Health behaviors before pregnancy impact pregnancy outcomes. Research is limited on whether women adopt healthier behaviors when they intend to become pregnant. In a cross-sectional study, Green-Raleigh et al.¹ showed that women planning pregnancy within the next year reported healthier behaviors including smoking and vitamin supplementation compared with women not planning pregnancy.

The aim of this study² was to use longitudinal data to determine whether pregnancy intention affects health behaviors that could impact pregnancy outcomes.

The Central Pennsylvania Women’s Health Study

The Central Pennsylvania Women’s Health Study (CePAWHS) included a population-based longitudinal cohort of women aged 18-45 residing in Central Pennsylvania interviewed at Baseline and 2-years later³. The analytic sample presented here included 847 women who were not pregnant at baseline and had not had a hysterectomy or tubal sterilization.

The outcome variables were measures of health behaviors over a two-year period: nutrition (Fruit and Vegetable (F&V) consumption), folic acid supplementation, physical activity, binge drinking, smoking and vaginal douching. For each health behavior, we assessed whether women engaged in positive longitudinal behavior, defined as sustained healthy levels of the behavior or improved health behavior between baseline and follow-up. The main independent variable was pregnancy intention at baseline, which was defined as considering pregnancy within the next year, at some other time in the future, or not at all.

Analyses were adjusted for pregnancy-related variables (previous pregnancy, perceived severity of preterm birth or low birthweight, incident pregnancy during the two-year study), health status variables (overall self-rated health status, stress, depressive symptoms, obesity), accessibility to the health care system and sociodemographic variables (age, race/ethnicity, education, marital status, poverty status).

Pregnancy intention did not change health behaviors

At baseline, 9% of women were considering pregnancy in the next year, 37% some other time in the future and 53% not at all. In unadjusted analysis, women considering pregnancy within the next year were more likely to report positive longitudinal folic acid supplementation only.

In adjusted analyses, women considering pregnancy in the next year were no more likely to be engaging in positive longitudinal health behaviors than other women. However, becoming pregnant during the two-year follow-up period increased the odds of folic acid supplementation and avoiding binge drinking.

The need to for improved health promotion

In this population, intention for pregnancy was not associated with maintaining or improving healthy behaviors. These findings confirm the need for improved preconception health promotion. The importance of health behaviors including F&V consumption, physical activity, and avoiding alcohol and tobacco needs to be emphasized by health care providers and policy makers.