Predicting Pregnancy Risk in Women

Background:
Most STD clinics focus solely on STD treatment and prevention. However, certain women presenting for care are also at high-risk for unintended pregnancy.

Objective:
To evaluate the relationship between baseline demographic and clinical characteristics and incident pregnancy among women provided contraception in an STD clinic and to identify which women are at risk for unintended pregnancy.

Method:
Computerized record review of women attending an STD clinic who initiated contraception, were seen at least twice within a four year period (repeat visitors), and who indicated no intention of pregnancy were included in these analyses. Incident pregnancy was defined as change in gravida or positive pregnancy test at subsequent visit. Association between baseline demographic, behavioral, and clinical characteristics and incident pregnancy were assessed using multivariate logistic regression.

Result:
Among 4,617 women seen from 2003 to 2006, 710 (15%) were repeat visitors and 3,907 (85%) were single visitors (only seen during a single year). Among repeat visitors, 642 (90%) indicated no interest in subsequent pregnancy, of which 138 (19.3%) had a subsequent pregnancy. Using multivariate analysis and controlling for age and race/ethnicity, incident pregnancy was associated with previous pregnancy (OR 2.57, 95% CI: 1.63-4.04), ≤150% Federal Poverty Level (OR 2.22, 95%CI: 1.05-4.71), and no contraceptive use at last sex (OR 1.67, 95%CI: 1.11-2.52). Incident pregnancy was not associated with educational level, sexual frequency, age of first pregnancy, number of partners, prior therapeutic abortion, current STD, prior STD, or provision of effective contraception at the initial STD clinic visit.

Conclusion:
Certain baseline characteristics identified a subset of women at high-risk for unintended pregnancy. Targeted interventions that address identified risk factors associated with unintended pregnancy are needed.

Implications:
Certain women attending STD clinics are at high-risk for unintended pregnancy. STD clinics should implement integrated programs that target these high-risk women for both pregnancy and STD/HIV prevention.