Objectives To determine the prevalence, patterns, and predictors of alcohol consumption prior to and during various intervals of pregnancy in the U.S. Methods Alcohol-related, pregnancy-related, and demographic data were derived from computer-assisted telephone interviews with 4,088 randomly selected control mothers from the National Birth Defects Prevention Study who delivered live born infants without birth defects during 1997–2002. Alcohol consumption rates and crude and adjusted odds ratios (OR) were calculated. Results 30.3% of all women reported drinking alcohol at some time during pregnancy, of which 8.3% reported binge drinking (4+ drinks on one occasion). Drinking rates declined considerably after the first month of pregnancy, during which 22.5% of women reported drinking, although 2.7% of women reported drinking during all trimesters of pregnancy and 7.9% reported drinking during the 3rd trimester. Pre-pregnancy binge drinking was a strong predictor of both drinking during pregnancy (adjusted OR = 8.52, 95% CI = 6.67–10.88) and binge drinking during pregnancy (adjusted OR = 36.02, 95% CI = 24.63–52.69). Other characteristics associated with both any drinking and binge drinking during pregnancy were non-Hispanic white race/ethnicity, cigarette smoking during pregnancy, and having an unintended pregnancy. Conclusions Our study revealed that drinking during pregnancy is fairly common, three times the levels reported in surveys that ask only about drinking during the month before the survey. Women who binge drink before pregnancy are at particular risk for drinking after becoming pregnant. Sexually active women of childbearing ages who drink alcohol should be advised to use reliable methods to prevent pregnancy, plan their pregnancies, and stop drinking before becoming pregnant.

Alcohol consumption by women before and during pregnancy

Preventing alcohol-exposed pregnancies: a randomized controlled trial.

Objective: The aim of the study was to determine the prevalence and characteristics of fetal alcohol syndrome (FAS) in a second primary school cohort in a community in South Africa. Method: Active case ascertainment, two-tier screening, and Institute of Medicine assessment methodology were employed among 857 first grade pupils, most born in 1993. Characteristics of children with FAS were contrasted with characteristics of a randomly selected control group from the same classrooms. Physical growth and development, dysmorphology and psychological characteristics of the children and measures of maternal alcohol use and smoking were analyzed. Results: The rate of FAS found in this study is the highest yet reported in any overall community in the world, 65.2-74.2 per 1,000 children in the first grade population. These rates are 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000). Detailed documentation of physical features indicates t...

Fetal alcohol syndrome epidemiology in a South African community: a second study of a very high prevalence area

A healthy baby and a healthy mother are valued hopes and dreams of families of all cultural heritages. National health goals in many countries around the world prioritize infant and maternal mortality and morbidity. In the United States, as in many other industrialized countries, pregnancy outcomes and maternal and infant health indicators have improved dramatically. At the turn of the 20th century, 7.28 women and 96 infants died for every 1,000 babies born alive [1]. By the end of the year 2000, the maternal mortality rate had decreased to less than 0.08 and infant mortality had decreased to less than 7 deaths per 1,000 live births [2]. These changes were characterized as one of the ten “great public health achievements” of the 20th century [3]. Much of this progress can be attributed to changes in social and living conditions as well as the development and implementation of effective medical interventions. Despite this progress, during the last two decades of the 20th century, even in the presence of significant breakthroughs in medical technology and its application, improvements in maternal and infant pregnancy ouctomes slowed down significantly, and in some cases, outcomes deteriorated. For example, from 1960 to 1980, the maternal mortality rate decreased from 32.1 to 9.4 deaths per 100,000 live births, a decrease of 70.7%. From 1980 to 2000, the maternal mortality rate decreased only 12.8%, from 9.4 to 8.2 (Figure 1) [2]. At the same time, from 1980 to 2000, the proportion of babies born preterm, very preterm, low birth weight, and very low birth weight increased by 26%, 8.2%, 14.7% and 25.9%, respectively (Figure 2) [4]. However, unlike other maternal and infant health indicators, from 1980 to 2000 the infant mortality rate continued to decrease almost at a similar pace as that from 1960 to 1980, dropping by 45.2% from 12.6 to 6.9 infant deaths per 1,000 live births, compared with a drop of 51.5% from 26.0 to 12.6 per 1,000 live births for 1960 to 1980 (Figure 1) [2]. Finally, it is estimated that the proportion of babies born in the United States who have a serious or major structural defect that can have adverse effects on their health or development continues to be about 3% [5]. 



Fig. 1

Maternal and infant mortality rates, United States, 1960–2002





Fig. 2

Percent of all live births that are preterm delivery, very preterm delivery, low birth weight, and very low birth weight, United States, 1980–2002



Associated with this slowing rate of improvement (and, in some cases, deterioration) in pregnancy outcomes and maternal and infant health indicators is a shift in the leading causes of infant mortality. In 1960, maternal complications of pregnancy (including complications of placenta, cord, and the membranes) did not appear on the list of the 10 leading causes of infant mortality [1]. By 1980, maternal complications of pregnancy became the fifth leading cause of infant mortality, and the third leading cause of infant death in 2002, after congenital anomalies and low birth weight/preterm delivery [6, 7]. In 2002, congenital anomalies, low birth weight, preterm delivery, and maternal complications of pregnancy accounted for 46.4% of all infant deaths in the United States (12,996 infant deaths) (Figure 3) [7]. Although some of these infant deaths might have been prevented through interventions targeted at improving the health of mothers and modifying behaviors contributing to adverse pregnancy outcomes, poor maternal health, behaviors contributing to adverse pregnancy outcomes, and maternal complications of pregnancy continue to be prevalent. For example, 28.6% of women who gave birth between 1993 and 1997 were reported to have an obstetric complication, 4.1% had a preexisting medical condition, and 43.0% experienced some form of maternal morbidity (i.e., an obstetric complication, a preexisting medical condition, a cesarean section, or any combination of the three types of morbidity) [8]. In 2002, 26.1% of all deliveries were performed using cesarean section, presumably because of maternal or infant complications [8]. 



