Article Text

Medical, behavioural and social preconception and interconception risk factors among pregnancy planning and recently pregnant Canadian women
  1. Cindy-Lee Dennis1,2,
  2. Alessandra Prioreschi3,
  3. Hilary K Brown4,5,
  4. Sarah Brennenstuhl1,
  5. Rhonda C Bell6,
  6. Stephanie Atkinson7,
  7. Dragana Misita6,
  8. Flavia Marini2,
  9. Sarah Carsley4,8,
  10. Nilusha Jiwani-Ebrahim9 and
  11. Catherine Birken10,11
  1. 1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  2. 2St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
  3. 3SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
  4. 4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  5. 5Department of Health & Society, University of Toronto, Toronto, Ontario, Canada
  6. 6Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
  7. 7Paediatrics, McMaster University, Hamilton, Ontario, Canada
  8. 8Public Health Ontario, Toronto, Ontario, Canada
  9. 9York Region Public Health, Vaughan, Ontario, Canada
  10. 10Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  11. 11Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Cindy-Lee Dennis; cindylee.dennis{at}


Objectives The objective of this study is to describe the clustering of medical, behavioural and social preconception and interconception health risk factors and determine demographic factors associated with these risk clusters among Canadian women.

Design Cross-sectional data were collected via an online questionnaire assessing a range of preconception risk factors. Prevalence of each risk factor and the total number of risk factors present was calculated. Multivariable logistic regression models determined which demographic factors were associated with having greater than the mean number of risk factors. Exploratory factor analysis determined how risk factors clustered, and Spearman’s r determined how demographic characteristics related to risk factors within each cluster.

Setting Canada.

Participants Participants were recruited via advertisements on public health websites, social media, parenting webpages and referrals from ongoing studies or existing research datasets. Women were eligible to participate if they could read and understand English, were able to access a telephone or the internet, and were either planning a first pregnancy (preconception) or had ≥1 child in the past 5 years and were thus in the interconception period.

Results Most women (n=1080) were 34 or older, and were in the interconception period (98%). Most reported risks in only one of the 12 possible risk factor categories (55%), but women reported on average 4 risks each. Common risks were a history of caesarean section (33.1%), miscarriage (27.2%) and high birth weight (13.5%). Just over 40% had fair or poor eating habits, and nearly half were not getting enough physical activity. Three-quarters had a body mass index indicating overweight or obesity. Those without a postsecondary degree (OR 2.35; 95% CI 1.74 to 3.17) and single women (OR 2.22, 95% CI 1.25 to 3.96) had over twice the odds of having more risk factors. Those with two children or more had 60% lower odds of having more risk factors (OR 0.68, 95% CI 0.52 to 0.86). Low education and being born outside Canada were correlated with the greatest number of risk clusters.

Conclusions Many of the common risk factors were behavioural and thus preventable. Understanding which groups of women are prone to certain risk behaviours provides opportunities for researchers and policy-makers to target interventions more efficiently and effectively.

  • Health
  • Women's Health
  • Maternal-Child Health Services

Data availability statement

Data are available on reasonable request. Data are available by request via the corresponding author.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available on reasonable request. Data are available by request via the corresponding author.

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  • Contributors C-LD, AP, SC, HKB and SB wrote the first draft of the manuscript; C-LD, CB, FM, RCB, DM and SA participated in research design and data collection. SB, C-LD and AP contributed to data analysis and interpretation. C-LD, CB, FM, RCB, SA, NJ-E and DM contributed to questionnaire development. C-LD is the guarantor and accepts full responsibility for the work, conduct of the study, had access to the data and controlled the decision to publish. All authors contributed to reviewing the manuscript and the decision to submit for publication. No honorarium, grant or other form of payment was given to anyone to produce the manuscript.

  • Funding This study was supported by a Canadian Institutes of Health Research Healthy Life Trajectories Initiative grant (grant # HLC-154502).

  • Disclaimer The sponsor had no role in the study design; collection, analysis, or interpretation of data, writing of the manuscript, or decision to submit the proposal for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.