The Role of Pregnancy Intentions in U.S. Women's Contraceptive and Alcohol Use Behaviors

Abstract

Background Alcohol use in early pregnancy increases the risk for Fetal Alcohol Spectrum Disorders. Women who engage in heavy drinking and become pregnant when they are not actively trying to conceive are at heightened risk for alcohol-exposed pregnancies. Identifying factors associated with greater risk for alcohol-exposed pregnancies is critical for prevention. Objective This study explored the odds of contraceptive nonuse and heavy drinking for women trying to conceive or ambivalent about pregnancy as compared to those trying to avoid pregnancy. Methods Logistic regression analysis was used to examine the role of pregnancy intentions, including ambivalence, on contraceptive nonuse and heavy drinking among a national sample of 583 sexually active heterosexual women of childbearing age conducted online in 2024. Results Results showed that women who are trying to conceive or are ambivalent about pregnancy have higher odds of contraceptive nonuse than women trying to avoid pregnancy (OR = 13.19, p < .01 and OR = 3.56, p < .001, respectively), but no significant differences in heavy alcohol use by pregnancy intention. Conclusion Pregnancy intentions are associated with contraceptive nonuse but not heavy alcohol use. Delayed pregnancy recognition among those not actively trying to conceive but also not consistently using an effective form of contraception might place women who are avoiding or ambivalent about pregnancy at heightened risk for an alcohol-exposed pregnancy.