Fig. 3

Leading causes of infant mortality, United States, 1960, 1980, and 2002. *IMR = Infant Mortality Rate




Early prenatal care is too late
One of the reasons that progress in improving pregnancy outcomes has slowed down, and in some cases reversed direction, is that we have failed to intervene before pregnancy to detect, manage, modify, and control maternal behaviors, health conditions, and risk factors that contribute to adverse maternal and infant outcomes. Although we know many interventions that, if delivered before pregnancy, could improve pregnancy outcomes, we have failed to make those services and interventions available to couples and women in need. Women of childbearing age suffer from a variety of chronic conditions that could potentially contribute to adverse pregnancy outcomes. For example, in 2002, the U.S. Department of Health and Human Services reported that 6.1% of women of reproductive age have asthma, 5% are obese, 3.4% have cardiac disease, 3.0% are hypertensive, 9.3% are diabetic, and 1.4% have thyroid disorder [9]. Moreover, a substantial proportion of women continue to enter pregnancy with risks proven to contribute to adverse pregnancy outcomes: in 2002, 11.4% of pregnant women smoked during pregnancy, a risk factor for low birth weight [4]; at the same time, 10.1% of pregnant women and 54.9% of women at risk of getting pregnant consumed alcohol, a risk factor for fetal alcohol syndrome [10]. Finally, using the Perinatal Periods of Risk approach, researchers in three cities (New York City; Tulsa, Oklahoma; and Kansas City, Missouri) concluded that racial and ethnic disparities in feto-infant mortality were largely related to maternal health, and, interventions to reduce feto-infant mortality should include preconception care and improvements in women's health [11–13].

The prenatal care “revolution” of the 1980s resulted in an increase in the proportion of women receiving early prenatal care (defined as prenatal care begun in the first trimester) [2]. After decreasing from 76.3% in 1980 to 75.8% in 1990, the proportion of women receiving early prenatal care increased to 83.2% in 2000 [2]. However, for many women, “early prenatal care is too late” [14]. By the time a pregnant woman makes it to her first early prenatal visit, most fetal organs are already been formed, and many interventions to prevent birth defects or adverse maternal and infant outcomes come too late to have any effect. As a result, many national organizations now recommend routine preconception care. For example, the March of Dimes recommends that “as the key physician/primary care provider, the obstetrician/gynecologists must take advantage of every health encounter to provide preconception care and risk reduction before and between conceptions—the time when it really can make a difference” [14]. The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that “all health encounters during a woman's reproductive years, particularly those that are a part of preconception care, should include counseling on appropriate medical care and behavior to optimize pregnancy outcomes” [15].

/pdf/preconception-care-for-improving-perinatal-outcomes-the-time-44vn9h5eop.pdf

Preconception Care for Improving Perinatal Outcomes: The Time to Act

Background: Many pregnant women continue to drink alcohol despite clinical recommendations and public health campaigns about the risks associated with alcohol use during pregnancy. This review examines the predictors of prenatal alcohol use, with the long-term goal of developing more effective preventive efforts. Methods: A literature search of several databases for relevant articles was undertaken. Studies were included if they occurred in the context of antenatal care, collected data during the woman's pregnancy (between 1999 and 2009), investigated predictors of any drinking, had a population-based orientation (e.g., did not focus only on high-risk drinkers), and were published in English in a scientific peer-reviewed journal between 1999 and 2009. Results: Fourteen studies published between 2002 and 2009 fulfilled the inclusion criteria (United States, 4; Europe, 4; Australia and New Zealand, 3; Japan, 2; and Uganda, 1). The predictors of prenatal alcohol use most consistently identified were...

http://liu.diva-portal.org/smash/get/diva2:433286/FULLTEXT01.pdf

Predictors of drinking during pregnancy: a systematic review.

Alcohol use during pregnancy is associated with health problems that adversely affect the mother and fetus; no level of alcohol consumption during pregnancy has been determined safe. Fetal alcohol syndrome (FAS) is recognized as the foremost preventable condition involving neurobehavioral and developmental abnormalities. Women who drink during pregnancy place themselves at risk for having a child with FAS or fetal alcohol spectrum disorders (FASD). To determine the alcohol consumption patterns among all women of childbearing age, including those who are pregnant or might become pregnant, CDC analyzed data for women aged 18-44 years from the 2002 Behavioral Risk Factor Surveillance System (BRFSS) survey. The results of that analysis indicated that approximately 10% of pregnant women used alcohol, and approximately 2% engaged in binge drinking or frequent use of alcohol. The results further indicated that more than half of women who did not use birth control (and therefore might become pregnant) reported alcohol use and 12.4% reported binge drinking. Women who are pregnant or who might become pregnant should abstain from alcohol use.

J. Tsai

Papers

Alcohol consumption among women who are pregnant or who might become pregnant - United States, 2002