Is Periconceptional Substance Use Associated with Unintended Pregnancy?

Abstract

Background: To evaluate the relationship between periconceptional (period before and/or after conception) substance use and unfavorable pregnancy contexts, including unintended pregnancy. Materials and Methods: This is a cross-sectional analysis of English-or Spanish-speaking women aged 16-44 years with pregnancies <24 weeks' gestation presenting to pregnancy testing clinics and enrolled between June 2014 and June 2015. Participants self-reported periconceptional substance use (tobacco, alcohol, marijuana, and other illicit substances during the 3 months before enrollment), and pregnancy ''contexts,'' including pregnancy intention, wantedness, planning, timing, desirability, and happiness. Multivariable logistic regression was performed adjusting for potential confounding variables. Results: We enrolled 123 women, averaging 27 -6 years, and mean gestational age 7.5 -3.0 weeks. Most participants were black, non-Hispanic (37%), or Hispanic (46%), and chose to complete the study in English (69%). Sixty-five percent participants reported use of one or more substances during prior 3 months: alcohol (54%), tobacco (31%), and marijuana (21%). In multivariate analysis, periconceptional alcohol use was associated with increased odds of unintended or ambivalent pregnancy and unwanted or mixed feelings regarding pregnancy (odds ratios [OR] = 3.29, 95% confidence interval [CI] 1.08-10.08 and OR = 2.81, 95% CI 1.07-7.36, respectively). Weekly or daily tobacco use was associated with unhappiness about pregnancy (OR = 7.56, 95% CI 1.65-34.51) and undesired or unsure pregnancy (OR = 4.00, 95% CI 1.14-14.06). Conclusions: Periconceptional alcohol or tobacco use demonstrates increased odds of specific unfavorable pregnancy contexts, including pregnancy described as undesired, unintended, unwanted, and unhappiness with pregnancy. Primary prevention of periconceptional substance use and the negative effects of alcohol and tobacco may be improved by increasing contraception access for women at risk for unfavorable pregnancy contexts.Keywords: alcohol; pregnancy; tobacco; unintended pregnancy; unplanned pregnancy However, focusing on preconception care in this way may be insufficient as it assumes that women have control over their reproductive lives, that contraception never fails, that all pregnancies are planned, and that such assumptions are inherently flawed. 5,6 For example, purposeful abstinence regarding tobacco, alcohol,

Mapping evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa: A scoping review

“…In the same vein, a self-reported periconceptional substance use study conducted among women reported that women who use alcohol were more likely to report unintended pregnancy. 48 …”

Association between pregnancy intention and preconception health behaviors

“…Only 2 prior studies measured ambivalent pregnancy intention in studying preconception behavior. Lundsberg et al 7 found that in a sample of healthy pregnant women, ambivalence toward a current pregnancy was associated with greater preconception alcohol intake and smoking. In contrast, the 2004 Behavior Risk Factor Surveillance System data showed no association between ambivalent intention and smoking or alcohol intake 32 .…”

“…5 Healthy preconception behaviors such as engaging in physical activity (PA) at recommended guidelines can be protective against excessive weight gain and gestational diabetes, whereas risky behaviors such as smoking and high alcohol consumption are associated with reduced fertility, a higher likelihood of unintended pregnancies, and adverse neonatal outcomes. [6][7][8][9] AYA survivors are less physically active, have higher rates of smoking, and drink alcohol at similar rates in comparison with peers without cancer. 10,11 Poor health behaviors in AYA survivors are concerning because they may adversely affect already increased reproductive risks.…”

“…Preconception health behaviors can affect fertility, pregnancy, and neonatal outcomes, but studies show that AYA survivors engage in risky behaviors 5 . Healthy preconception behaviors such as engaging in physical activity (PA) at recommended guidelines can be protective against excessive weight gain and gestational diabetes, whereas risky behaviors such as smoking and high alcohol consumption are associated with reduced fertility, a higher likelihood of unintended pregnancies, and adverse neonatal outcomes 6‐9 . AYA survivors are less physically active, have higher rates of smoking, and drink alcohol at similar rates in comparison with peers without cancer 10,11 .…”

Preconception Substance Use and Risk of Unintended Pregnancy: Pregnancy Risk Assessment Monitoring System 2016–17

“…Women with substance use have reported a higher prevalence of unintended pregnancies. However, these studies have been limited to small-scale and hospital-based investigations 12,13 . To address this gap, this study investigates the association of preconception substance use to unintended pregnancy and its sub-types, that is, mistimed, unwanted, and ambivalent, using large national data from the Pregnancy Risk Assessment Monitoring System (PRAMS).…”