Attitudes and behavior of pregnant women and health professionals towards alcohol and tobacco consumption

Prevalence of Alcohol and Tobacco Use and Perceptions Regarding Prenatal Care among Pregnant Brazilian Women, 2017 to 2018: A Mixed-Methods Study

OBJECTIVE

To identify the prevalence of alcohol and tobacco drug use among pregnant women and investigate their perceptions regarding advice from health professionals during prenatal care.

METHOD

We used a sequential explanatory mixed-methods design for this cross-sectional study; the study period was January 2017 to December 2018. Multistage random sampling resulted in the selection of 255 pregnant women assisted in primary care units and through the Family Health Strategy in a city in southern Brazil. Trained interviewers collected data on the use of alcohol and tobacco drugs and socioeconomic characteristics via a questionnaire. Qualitative interviews were performed with pregnant women identified as alcohol and tobacco drug users in the quantitative phase. Interviews proceeded consecutively until saturation was reached, followed by a thematic analysis of interview content based on Braun and Clarke.

RESULTS

The prevalence of smoking and alcohol use was 12.55% and 14.12%, respectively. From the 14 interviews conducted, five categories emerged from the discourses: prenatal care from the perspective of pregnant women, habits and knowledge regarding smoking during pregnancy, habits and knowledge regarding alcohol use during pregnancy, previous experiences and empirical knowledge, and pregnant women's preferences for talking about their habits.

CONCLUSION FOR PRACTICE

Study findings identified smoking and alcohol use as habits among some women during pregnancy and, consequently, the need for improving care because of their superficial knowledge regarding tobacco and alcohol use. The findings underscore the importance of strengthening measures and establishing new strategies that ensure women's understanding, empowerment, and choices-from the beginning of childbearing age-regarding habits during pregnancy.

Alcohol consumption and its associated factors among pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis' as given in the submission system

Background

Alcohol consumption during pregnancy represents a significant public health concern. It has several adverse health effects for both the mother and the developing fetus. This study aimed to estimate the pooled prevalence and the effect size of associated factors of alcohol consumption during pregnancy in Sub-Saharan Africa countries.

Methods

The results of the review were reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA) guideline and, it was registered in the Prospero database, number CRD42019127103. The available primary studies were collated from different databases: PubMed, CINAHL, Cochrane Library, PsycINFO, Google Scholar, African Journals Online and Centre for Addiction and Mental Health Library. The main search terms were [((alcohol consumption) OR (alcohol drinking) OR (alcohol use) OR (ethanol use) OR (alcohol exposure)) AND ((pregnant women) OR (pregnant mother) OR (during pregnancy)) AND (Sub-Saharan Africa)]. We used the Joanna Briggs Institute (JBI) for critical appraisal of studies. The random-effects model was computed to estimate the pooled prevalence. Heterogeneity between studies was checked using the I² statistic and the Cochrane Q test.

Results

The review resulted in 963 original studies after searching various databases, and finally 37 studies in qualitative synthesis and 30 articles in the systematic review and meta-analysis were included. The overall summary estimate of the prevalence of alcohol consumption during pregnancy was found to be 20.83% (95% CI: 18.21, 23.46). The pooled estimate of meta-analysis showed that depression (OR: 1.572; 95% CI: 1.34, 1.845), partners’ alcohol use (OR: 1.32, 95% CI: 1.11, 1.57), knowledge on harmful effect of alcohol consumption (OR: 0.36, 95% CI: 0.29, 0.45) and, unplanned pregnancy (OR: 2.33, 95% CI: 1.17, 4.63) were statistically significant factors with alcohol consumption during pregnancy.

Conclusions

The result showed that there was high alcohol consumption during pregnancy in Sub- Saharan Africa. Alcohol consumption during pregnancy was associated with depression, partners’ alcohol use, unplanned pregnancy and knowledge of the harmful effects of alcohol consumption. Therefore, this will be a basis for public policy and resource allocation for prevention initiatives.

Warning about drinking during pregnancy: lessons from the French experience

Background

In France, since 2007, there is a compulsory warning recommending abstinence during pregnancy on every container of alcohol. Awareness of this warning, which consists of a small pictogram, is unknown. The aim of this study was to assess awareness of the warning and risk perceptions about prenatal drinking in pregnant and postpartum women.

Methods

A cross-sectional survey was carried out by telephone five years after the introduction of the warning label. A total of 3603 pregnant or postpartum French women participated. A quota sampling method was used to ensure the sample reflected the population. Multivariate analyses examined the characteristics associated with knowledge of risks and with awareness of the warning label.

Results

The warning label had been noticed by 66.1% of women and 77.3% of drinkers. Of those who had noticed the warning, 98.6% thought that it suggested abstinence. Overall, 40.8% of the women thought that spirits were more harmful than wine or beer, and 8.9% thought that drinking beer was recommended for lactation.

