Sun-protective behaviors among pregnant patients: a cross-sectional analysis of the NHANES database from 2005 to 2023

Pregnancy is associated with physiologic skin changes and altered considerations surrounding ultraviolet exposure and sun protection. However, sun-protective behaviors (SPBs) during pregnancy have not been well characterized at a population level. We conducted a cross-sectional analysis of women aged 20 to 59 years using data from the National Health and Nutrition Examination Survey from 2005 to 2023 to evaluate differences in SPBs between pregnant and nonpregnant women. Demographic, socioeconomic, and SPB data were compared by pregnancy status. Multivariable logistic regression models were used to estimate associations between pregnancy status and SPBs, adjusting for age, race/ethnicity, education, and household income. Temporal trends in SPBs across survey periods were also evaluated. Among 11,509 women included, 820 were pregnant at the time of survey participation. In adjusted analyses, pregnancy was associated with greater odds of shade-seeking behavior (adjusted odds ratio: 1.31, 95% confidence interval: [1.08–1.59]) and lower odds of reporting sunburn within the prior year (adjusted odds ratio: 0.82; 95% confidence interval: [0.68–0.98]). No significant differences were observed in sunscreen use or long-sleeved shirt use after adjustment. Across survey periods, SPBs generally increased over time among both pregnant and nonpregnant women, particularly for shade-seeking, long-sleeved shirt use, and sunscreen use. These findings suggest distinct patterns of sun protection during pregnancy, with decreased reliance on clothing-based and sunscreen protection but fewer reported sunburns. Pregnancy-specific counseling should emphasize safe and effective sun protection strategies, including shade-based behaviors and the use of mineral sunscreens.