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Multiple Lifestyle and Psychosocial Risks and Delivery of Small for Gestational Age Infants

From the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta; Children’s Healthcare of Atlanta, Atlanta; and TRW, Inc., Atlanta, Georgia.

Address reprint requests to: Indu B. Ahluwalia, MPH, PhD Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention 4770 Buford Highway, NE Mailstop K-22 Atlanta, GA 30341-3717 E-mail: iahluwalia{at}cdc.gov

Objective: To examine the occurrence of multiple risk behaviors during pregnancy among women who delivered a live birth and to examine the risk of delivering small for gestational age (SGA) infants for women with multiple risks.

Methods: We used data from the Pregnancy Risk Assessment Monitoring System to conduct the research. Pregnancy Risk Assessment System is a population-based, mixed-mode surveillance system that collects information on maternal behaviors and experiences. We used data for 1997 from 13 (n = 19,331) states that had response rates of over 70%. We considered ten self-reported individual risk behaviors or exposures (eg, smoking, unintended pregnancy) and several demographic variables. The main outcome was SGA.

Results: Pregnant women engage in or are exposed to multiple risks and often these risks are inter-related. The occurrence of multiple risks appears to be associated with an increased likelihood of delivering an SGA infant. Compared with women with no reported risks or exposures, the adjusted odds ratios for delivering an SGA infant were as follows: 1.29 (95% confidence interval [CI] 0.69, 2.43) for one, 1.86 (95% CI 1.00, 3.44) for two, 1.67 (95% CI 0.90, 3.10) for three, 2.06 (95% CI 1.10, 3.89) for four, 3.53 (95% CI 1.71, 7.30) for five, and 3.82 (95% CI 1.97, 7.41) for six or more risks or exposures.

Conclusion: A large proportion of pregnant women engage in or are exposed to multiple risks. Women with a larger number of risks are at greater risk for delivering an SGA infant than women with fewer or no risks.

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