The Baby "Oops":
Potential Dangers of Unplanned Pregnancies

In North Carolina there are nearly two million women of childbearing age. Of those who experience a pregnancy, half will be unplanned. Unfortunately, unplanned pregnancies are common in the United States and the issue highlights the connection between a woman's health before she gets pregnant and the health of her baby. Studies show that unplanned pregnancies are at a greater risk of ending in preterm births and low birthweight babies and women getting late prenatal care. These infants, born too early and/or too small, are more likely to have health problems throughout their lives.

Because so many pregnancies are unplanned, every woman of childbearing age needs to think about her health, whether or not she is planning to have a baby. She should know how her health conditions, genetic risks, behavioral risks and unmanaged chronic conditions could affect her and her unborn baby if she becomes pregnant.

Why Is a Woman's Health Important?

We know that many women in North Carolina enter pregnancy with risk factors such as obesity, tobacco use and poor mental health that can lead to poor birth outcomes. Analyzing births from 1997 - 2001, the Perinatal Periods of Risk Analysis documented that a significant number of feto-infant deaths occurred due to risks attributable primarily to maternal factors—the health of women before they get pregnant. Unfortunately, women experiencing one poor birth outcome (fetal death, stillbirth, birth defects or premature birth) are at increased risk for having another poor outcome if they become pregnant again.

Health care for women before they become pregnant is critical because we know that prenatal care, which usually begins at week 11 or 12 of a pregnancy, comes too late to prevent a number of serious maternal and child health problems. The fetus is most susceptible to developing certain problems in the first two months after conception, before prenatal care normally begins. Because many women are often unaware of their pregnancy during this critical time period, they are unable to reduce their risks. Many interventions such as weight loss, smoking cessation and folic acid supplementation, take months to reap the benefits and must be initiated long before conception.

Women need to carefully consider and make their "reproductive life plan". This plan includes knowing if they want to have children, how many and when. The action a woman takes depends upon what her plan is. Healthcare providers should ask women of reproductive age about their pregnancy intentions and fully inform them of their contraceptive options. Healthcare providers should also connect women with available resources and inform them about how to apply for publicly funded insurance to cover planning services such as North Carolina's Family Planning Waiver (Medicaid).

In a recent report from the N.C. Department of Health and Human Services, among women who said that they were not trying to get pregnant: 48 percent reported that they were doing something to keep from getting pregnant, 52 percent said they were not. Studies show the percentage of unintended pregnancy decreases with age. For teenage mothers who had a live birth, 70 percent reported that their pregnancies were unintended. Yet, it's worth noting that five out of six unintended pregnancies in North Carolina are to women over 20 years of age, so efforts to reduce unintended pregnancies need to include young adults and older women as well.

Providers should:

• Encourage each woman and every couple to have a reproductive life plan.
• Offer risk assessment and counseling to all women of childbearing age at primary care visits to reduce risks related to poor pregnancy outcomes.
• Review a couple's family history and recommend genetic testing, if needed.
• Provide preconception risk screening, focusing on high-priority interventions.
• Conduct pre-pregnancy checkups for couples planning a pregnancy.

Women should:

• Take a multivitamin with 400 micrograms (400 mcg or 0.4 mg) of folic acid every day for at least three months before getting pregnant to lower the risk of some birth defects of the brain and spine, including spina bifida.
• Stop smoking and drinking alcohol.
• Make sure that chronic conditions such as asthma, diabetes and high blood pressure are under control.
• Talk to a doctor about any over-the-counter and prescription medicine use.
• Keep vaccinations up-to-date.
• Avoid contact with toxic substances or materials that could cause infections. Stay away from chemicals and cat or rodent feces.

It's important that women know by taking action on health issues and risks before pregnancy, she may prevent some problems that might affect her or her baby. For more information about family planning and how to have a healthy pregnancy, visit the North Carolina Health Start Foundation at www.NCHealthyStart.org.