Examining the roles of pregnancy intention and perceived infertility risk on preconception health behaviors to optimize pregnancy among female survivors of adolescent and young adult cancers

Background: Fertility and family planning are key areas of focus for adolescent and young adult (AYA) cancer survivors. Pregnancy intention is associated with preconception health behaviors in healthy populations of women, but few studies explored the role of intention among AYA cancer survivors. Aims: The aims of this dissertation were to evaluate: 1) if pregnancy intentions are associated with preconception health behavior, 2) if perceptions on post-cancer treatment infertility risk were associated with varying engagement in preconception health behavior, and 3) what factors informed infertility risk perception and are associated with to discordant estimation. Methods: Data for the dissertation came from participants consented to the Reproductive Window in Young Adult Cancer Survivors (Window) study, a longitudinal study to estimate the trajectory of ovarian function among AYA survivors. Participants were followed for 1.5 years encompassing 4 data collection time points from baseline and every 6 months. Study #1 utilized baseline data to evaluate the association between pregnancy intention and preconception behavior with regression analysis. Study #2 utilized data from all 4 time points; associations between changing pregnancy intention and preconception behavior was determined by longitudinal mixed effects. Both Study #1 & #2 evaluated potential effect modification by infertility risk perception. Study #3 utilized baseline surveys, treatment details abstracted from medical charts, and ovarian reserve measured by biomarkers. Multivariable logistic regressions evaluated associations with perceived infertility risk and with discordant risk estimation between perceived and objective infertility risk. Results: Study 1 and 2 found urgent pregnancy intention was associated with higher preconception PA. Study #1 found among survivors with higher pregnancy intention, perception of infertility risk resulted in more PA compared to women who did not perceive reduced infertility. Study 3 found both higher gonadotoxicity of cancer treatment and amenorrhea were associated with higher odds of infertility risk perception. Survivors perceived infertility risk was in poor agreement with objective infertility risks. Conclusions: The dissertation provided insight into the role of pregnancy intention on preconception health behavior and identified factors that may inform perceived infertility risk. The knowledge gained from this dissertation may guide preconception behavioral interventions targeting female AYA survivors and inform infertility risk education needs within survivorship care