Perceived risk of preterm and low-birthweight birth in the Central Pennsylvania Women's Health Study.

Preterm and low-birthweight births continue to be significant causes of perinatal mortality and morbidity in the United States. Although prenatal care became more accessible after the mid-1980s with expansion of Medicaid coverage, rates of adverse pregnancy outcomes have not improved, and there is even evidence that these adverse pregnancy outcomes are on the rise.1 Perhaps this is not surprising because the prenatal period is a narrow one in which to intervene in hopes of improving pregnancy outcomes. Optimizing health in the preconception stage may prove to be more effective than prenatal care alone in reducing the incidence of adverse pregnancy outcomes and perhaps maternal health in general.2 In response to these issues, the Centers for Disease Control and Prevention (CDC) has made improving preconception health delivery a priority as detailed in their recent recommendations on preconception health.3 Meeting the recommendations set out by the CDC will require engagement of both the health care delivery system and active participation of women in the preconception period. The Health Belief Model suggests that perceived susceptibility to a condition and perceived severity of a condition contribute to likelihood of engaging in health-promoting behavioral change.4 Adopting this theory, we hypothesized that women who perceive increased susceptibility (or risk) of an adverse pregnancy outcome (as well as perceive increased severity of these outcomes) are more inclined to participate in preconception health optimization programs. The main purpose of this research was to better understand how women perceive their risk of pre-term and low-birthweight birth. However, whether risk perception of adverse pregnancy outcome directly affects preconception health promotion has yet to be investigated. We used the commonly applied Psychometric Model of risk perception to model our study design. The Psychometric Model suggests that people perceive risk across 2 principal factors: how well the risk is understood and how much of a feeling of dread it evokes.5,6 Applying the first factor of the Psychometric Model, we considered groups of women who have higher understanding of preterm/low-birthweight birth. This may be women who have had previous experience (either direct or indirect) with pre-term or low-birthweight birth or women with known risks for preterm birth or low-birthweight birth (such as advancing age, nonwhite race, underweight, hypertension, smokers) who have been counseled by health care providers about those risk factors and therefore perceive an increased risk. The second factor in risk perception as described by the Psychometric Model is defined by the amount of a feeling of dread is evoked by thoughts of the hazard. We hypothesized that a greater feeling of dread may be seen in women who feel less control or self-efficacy toward achieving a healthy pregnancy. This may be the case in women with higher levels of psychosocial stress or lower overall health status. In this study, we use the Central Pennsylvania Women's Health Study (CePAWHS), a population-based cohort of reproductive-age women, to determine how women perceive their risk of preterm or low-birthweight birth. Based on the Psychometric Model of risk perception, we also analyzed whether sociodemographics, pertinent health variables, pregnancy history, health status, health behaviors, attitudes, or health care utilization are associated with risk perception of preterm or low-birthweight birth.