Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Pregnancy ambivalence may be common but it is unclear if women who report both positive and negative feelings about a pregnancy are at higher perinatal risk than women with less conflicted feelings. The purpose of this study was to examine the relationship between ambivalent feelings about pregnancy and perinatal behaviors including early prenatal care initiation, breastfeeding, and smoking. Methods: The study involved 1,538 women from the 2002 National Survey of Family Growth who were older than 17 years and had a singleton livebirth in the past 5 years. Women responded to questions about their last pregnancy: satisfaction with pregnancy timing/intention, pregnancy happiness, pregnancy wantedness, and whether attempts were made to avoid the pregnancy. In multivariable logistic regression analyses, the perinatal behaviors (early prenatal care, breastfeeding, prenatal smoking) of women who consistently reported negative feelings and of women with ambivalent feelings were compared with those who consistently reported positive pregnancy feelings. Results: Forty-six percent reported ambivalent feelings, 36% were consistently positive, and 18% were consistently negative. Compared with women with positive feelings, those who consistently reported negative feelings were more likely to have initiated prenatal care after 8 weeks (OR=1.7; 95% CI=1.1, 3.0) and to have smoked during pregnancy (OR=3.2; 95% CI=1.6, 6.5). The individual variables about feelings were not strongly associated with outcomes in separate analyses. Implications: While retrospective recall of pregnancy feeling should be interpreted cautiously, these analyses do not support that pregnancy ambivalence is associated with select perinatal behaviors. The data suggest that women with negative pregnancy feelings may be at risk for pregnancy risk behaviors and that a series of questions—rather than a single question—may better identify the highest risk women. Social workers in a variety of settings are in a unique position to query women about their pregnancy attitudes and feelings. Women at highest risk can be identified and referred to appropriate services for healthy lifestyle interventions and for early and adequate prenatal care.