Objectives Better understanding of the impact of unintended childbearing on infant and early childhood health is needed for public health practice and policy. Methods Data from the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) survey and The Oklahoma Toddler Survey (TOTS) from 2006-2010 were used to examine associations between a four category measure of pregnancy intentions (intended, mistimed<2 years, mistimed>=2 years, unwanted) and maternal behaviors and child health outcomes up to age two. Propensity score methods were used to control for confounding. Results Births mistimed by two or more years (OR =.58) and unwanted births (OR=.33) had significantly lower odds than intended births of having a mother who recognized the pregnancy within the first 8 weeks; they were also about half as likely as intended births to receive early prenatal care, and had significantly higher likelihoods of exposure to cigarette smoke during pregnancy. Breastfeeding was significantly less likely among unwanted births (OR=.68); breastfeeding for at least six months was significantly less likely among seriously mistimed births (OR=.70). We find little association between intention status and early childhood measures. Conclusions Measured associations of intention status on health behaviors and outcomes were most evident in the prenatal period, limited in the immediate prenatal period, and mostly insignificant by age two. In addition, most of the negative associations between intention status and health outcomes were concentrated among women with births mistimed by 2 or more years or unwanted births. Surveys should incorporate questions on the extent of mistiming when measuring pregnancy intentions.

Intimate partner violence has been previously examined in relation to numerous pregnancy, labor and delivery outcomes. We evaluated whether women who experienced physical violence by their intimate partners around the time of pregnancy were less likely to achieve weight gain according to Institute of Medicine (IOM) guidelines. A cross-sectional study was conducted using the 2000–2006 Oklahoma Pregnancy Risk Assessment Monitoring Survey (PRAMS) data for post-partum women, 20 years and older. Physical violence perpetrated by an intimate partner before and/or during pregnancy was prevalent in nearly 6.5% of women. Weight gain was adequate in 38.8%, deficient in 28.4% and excessive in 32.8% of these women, respectively. After adjusting for maternal age, marital status, education, pregnancy intention, stressful life events, third-trimester use of tobacco and alcohol and gestational age at delivery, physical violence by an intimate partner around the time of pregnancy was positively but non-significantly associated with excessive (but not deficient) gestational weight gain. After stratifying by age group, positive and significant associations between physical violence by an intimate partner around the time of pregnancy and inadequate gestational weight gain were observed only among women 35 years and older. With the exception of mothers ≥ 35 years of age, deficient and excessive gestational weight gains were not significantly related to experiences with physical violence by an intimate partner prior to delivery. Prospective cohort studies are needed to establish whether other forms of violence, including emotional and sexual abuse, can affect gestational weight gain and whether gestational weight gain can mediate the effect of physical, sexual and emotional abuse on pregnancy, labor and delivery outcomes.

Preconception health care and reproductive life planning are essential to improving women's health and reducing poor birth outcomes. Preconception health care and education provide opportunities to identify risk factors related to family health history, preexisting medical conditions, body weight, nutrition, physical activity, and immunization status. Modifiable risk factors can be mitigated, thereby improving the health of a woman before she becomes pregnant. Preconception health covers a broad range of topics and may be difficult to incorporate into the busy schedules of health care providers. National and state resources have been developed to help health care providers assist women and men of reproductive age (including adolescents) in developing a reproductive life plan, identifying risk factors for adverse pregnancy outcomes, and providing education and resources to assist in addressing risk factors prior to pregnancy. The current amount of literature available on preconception and interconception health can be overwhelming. This article presents some key screening tools and resources that are available to assist busy health care providers and staff. Some of these resources can be obtained at little or no cost and tailored to individual practices.

CONTEXT Beyond associations with health outcomes, pregnancy intentions may be associated with social outcomes, including marital transitions. METHODS Linked data from the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) survey and The Oklahoma Toddler Survey (TOTS) from 2006-2010 were used to examine a four category measure of women’s pregnancy intentions (intended, mistimed <2 years, mistimed >=2 years, unwanted) and changes in marital status between conception, birth and age two. Analyses were stratified by marital status at conception (married, N=3,617; unmarried, N=2,123). Propensity score methods were used to adjust for confounding factors, and logistic regressions were used to estimate the association between pregnancy intention and marital formation and dissolution at birth and child’s age two. RESULTS Intention status was associated with mothers’ marital transitions by child’s age two, both in analyses unadjusted and adjusted for confounding background characteristics. In adjusted models, among women married at conception, those with a birth resulting from an unwanted pregnancy were more likely (OR=2.2) than those with an intended pregnancy to transition out of marriage by the time their child was age two. Among women unmarried at conception, those with an unwanted pregnancy were less likely (OR=.4) than those with an intended pregnancy to marry before the child was age two. Births resulting from mistimed pregnancies were not significantly associated with marital transitions. CONCLUSIONS Women with a child resulting from an unwanted pregnancy are less likely to marry, and less likely to stay married, than women with an intended birth. Future assessments of the consequences of unintended childbearing should distinguish between mistimed and unwanted births.

Background: Medical homes are proposed to provide a new standard of primary care that is comprehensive, family centered, and coordinated. Disparities in access to medical homes may affect healthcare outcomes among populations that include infants, children, and caregivers. This study examined disparities among pregnant mothers in a Midwestern state in the United States of America (USA) with regard to self-reported medical home access for their infants. Method: Data from the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of maternal behaviors, were analyzed. Medical home access was determined by the respondents answering a question about whether their child had a personal doctor or nurse familiar with their medical history. Results: A series of Cochran-Mantel-Haenszel Chi-Square (?2) tests revealed that medical home access differed significantly across race, marital status, education, age, income, insurance status of infant, and prenatal care transportation availability. Multiple logistic regression results showed that mothers who had education higher than a high school diploma, mothers with an annual household income of $50,000 or more and mothers whose infants had health insurance were more likely to report access to a medical home for their infant. Mothers with an annual income of less than $20,000 and no transportation were less likely to report access to a medical home. Conclusion: Similar to other disparity research, our analyses highlighted that pregnant mothers with less education, less income, mothers without insurance for their infants, and pregnant mothers without transportation reported less access to a medical home. The present study indicates a need to continue to examine implications of medical home access for pregnant mothers.