Background:
Racial and ethnic minorities are at increased risk for infant mortality, low birth weight, and fetal alcohol syndrome. Many of the risk factors for these outcomes are best addressed during the preconception period.

Objectives:
To examine disparities in multiple risk factors that can lead to poor preconception health among childbearing age women by age, education, and race/ethnicity.

Methods:
Data from the 2006 Behavioral Risk Factor Surveillance System were analyzed to assess the prevalence of multiple risk factors (i.e. 2 or more risk factors among binge drinking; current smoking; obesity; nongestational diabetes; and frequent mental distress, i.e., 14 or more mentally unhealthy days during the previous 30 days) for poor preconception health among 60,285 nonpregnant U.S. women, aged 18-44, by demographic groups.

Results:
Among all women, 15.9% reported binge drinking, 21.3% were current smokers, 22.0% were obese, 2.1% had diabetes, and 13.4% reported frequent mental distress. Overall, 18.3% had multiple risk factors. The prevalence of multiple risk factors decreased with increasing education. The prevalence of multiple risk factors was highest among American Indians and Alaska Natives (29.1%, 95% CI = 23.8-35.0) and lowest among Asians (6.0%, 95% CI = 3.1-11.1). American Indians and Alaska Native women reported the highest prevalence of current smoking, diabetes, and frequent mental distress. Black (19.0%, 95% CI = 17.3-20.8) and white (19.6%, 95% CI = 18.9-20.4) women had a similar prevalence of multiple risk factors with whites more likely to report binge drinking and current smoking and blacks more likely to report obesity and diabetes.

Conclusion and implications for practice:
One in five (18.3%) women of childbearing age had multiple risk factors for poor preconception health. Women with less than a high school education and American Indian and Alaska Native women were most likely to have multiple risk factors for poor preconception health. Making comprehensive preconception care available to all women might reduce risk factors and help to decrease existing disparities in birth outcomes.