Preconception Health Among Women with Frequent Mental Distress: A Population-Based Study

Purpose: We examined the extent to which mental distress may be associated with a woman's preconception health. Methods: We analyzed population-based, self-reported data from the 2005, 2007, and 2009 Behavioral Risk Factor Surveillance System (BRFSS) and limited analyses to 213,137 women aged 18-44 years. Women whose mental health was not good for >= 14 days during the past month were categorized as having frequent mental distress. For 15 preconception health indicators, we used chi-square tests to measure differences in prevalence by mental distress and the average marginal predictions approach to logistic regression to assess associations between mental distress and each preconception health indicator in separate models, adjusted for demographic characteristics. We conducted analyses using SUDAAN software to account for the complex sampling design and used weights to produce unbiased estimates. Results: The prevalence of good preconception health for each indicator was higher for women reporting infrequent mental distress (chi-square p value < 0.001 for all). The greatest disparities in preconception health between women with infrequent and frequent mental distress, respectively, were adequate social and emotional support (adjusted prevalence ratio [aPR] = 1.4, prevalence = 83.7% and 54.8%), not smoking (aPR = 1.2, 82.3% and 62.4%), adequate fruit and vegetable consumption (aPR = 1.2, 26.1% and 21.5%), normal weight (aPR = 1.2, 50.4% and 39.0%), and good general health (aPR = 1.2, 91.7% and 71.5%). Conclusions: Interventions tailored for women with poor mental health may be needed to target specific preconception health indicators, such as social support, smoking, weight, and nutrition.