for low birth weight
• alcohol use increases the risk for fetal alcohol
  spectrum disorder

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Public Health Importance

• An estimated 49 of all U.S. pregnancies are
  unintended (i.e. mistimed or unwanted)
• Unintended pregnancies affect all of society
• Women with unintended pregnancies are
• more likely to
• smoke cigarettes
• seek prenatal care late
• drink alcohol
• have inadequate folic acid intake

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Objectives

• To examine association between pregnancy plans
  and a variety of lifestyle behaviors cigarette
  smoking, alcohol use, multivitamin consumption,
  and visiting a health care provider
• To examine differences in reported advice from
  health care professionals about lifestyle
  behaviors by womens pregnancy plans

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Methods

• Cross-sectional
• Random telephone survey
• Female members aged 18 to 40 (nonpregnant)
• Kaiser Foundation Health Plan, 1998-2000
• Crude and adjusted odds ratios and 95 confidence
  intervals using logistic regression analyses

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Variables

• Lifestyle Behavior Variables
• Cigarette Smoking
• Alcohol Use
• Multivitamin Consumption
• Health care visit
• Independent Variables
• Pregnancy Planning Status
• Age
• Education
• Marital Status
• Race/Ethnicity

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Pregnancy Planning

• Which of the following statements best describe
  your pregnancy plans
• Desire
• I am planning to get pregnant in the future
• I am not planning to get pregnant at any time in
  the future
• Timing
• Do you plan to get pregnant in the next year?
• yes planning pregnancy (sooner)
• no planning pregnancy (later)

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Results Women from Kaiser Foundation
Health Plan Membership Database
Women selected for the survey n6,300
No home or work phone n300 (5)
Called n6,000 (95)
Did not complete survey n2,562 (43)
Completed survey n3,438 (57)
Could not get pregnant n430 (13)
Final Study Sample n2,886
Dont know or refused n122 (4)
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Demographics N 2,886

• Characteristics No. ()
• Pregnancy Plans
• Sooner (next year) 376 (13)
• Later 1163 (40)
• Not planning 1347 (47)
• Age
• 18-24 799 (28)
• 25-34 1370 (46)
• 35-40 717 (25)
• Marital Status
• Married/Cohab 1763 (61)
• Single 1123 (39)

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Demographics (contd) N 2,886

• Characteristics No. ()
• Race/Ethnicity
• White, non-Hispanic 1396 (48)
• Hispanic 825 (29)
• Asian Pacific Islander 292 (10)
• Black, non-Hispanic 183 (6)
• Other 166 (6)
• Education
• Any college 1950 (68)

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Demographics by Pregnancy Plans
Pregnancy Plans
Characteristics
Sooner n ()
Not planning n ()
Later n ()

Age
18-24
51 (14)
142 (11)
606 (52)
624 (46)
506 (44)
240 (64)
25-34
35-40
581 (43)
51 (4)
85 (23)
Marital Status
married/cohabitating
343 (91)
982 (73)
438 (38)
364 (27)
724 (62)
32 (9)
single/divorced/widow
Education
509 (38)
312 (27)
108 (29)

any college
268 (71)
832 (62)
850 (73)
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• Objective 1
• To examine associations between pregnancy
• plans and a variety of lifestyle behaviors
• cigarette smoking, alcohol use, multivitamin
• consumption, and visiting a health care provider

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Adjusted Odds Ratios for Lifestyle Behaviors by
Pregnancy Plans

Adjusted for age, education, race, marital
status and alcohol Adjusted for age, education,
race, marital status and smoking Adjusted for
age, education, race and marital status P
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• Objective 2
• To examine the association between pregnancy
• plans and reported advice from health care
• professionals on lifestyle behaviors

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Advice from Health Care Professional

• During the past 12 months, has a Kaiser
  Permanente physician or other health care
  professional ever talked with you about
• Taking vitamin or mineral supplements?
• Smoking?
• Alcohol consumption?

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Reported Health Care Professional (HCP) Advice on
Lifestyle Behaviors by Pregnancy Plans
Pregnancy Plans

Lifestyle Behaviors
Not planning (n1341)
Later (n1159)
Sooner (n374)
Vitamin Use
No
1019 (76)
896 (77)
247 (66)
Yes
322 (24)
263 (23)
127 (34)
Alcohol
No
1115 (83)
962 (83)
312 (84)
Yes
226 (17)
197 (17)
62 (16)
Smoking
968 (72)
807 (70)
288 (77)
No
Yes
373 (28)
352 (30)
86 (23)
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Adjusted Odds Ratios for Reported HCP Advice on
Lifestyle Behaviors by Pregnancy Plans

Adjusted for age, education, race and marital
status.
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Conclusions (1)

• Women planning sooner were significantly
• less likely to smoke cigarettes
• more likely to consume a multivitamin
• regularly
• more likely to visit a health care provider
  in the past 12 months
• Women planning later were significantly
• more likely to report alcohol use and had
  behaviors similar to women not planning pregnancy

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Conclusion (2)

• Women planning sooner were significantly more
  likely to report receiving advice about vitamins
  from a health care professional
• There was no difference in reported advice on
  smoking and alcohol consumption by pregnancy plans

