Pregnancy Prevalence in the U.S.: A Multilevel Examination of Race, Sociodemographic Factors, and Behavioral Characteristics Using the NSDUH.

OBJECTIVE

This paper explores the association between pregnancy prevalence, race, sociodemographic stressors, and behavioral factors among U.S. women.

METHODS

Using the 2024 National Survey on Drug Use and Health (NSDUH) data (n = 22,172 women), cross-sectional analyses were conducted, including bivariate and multivariate regression analyses. Model fit was assessed using McFadden pseudo-R² and likelihood ratio tests.

RESULTS

Pregnancy prevalence in the analytic sample was 2.6%. In the reduced fully adjusted model, marital status, educational attainment, insurance coverage, alcohol use frequency, and past 30-day cigarette use were independently associated with pregnancy status. Marital status was independently associated with pregnancy status (OR = 0.96, 95% CI: 0.94-0.98, p = 0.0002). Higher educational attainment was associated with reduced odds of pregnancy (OR = 0.80, 95% CI: 0.74-0.87, p < 0.001). Insurance coverage was associated with lower odds (OR = 0.68, 95% CI: 0.50-0.92, p = 0.011). Alcohol use frequency was positively associated with pregnancy status (OR = 1.03 per unit increase, p < 0.001), and past 30-day cigarette use was modestly associated (OR = 1.01, p = 0.0015). Race/ethnicity and income were not independently associated with pregnancy after adjustment. The final reduced model demonstrated meaningful explanatory power (McFadden pseudo-R² = 0.1310) after addressing multicollinearity among predictors.

CONCLUSIONS

Pregnancy status among U.S. women reflects the intersection of marital structure, educational attainment, healthcare access, and health behaviors rather than race operating independently. These findings support a structural determinants framework in understanding reproductive health disparities and highlight the importance of integrating socioeconomic and behavioral considerations in reproductive health policy and intervention efforts.