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      Is Preconception Substance Use Associated With Unplanned or Poorly Timed Pregnancy? :

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d8940677e151">Objective</h5> <p id="P1">Unplanned and poorly timed pregnancies are associated with adverse maternal and neonatal outcomes. Further understanding of preconception substance use with unplanned and poorly timed pregnancy is warranted. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d8940677e156">Methods</h5> <p id="P2">Data were analyzed from a prospective study enrolling women early in pregnancy. Preconception tobacco, alcohol, marijuana, opioid, and cocaine use was ascertained. Participants reported whether their current pregnancy was planned and whether it was a good time to be pregnant. Multivariable logistic regression modeling generated risk estimates for preconception substance use and pregnancy planning and timing, adjusting for confounders. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d8940677e161">Results</h5> <p id="P3">Overall 37.2% reported unplanned pregnancy, 13.0% poorly timed pregnancy, and 39.0% reported either unplanned and/or poorly timed pregnancy. Within six months preconception, one-fifth (20.2%) reported nicotine cigarette use. In the month before conception, 71.8% reported alcohol use, 6.5% marijuana, and approximately 1% opioid or cocaine use. Multivariable analysis demonstrated preconception opioid use was associated with increased odds of poorly timed pregnancy, OR=2.87, 95% CI 1.03–7.99. Binge drinking the month prior to conception was associated with increased odds of poorly timed pregnancy and unplanned pregnancy, OR=1.75, 95% CI 1.01–3.05 and OR=1.68, 95% CI 1.01–2.79, respectively. Marijuana use 2–3 times in the month preconception was associated with increased risk of unplanned pregnancy and unplanned and/or poorly timed pregnancy compared to nonuse, OR=1.78 (95% CI 1.03–3.08) and OR=1.79 (95% CI 1.01, 3.17), respectively. Preconception tobacco or cocaine use was not associated with unplanned or poorly timed pregnancy following adjustment. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d8940677e166">Conclusions</h5> <p id="P4">We demonstrate increased odds of unplanned or poorly timed pregnancy among women with preconception binge drinking, marijuana use, and opioid use; however, no association is observed with other substances after multivariable adjustment, including tobacco. Further research to evaluate high-level preconception substance use and substance disorders with pregnancy planning and timing is warranted. Focused efforts optimizing preconception health behaviors and reducing risk of unplanned or poorly timed pregnancy are needed. </p> </div>

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          Most cited references 22

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          Maternal smoking during pregnancy and psychiatric adjustment in late adolescence.

          This study assessed the extent to which exposure to maternal smoking during pregnancy was associated with increased risks of psychiatric symptoms in late adolescence (adolescents aged 16-18 years) when due allowance was made for confounding or selection factors associated with maternal smoking during pregnancy. Data were gathered during an 18-year longitudinal study of a birth cohort of 1265 children born in New Zealand. The measures collected included (1) maternal smoking during pregnancy; (2) assessments of psychiatric problems (conduct disorder, major depression, and anxiety and substance use disorders) at age 16 to 18 years; and (3) measures of potentially confounding social, family, and parental factors. Children exposed to maternal smoking during pregnancy had higher psychiatric symptom rates for conduct disorder, alcohol abuse, substance abuse, and depression. Those children whose mothers smoked at least 1 pack of cigarettes per day during their pregnancy had symptom rates that were between 1.4 and 2.5 (median, 2.0) times higher than the children of nonsmokers. Smoking during pregnancy was also associated with a series of adverse or disadvantageous factors that included (1) socioeconomic disadvantage, (2) impaired child-rearing behaviors, and (3) parental and family problems. After adjustment for these confounding and selection factors, smoking during pregnancy was significantly associated with an increased rate of conduct disorder symptoms in late adolescence (P<.001). This effect was more pronounced for male than female adolescents. This study suggests that maternal smoking during pregnancy may contribute to childrens' risk of later externalizing problems. There is a need to further explore the moderating effect of the sex of the child and to clarify the underlying pathophysiological features of this relationship.
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            Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom.

            Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries.
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              Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, National Birth Defects Prevention Study, 1997-2002.

              Given that approximately half of all pregnancies in the United States are unplanned, the authors sought to understand the relation between pregnancy intention and health behaviors. Mothers of live-born infants without major birth defects were interviewed as part of the National Birth Defects Prevention Study. The interview assessed pregnancy intention as well as exposures to vitamins, alcohol, tobacco, illicit drugs, occupational hazards, exogenous heat (e.g., hot tubs and saunas) and caffeine. Crude odds ratios and 95% confidence intervals were calculated and stratified analyses were performed to assess interaction. Multiple logistic regression was used to calculate adjusted odds ratios. Both before and after the diagnosis of pregnancy, women with unintended pregnancies were more likely to use illicit drugs, smoke, be exposed to environmental smoke, and not take folic acid or multivitamins. The degree to which women altered behaviors after they realized they were pregnant was also associated with their pregnancy intention status. For certain behaviors, maternal age or parity altered the association between pregnancy intention and changing behaviors after awareness of pregnancy. Pregnancy intention status is a key determinant of pregnancy-related behavior. To improve reproductive outcomes, preconceptional and prenatal programs should consider a woman's desire for pregnancy.
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                Author and article information

                Journal
                Journal of Addiction Medicine
                Journal of Addiction Medicine
                Ovid Technologies (Wolters Kluwer Health)
                1932-0620
                2018
                2018
                : 12
                : 4
                : 321-328
                Article
                10.1097/ADM.0000000000000409
                6066412
                29570477
                © 2018
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