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Limitations

• Self-report data is subject to recall bias
• Limited to women who were members of a health
  care delivery system
• No information on womens contraceptive use
• Referent group may include both women who did or
  did not use contraception

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Recommendations

• Increase educational efforts to encourage all
  women of benefits of healthy behaviors before and
  during pregnancy
• Health care providers need to screen all women
  for alcohol use and risk for pregnancy
• Intervene with those women at higher risk for
  alcohol-exposed pregnancy

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Recommendations

• Implement educational initiatives for all women
  of childbearing age and their health care
  providers about importance of daily consuming
  folic acid

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Acknowledgments

• Kaiser Permanente
• Jean M. Lawrence, ScD, MPH
• NCBDDD/CDC
• Joseph Mulinare, MD, MSPH
• Jennifer Williams, MSN, MPH
• Owen Devine, PhD
• Huichao Chen, MS, Fellow
• Christine Prue, PhD
• NCCDHP/DRH/CDC
• Diana Bensyl, PhD
• Christine Galavotti, PhD

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Future Research

• Need to better understand how womens feelings
  and attitudes about becoming pregnant and timing
  of pregnancy planning
• Concept of planning and pregnancy intention may
  not be meaningful to all women
• Need to examine influence of gender and power on
  reproductive health decision making and role of
  partners in determining intention and
  contraceptive use

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Selected Characteristics of Women who Reported
Alcohol Use n 1705 (59)

• Characteristics No. ()
• Age
• 18-24 475 (28)
• 25-34 825 (48)
• 35-40 405 (24)
• Marital Status
• Married/Cohab 798 (47)
• Single 904 (53)
• Education
• Any college 566 (33)

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Characteristics of Women who Reported
Multivitamin Use n 1173 (41)

• Characteristic No. ()
• Age
• 18-24 241 (21)
• 25-34 616 (52)
• 35-40 316 (27)
• Marital Status
• Married/Cohab 522 (45)
• Single 649 (55)
• Education
• Any college 409 (35)

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Kaiser Foundation Health Plan

• Provides care on prepaid basis to
• 3 million residents of southern CA
• 350,000 women of childbearing age
• Representative of CA population
• race/ethnicity, education, and income
• Member assigned to member service area
• 1 to 3 medical centers
• 4 to 12 medical offices

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Race/Ethnicity
Kaiser Permanente Study 1998-2000
California Population Survey 2000
6
6
29
30
48
48
10
11
6
6
Asian/Pacific Islanders
Other
White
Blacks
Hispanics
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Lifestyle Behaviors by Pregnancy Plans
Lifestyle Behaviors
Pregnancy Plans
Sooner (n 376) n ()
Later (n 1163) n ()
Not planning (n 1347) n ()

Smoking
No
1144 (85)
974 (84)
343 (91)
200 (15)
189 (16)
31 (8)
Yes
3 (0)
0
2 (1)
Data missing
Alcohol
No
594 (44)
403 (35)
165 (44)
746 (55)
751 (64)
208 (55)
Yes
7 (1)
9 (1)
3 (1)
Data missing
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Lifestyle Behaviors by Pregnancy Plans
Pregnancy Plans
Sooner (n 376) n ()
Later (n 1163) n ()
Lifestyle Behaviors
Not planning (n 1347) n ()

Multivitamin
No
787 (58)
739 (64)
183 (49)
557 (41)
423 (36)
193 (51)
Yes
3 (0.2)
1 (0.1)
0
Data missing
Health care Visit
No
181 (13)
126 (11)
35 (9)
1160 (86)
1033 (89)
339 (90)
Yes
6 (1)
4 (0.3)
2 (1)
Data missing
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Adjusted Odds Ratios for Lifestyle Behaviors by
Pregnancy Plans

Adjusted for age, education, race, marital
status and alcohol Adjusted for age, education,
race, marital status and smoking Adjusted for
age, education, race and marital status.
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Advice from Health Care Professional

• During the past 12 months, has a Kaiser
  Permanente physician or other health care
  professional ever talked with you about
• Taking vitamin or mineral supplements?
• Smoking?
• Alcohol consumption?

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Adjusted Odds Ratios for Reported HCP Advice on
Lifestyle Behaviors by Pregnancy Plans

Adjusted for age, education, race and marital
status.
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Current Cigarette Smoking

• Do you now smoke cigarettes everyday, some
• days, or not at all?
• Nonsmokers not at all
• Smokers everyday or some days

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Alcohol Use

• During the past month, how many alcoholic
• beverages (beer, wine, wine coolers, or
• liquor) did you drink per week or per month,
• on the average?
• No use no drinks per week
• Any use any drinks per week

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Multivitamin Consumption

• Do you take a multivitamin?
• No
• Yes ? How often do you take these
  multivitamins, everyday, 4-6 times per week, 2-3
  times a week, once a week, or less frequently?
• Nonuser less than 4 times a week
• Regular User at least 4 times per week

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Health Care Visit

• In the past 12 months, have you seen a
• Kaiser Permanente physician or other health
• care professional?
• no
• yes