The preconception counseling model tested in the CDC funded Project CHOICES efficacy trial to reduce the risk of an alcohol-exposed pregnancy (AEP) could be extended to smokers to prevent a nicotine-exposed pregnancy (NEP), when pharmacotherapy can be provided safely and disclosure of these risk behaviors is more likely. The CHOICES model, which incorporates motivational interviewing, encourages reduction of AEP risk by decreasing risky drinking or using effective contraception; in the efficacy trial, most women chose both options. We conducted a secondary analysis of the CHOICES epidemiologic survey data (N = 2,672) (Project CHOICES Research Group in Am J Prev Med 23(3), 166-173, 2002) to identify the prevalence of risk of NEP and the factors associated with this risk using logistic regression modeling procedures. Conducted in six settings with women at risk for AEP, the percentage of AEP was 12.5% (333/2,672) among women of childbearing age (18-44). A total of 464 of the 2,672 (17.4%) were at risk for NEP. Among women at-risk of an unplanned pregnancy (n = 1,532), the co-occurrence of AEP and NEP risk was more prevalent (16.3%) than AEP risk alone (5.5%) or NEP risk alone (14.0%). In the multivariable model, statistically significant correlates for NEP risk included lifetime drug use, prior alcohol/drug treatment, drug use in the last 6 months, being married or living with a partner, having multiple sexual partners in the last 6 months, physical abuse in the last year, and lower levels of education. These findings suggest that preconception counseling for NEP could be combined with a program targeting AEP.
and severe morbidity for women at various weight classes. Interactions between obesity and other important risk factors were assessed on both the additive and multiplicate scales. RESULTS: Among all women (n¼283,697), 13.1% were obese (prepregnancy BMI 30m/kg2), and 60.1% had normal BMI (18.5-24.9 m/kg2). As a fraction of ongoing pregnancies, adverse outcomes increased with increasing gestational age at delivery in women of all weights. There was a dose-response relationship with increasing BMI with those morbidly obese (BMI 40m/kg2) at the highest risk.Other key risk factors included nulliparity, chronic hypertension and diabetes mellitus. Obese women with any of these additional risk factors exhibited far worse outcomes than those without with increasing disparities at later delivery. There was additive interaction between nulliparity, chronic hypertension and diabetes mellitus and obesity, but no multiplicate interactions. CONCLUSION: Obese women are at increased risk of worse perinatal outcomes at all gestational ages. These risks are compounded by other known risk factors of adverse perinatal outcomes, especially closer to term.
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