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Article Title

Are Race/Ethnicity and Comorbid Conditions Associated With Pregnancy Intention Status?

Publication Date

4-30-2015

Keywords

pregnancy intention, racial/ethnic disparities

Abstract

Background/Aims: The proportion of pregnancies in the United States self-reported as unintended (49%), among the insured and uninsured, has not improved for more than a decade, representing a major public health problem. Unintended pregnancy has been found to be associated with poor pregnancy outcomes in numerous studies. The purpose of this study was to identify risk factors for unintended pregnancy in a health care system with equal access to all that could be used to determine groups of women who would benefit from risk reduction strategies.

Methods: In this retrospective cohort study, women age 15–44 as of the index date of 6/30/2010 who were members of an integrated health care delivery system were followed electronically through 12/31/12 for evidence of pregnancy (N=45,351). Self-reported pregnancy intention status at entry to prenatal care (intended, unintended [mistimed or unwanted]) and potential risk factors, including age, race/ethnicity, marital status, education/income, parity, long-acting reversible contraceptive (LARC) use prior to pregnancy, and comorbidities (diabetes, hypertension, cardiovascular disease, obesity), were obtained from electronic medical records. Pregnancy intention groups were compared on all risk factors using chi-squared tests. Logistic regression models were developed to determine which factors were associated with intended pregnancy.

Results: Bivariate analyses showed that significantly more black women had unintended pregnancies (71.9% [2,618/3,641] vs. 32.6% [5,908/18,107] white, 45.7% [4,808/10,520] Hispanic, 32.8% [3,994/12,190] Asian, p 2 [odds ratio: 0.25 vs. 0, P<0.0001]), and those who did not use LARC (odds ratio: 0.44 vs. LARC, P<0.0001) were significantly less likely to have an intended pregnancy. Having comorbidities was not significantly related to intended pregnancy.

Discussion: Even when there is equal access to health care, there are racial and other demographic disparities in pregnancy intention. Age-appropriate, culturally sensitive unintended pregnancy reduction interventions targeting groups of women with identified risk factors should be considered.

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