Original article Factors associated with pregnancy intention among women who have experienced a short birth interval: findings from the 2009 to 2011 Mississippi and 2009 Tennessee Pregnancy Risk Assessment Monitoring System Larissa R. Brunner Huber, PhD a,* , Kenesha Smith, MSPH a , Wei Sha, PhD b , Liang Zhao, BS b , Tara Vick, MD c a UNC Charlotte, Department of Public Health Sciences, Charlotte, NC b UNC Charlotte, Department of Bioinformatics and Genomics, Charlotte, NC c Carolinas Medical Center, Department of Obstetrics and Gynecology, Charlotte, NC article info Article history: Received 10 August 2017 Accepted 24 March 2018 Available online xxx Keywords: Birth intervals Rapid repeat pregnancy Unplanned pregnancy Unwanted pregnancies abstract Purpose: One-third of all pregnancies in the United States are conceived within 18 months of a prior live birth. Preventing unintended pregnancies may help to decrease the prevalence of pregnancies with these short interpregnancy intervals. However, data on factors associated with pregnancy intention among women who have had short birth intervals are sparse. Pregnancy Risk Assessment Monitoring System data were used to further evaluate these associations. Methods: Because only Mississippi and Tennessee Pregnancy Risk Assessment Monitoring System include a survey question about birth interval length, this analysis was limited to women from those states who recently had a short birth interval (n ¼ 384). Pregnancy intention and demographic, lifestyle, and reproductive data were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: Nearly 76% of women with short birth intervals reported their pregnancy as unintended. Women who were non-Hispanic black or consumed alcohol during pregnancy had statistically significant increased odds of reporting the pregnancy with a short birth interval as being unintended (OR ¼ 3.98; 95% CI: 1.73e9.16 and OR ¼ 10.56; 95% CI: 1.80e61.83, respectively). Conclusions: Although all women should be counseled on postpartum contraceptive use, findings sug- gest that important subpopulations of women may benefit from more targeted counseling during pre- natal care visits and the immediate postpartum hospital stay regarding the importance of using contraception to not only better space pregnancies but also prevent unintended pregnancies. © 2018 Elsevier Inc. All rights reserved. Introduction Pregnancies with short interpregnancy intervals account for one-third of pregnancies in the United States [1]. Evidence suggests that women should wait at least 18 months after a live birth before attempting their next pregnancy to avoid adverse pregnancy out- comes [2]. In particular, many studies have demonstrated that short interpregnancy intervals are associated with increased risks of preterm birth and low birth weight [3e16]. Although not studied extensively, research also suggests that short interpregnancy in- tervals are associated with other adverse pregnancy outcomes including small for gestational age, birth defects, fetal or neonatal death, anemia, premature rupture of membranes, third trimester bleeding, placenta previa, and maternal death [3e5]. Consequently, one of the Healthy People 2020 objectives is to reduce the pro- portion of pregnancies conceived within 18 months of a previous birth to 29.8%, a 10% improvement [1]. A number of studies have investigated factors associated with short interpregnancy intervals, with many of these studies focusing on adolescents [17e21] or other specific populations such as African-born immigrants [22]. Factors found to be associated with * Corresponding author. UNC Charlotte, Department of Public Health Sciences, 9201 University City Blvd., Charlotte, NC 28223-0001. Tel.: 704-687-8719. E-mail address: lrhuber@uncc.edu (L.R. Brunner Huber). Contents lists available at ScienceDirect Annals of Epidemiology journal homepage: www.annalsofepidemiology.org https://doi.org/10.1016/j.annepidem.2018.03.012 1047-2797/© 2018 Elsevier Inc. All rights reserved. Annals of Epidemiology xxx (2018) 1e5 Please cite this article in press as: Brunner Huber LR, et al., Factors associated with pregnancy intention among women who have experienced a short birth interval: findings from the 2009 to 2011 Mississippi and 2009 Tennessee Pregnancy Risk Assessment Monitoring System, Annals of Epidemiology (2018), https://doi.org/10.1016/j.annepidem.2018.03.012