Abstract
Objective
Conflicting research findings on the association of obesity and pregnancy intention
may be due to their collective definition of obesity at a body mass index of 30 kg/m2 or greater. However, obese women with a BMI of 40 kg/m2 or greater may be both behaviorally and clinically different from obese women with
a lower BMI. This study reexamines this relationship, stratifying by class of obesity;
the study also explores variations in contraceptive use by class of obesity given
their potential contribution to the incidence of unintended or unwanted pregnancy.
Methods
This study combined data from the 2006 through 2010 and 2011 through 2013 US National
Survey of Family Growth. Pregnancy intention (intended, mistimed, unwanted) and current
contraceptive use (no method, barrier, pill/patch/ring/injection, long-acting reversible
contraceptive, sterilization) were compared across body mass index categories: normal
(18.5–24.9 kg/m kg/m2), overweight (25.0–29.9), obese class 1 (30.0–34.9 kg/m2), class 2 (35.0–39.9 kg/m2), and class 3 (≥40 kg/m2, severe obesity). Weighted multinomial logistic regressions were refined to determine
independent associations of body mass index class and pregnancy intention, as well
as contraceptive method, controlling for demographic, socioeconomic, and reproductive
factors.
Results
Body mass index data were available for 9,848 nonpregnant, sexually active women who
reported not wanting to become pregnant. Women with class 3 obesity had significantly
greater odds of mistimed (adjusted odd ratio [aOR], 1.67; 95% confidence interval
[CI], 1.02–2.75) or unwanted (aOR, 1.96; 95% CI, 1.15–3.32) pregnancy compared with
normal weight women. Women with class 2 or 3 obesity were more likely to not be using
contraception (aOR, 1.53–1.62; 95% CI, 1.04–2.29). Although women with class 2 obesity
were more likely to be using long-acting reversible contraceptive methods and sterilization
over short-acting hormonal methods (aOR, 1.67; 95% CI, 1.08–2.57; aOR, 2.05; 95% CI,1.44–2.91),
this association was not observed among women with class 3 obesity.
Conclusions
Women with class 3 obesity are at greater risk of unintended pregnancy and are less
likely to be using contraception than normal weight women. Whether these findings
are related to patient and/or provider barriers that are not as visible among women
with class 1 and class 2 obesity warrants further investigation.
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Biography
Dr. Brian T. Nguyen, MD, MSCP, is an assistant professor within the Department of Obstetrics and Gynecology at the University of Southern California and assistant program director for the Fellowship in Family Planning. Dr. Nguyen’s research addresses reproductive health disparities, with interest in the contributions of gender-based and structural barriers.
Biography
Jennifer L. Elia, DrPH, MPH, is an Assistant Researcher in the Department of Obstetrics, Gynecology, & Women’s Health at the University of Hawai‘i John A. Burns School of Medicine. Her research interests include health disparities, pregnancy intention, contraceptive use, and community engagement.
Biography
Cathrine Y. Ha is an undergraduate student at USC studying Health & Human Sciences and Gender Studies. As an aspiring Obstetrician Gynecologist, she is interested in how gender operates both positively and negatively in both healthcare and medicine.
Biography
Dr. Bliss E. Kaneshiro, MD, MPH, is a board-certified Obstetrician Gynecologist, Program Director of the Family Planning Fellowship, and Chief of the Family Planning Division at the University of Hawaii. She is also the Medical Director of Family Planning for the Hawaii State Department of Health.
Article info
Publication history
Published online: November 13, 2017
Accepted:
September 20,
2017
Received in revised form:
September 13,
2017
Received:
April 15,
2017
Footnotes
Conflicts of Interest: None.
Financial Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc.
