Original research article Contraception counseling, pregnancy intention and contraception use in women with medical problems: an analysis of data from the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) Jamila B. Perritt a, ⁎ , Anne Burke a , Roxanne Jamshidli a , Jiangxia Wang b , Michelle Fox a a The Johns Hopkins University, Baltimore, MD, 21224, USA b Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21224, USA Received 17 August 2011; revised 7 November 2012; accepted 7 November 2012 Abstract Background: Data from the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) were used to evaluate whether women with selected medical comorbidities are less likely than healthier women to report receiving contraceptive counseling during pregnancy and to report using contraception postpartum. Methods: We analyzed de-identified data from the 2004–2007 Maryland PRAMS using logistic regression to evaluate these outcomes: undesired pregnancy, self-reported antepartum contraceptive counseling and postpartum contraceptive use for women with and without hypertension, diabetes or heart disease. Survey data were used to estimate response frequency within the Maryland birth population. Results: Patient self-report of contraceptive use increased overall during the postpartum period as compared to the antepartum period, from 44.3%–90.1% (pb.001). Almost one fourth (23%) of 6361 respondents reported receiving no contraceptive counseling. There was no difference in reported contraceptive counseling in women with selected medical comorbidities as compared to those without, and only women with preconception diabetes mellitus were significantly less likely than healthier women to report postpartum contraceptive use. Conclusions: Overall, there was no difference in the report of receiving contraceptive counseling in women with selected medical comorbidities as compared to than those without. In addition, they were not more likely to report receiving contraceptive counseling either despite higher risk of pregnancy complications. These results indicate lost opportunities for effective counseling that could improve health outcomes. © 2013 Elsevier Inc. All rights reserved. Keywords: Pregnancy Risk Assessment Monitoring System: Contraceptive counseling; Medical comorbidities; PRAMS; Contraception 1. Introduction By age 45, more than half of women in the United States (US) will have had at least one unintended pregnancy with half of these ending in abortion [1,2]. Studies suggest that the rates of unintended pregnancy among women with some chronic conditions are similar to or may even exceed rates in the general population [3,4]. Women with some medical problems who carry their pregnancies to term are often more vulnerable to pregnancy-related complications than their healthier counterparts [5,6]. Compared to women with intended pregnancies, mothers who describe their pregnancy as unwanted or mistimed are more likely to engage in unhealthy perinatal behaviors and to have poorer maternal and birth outcomes [7,8]. This problem is compounded in women with medical comorbidities, such as hypertension, diabetes and cardiovascular disease, which may worsen during pregnancy and further compromise maternal and child health. The ability to plan a pregnancy is a key factor in improving all pregnancy outcomes, especially those for women with medical disorders. The American College of Obstetricians and Gynecologists (ACOG) and the US Centers for Disease Control and Prevention (CDC) recom- mend that women with medical comorbidities optimize their health prior to conception [9,10]. Consistent use of effective contraceptives is crucial to obtaining this goal. Many Contraception 88 (2013) 263 – 268 ⁎ Corresponding author. The Johns Hopkins University, OB/GYN, 4940 Eastern Ave., Baltimore, MD 202224. Tel.: +1-202-225-5992. E-mail address: jamila_perritt@hotmail.com (J.B. Perritt). 0010-7824/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.contraception.2012.11.009