The influence of deprivation and pregnancy planning on multiple health behaviour change before pregnancy: a secondary analysis of the Scottish Maternal and Infant Nutrition Survey

Abstract

Background Engaging in multiple, positive health behaviours prior to pregnancy improves health of adults and their future offspring for generations. Socio-demographic factors are often associated with health behaviours and outcomes, e.g. people from more deprived areas are more likely to engage in health risk behaviours during pregnancy and have highest rates of unplanned pregnancies, ultimately perpetuating health inequalities. This secondary analysis aimed to explore how relative deprivation and pregnancy planning status influence multiple health behaviour change before conception. Methods Secondary analysis was conducted on The Scottish Maternal and Infant Nutrition Survey (SMINS), a large-scale survey distributed to pregnant women across Scotland in 2017. Demographic data were collected including a measure of deprivation using the Scottish Index of Multiple Deprivation (SIMD), along with pregnancy planning status (London Measure of Unplanned Pregnancy, LMUP) which includes one question self-reporting behaviour changes prior to pregnancy (e.g. folic acid, smoking, alcohol and diet). A composite score for multiple behaviour change was generated ranging from zero to four where a higher score indicated greater health behaviour changes. Results Of the 2,523 responses, 78% of pregnancies were classed as planned (LMUP 10-12), 19% as ambivalent (LMUP 4-9) and 3% unplanned (LMUP 0-3). There was a significant effect of deprivation on mean composite score for health behaviour change (p<.05) where behaviour change scores in the most deprived quintile, SIMD 1 (M=.93, SD=1.08), were significantly lower than every other SIMD quintile. There was a significant effect of pregnancy planning on multiple behaviour change (p<.001) where multiple health behaviour change was significantly higher in the planned category (M=1.5, SD=1.06) than the ambivalent category (M=0.23, SD=0.60) and the unplanned category (M=0.04, SD=0.26). Overall change in multiple health behaviours was low. Across all participants, there was a higher degree of psychological planning compared to behavioural planning. Conclusions There is sub-optimal engagement in multiple health behaviour change before conception. However, this is particularly low among non-planners and people living in areas of higher deprivation. Individuals psychologically prepare for pregnancy more than they behaviourally prepare. Lack of behavioural preparation can have negative impacts on the physical health of women and babies.