Unintended pregnancy and prenatal behaviors among urban, black women in Baltimore, Maryland: the Baltimore preterm birth study

PURPOSE: We explored associations between intendedness of pregnancy with maternal prenatal behaviors, including smoking, use of alcohol, use of illicit drugs, and late initiation of prenatal care. METHODS: Pregnant black women ages 18 years or older (N = 913) were enrolled in the study at their first visit to prenatal clinics in Baltimore, Maryland, at which time data were obtained from the women about intendedness of pregnancy. Data on behavioral risks were abstracted from clinical records, Logistic regression was used to adjust analyses for maternal demographic characteristics. RESULTS: Women with unwanted pregnancies were significantly more likely than women with wanted or mistimed pregnancies, or who were unsure about intendedness, to smoke (odds ratio [OR], 2.0; 95% CI, 1.2-3.3), use alcohol (OR, 2.1; 95% CI, 1.1-3.9), and use illicit drugs (OR, 1.8; 95% CI, 1.0-2.9) during pregnancy, and to initiate prenatal care in the third trimester (OR, 5.7; 95% CI, 3.5-9.4). CONCLUSIONS: Unwanted pregnancy is associated with prenatal behaviors that increase the risk of poor pregnancy outcomes. The facilitation of wanted pregnancies and reduction of harmful maternal behaviors may result in improved pregnancy outcomes in the United States.