Introduction 1 2 3 2 4 4 Data 5 5 The survey includes core modules asked in all states, rotating modules asked every second year in all states, and optional modules that are included only in some states. Being a general survey, the BRFSS lacks information on some factors of interest to the present topic, for example month of pregnancy for pregnant women, or information on prenatal care. Further, the BRFSS is not designed specifically to study all known risk behaviors at preconception or pregnancy. In addition, as an interview survey, the survey relies on self-reported data which contain an unknown level of reporting error. 2 Table 1 Comparison of age and race/ethnicity, 2004 Women in preconception and pregnant (BRFSS) and Births (Vital Statistics data)  BRFSS  Preconception women Pregnant women Vital statistics  Percent CI Percent CI births Percent Age group       18–19 2.0 0.9 7.5 2.2 7.1  20–24 16.3 3.3 26.5 3.0 26.1  25–29 23.4 3.1 26.5 2.7 27.9  30–34 28.4 3.1 26.2 2.8 24.4  35–39 18.5 2.5 10.2 1.5 12.0  40–44 11.4 2.2 3.1 0.9 2.6  100.0  100.0   Race/ethnicity  NH White 64.9 3.9 60.1 3.4 56.8  NH Black 11.9 2.5 11.5 1.9 13.6  Hispanic 16.0 3.5 23.0 3.4 22.5  Others 7.2 2.1 5.5 1.6 7.2  100.0  100.0  100.0 Note. Table 2 Health risk indicators by pregnancy status Women 18–44, 2004 and 2002 BRFSS  Preconception women Pregnant women  Percent CI Percent CI a  General Health   Poor/fair general health status 8.3 2.1 6.4 1.7 * 12.8 2.4 9.6 1.9 * 18.8 3.5 11.9 2.3   No dental visit past year 28.3 3.2 30.2 3.1 * 2.0 0.9 0.7 0.4  HIV   Don’t know about prevention of MTC HIV transmission 38.2 3.5 34.1 3.0 * 34.9 3.4 24.4 3.0 * 4.3 1.4 6.9 1.8  Alcohol/smoking * 53.9 3.7 10.7 1.8 * 6.0 2.0 0.8 0.5 * 10.7 2.1 1.9 0.9 * 12.9 2.5 2.2 0.9 * 19.4 2.7 8.4 1.5  Obesity   Overweight, body mass index (BMI) >25 46.0 3.6 NA    Obese, BMI >30 22.4 3.1 NA  b,c  Folic acid   Don’t know about folic acid for birth defects prevention 46.1 6.9 38.4 5.6 * 36.9 7.1 10.2 3.6 * 38.4 7.0 17.5 4.5 daily * 44.8 6.9 19.9 4.7 d * 74.9 3.1 64.7 3.5  Fewer than 1 servings/fruit and vegetables 3.3 1.1 2.9 1.3 Note. a b c d * p ** Statistical methods 1 6 t Results 1 2 higher 7 2 8 3 3 Table 3 a  Preconception women (Estimated number) Currently pregnant women (Estimated number)  Percent CI 1000s CI N Percent CI 1000s CI N Total * 3.7 1,024 94 2286 32.0 3.1 835 101 2949 No health plan/insurance 63.4 11.7 222 52 328 52.7 10.3 156 50 303 Others * 3.7 802 79 1957 29.4 3.2 679 88 2646 No personal doctor * 9.0 278 59 448 46.3 9.2 234 73 467 Others * 3.9 745 73 1837 28.6 2.9 601 71 2482 Note. a * p Discussion The 2004 BRFSS provides an opportunity to measure the extent of risk behaviors on a relatively large sample of women who are planning to become pregnant. These nationally-representative survey data indicate that major health risks were reported by substantial proportions of US women in the preconception period. The data suggest that among those at risk during preconception, the majority continued the risk into pregnancy. Women appear to respond to messages regarding behaviors that can improve pregnancy outcomes such as consuming of folic acid, and the reduction in smoking, alcohol consumption, but many remain unaware of the benefits of available interventions to prevent HIV transmission and birth defects. The fact that more than one-third of preconception and pregnant women were not aware of methods to prevent mother-to-child HIV transmission and did not know about the benefits of taking folic acid during pregnancy suggests that education and public information programs could have some effect in reducing risk behaviors. 4 6 8 11 The finding that the percentage who report some risk behaviors is significantly lower among pregnant women compared with women in the preconception period may indicate the desire of many pregnant women to adopt healthier behaviors to achieve the best possible outcome for their pregnancy. Examination of three well known risk factors for which interventions are available (frequent alcohol consumption, current smoking, or never having been tested for HIV) illustrates that risks for adverse pregnancy outcomes exist among more than half of women in the preconception period and among one-third of pregnant women. Nationwide, this represents approximately one million women in the preconception period and 835,000 pregnant women. 5 10 4 12 13 14 15 13 16