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.