Conclusion

Awareness of the warning is high but knowledge about the risks associated with wine and beer is poor.

Practice Implications

Future information campaigns should educate women about standard drinks and their pure alcohol equivalent. They should emphasize the risks associated with drinking during breastfeeding.

What does the general public in the UK know about the risk to a developing foetus if exposed to alcohol in pregnancy? Findings from a UK mixed methodology study

INTRODUCTION

Foetal alcohol spectrum disorders (FASD) are a set of preventable conditions where the foetus is exposed to alcohol in utero and as a result suffers adverse consequences. To develop a public health strategy related to FASD, it is important to first establish what is known by the public about this condition. This study aimed to assess the current level of knowledge about FASD in the UK general population.

METHODS

A mixed methodology study was conducted using a 17-item questionnaire and focus group sessions. Four focus groups were held with an average of 10 people in each group. Semi-structured questions and thematic analysis of interviews alongside quantitative analysis of the questionnaire data was completed. The research was approved by an National Health service (NHS) research ethical committee.

RESULTS

A total of 674 people responded to the questionnaire and a majority (86.7%) had heard about FASD, with most receiving their information from the media (26.2%) or from their work (27.7%). Four broad themes emerged. Overall these were: a general lack of knowledge about the subject; information about the subject needed to be personally relevant; there was a need for further education; and there was a lack of clarity in the current guidance on alcohol use in pregnancy.

DISCUSSION AND CONCLUSIONS

Currently there appears to be a superficial level of knowledge about FASD in the UK general public. More detailed work in subgroups, such as young women, to identify their specific needs may be necessary before targeted public health and educational interventions can be developed to meet the needs of the general public.

[Pregnancy and substance use in France: a literature review]

OBJECTIVES

Substance use during pregnancy is an important public health issue. It requires identifying at-risk populations and risk perception among women.

MATERIALS AND METHODS

A literature review was conducted. It included French studies conducted since 2000 on substance use during pregnancy (tobacco, alcohol, marijuana, psychotropic drugs) and risk perception.

RESULTS

In France, in 2010, 24% of pregnant women smoke--17% in the 3rd trimester. Depending on studies, the prevalence of alcohol use ranged from 12 to 63% and binge drinking ranged from 1 to 7%; daily drinking was below 0.5%. Marijuana use ranged from 1 to 3%, and psychotropic drugs ranged from 2 to 4%. Little research has been dedicated to risk perception. Studies show a lack of awareness about the equivalence of risks between fermented and distilled beverages and about the risks of moderate smoking during pregnancy.

CONCLUSION

Data is lacking to characterize at-risk populations and mechanisms underlying risky behaviors.

What can public endorsement for a smoking ban policy mean? Preliminary findings from a qualitative study

OBJECTIVES

The aim of the study is to describe attitudes which underlie Pole's declarations of support for a smoking ban in public places.

METHODS

The qualitative study using semi-structured individual in-depth interviews was conducted. The 30 IDI-s (in depth interviews) being a part of a larger research project entitled 'Lay meanings of health and life orientation of Polish society versus prevention and health promotion attitudes' were realized between 2007-2009. People belonging to all key socio-demographic categories identified by variables such as sex, age, education, and place of domicile were interviewed. The resulting material was subjected to content analysis. In the study the structural concept of 'attitude' was adopted. In order to identify the attitudes towards smoking bans in public places statements related to all three components of attitudes were analysed, but the typology of attitudes was constructed mainly on the basis of the emotional-evaluative component.

RESULTS

The study identified as many as four attitudes behind the declared support for a smoking ban in public places. Those attitudes were labelled 'supportive', 'accepting', 'conditionally accepting', and 'ambivalent'. They differ as regards degree of acceptance for the ban, conviction about harmfulness of passive smoking, setting great store by other regulators of smoking like cultural norms or healthy consciousness, and propensity to observe and execute the smoking ban. The 'supportive' attitude can be characterized not only by total support for the smoking ban in public places but also by insistence on the need for its extension. The 'accepting' attitude means approval for the smoking ban, and the 'conditionally accepting' attitude is distinguished from the others by the stress put on the right of smokers to have an access to places where smoking is permitted. The 'ambivalent' attitude can be typified by underlining other than legal ways of influencing smoking in public places.

CONCLUSIONS

The study suggests that the attitudes underlying the Pole's declarations of support for a smoking ban in public places can be differentiated. However, because of the low number of participants in the study the results should be verified thus the further research is needed. Therefore, there is a need not only to study people's declaration of support or objection for the smoking ban in public places but also to examine their attitudes including cognitive and behavioural components using both qualitative and quantitative methods of social research.

Women's knowledge and attitudes regarding alcohol consumption in pregnancy: a national survey

Background

Alcohol exposure in pregnancy is a common and modifiable risk factor for poor pregnancy and child outcomes. Alcohol exposure in pregnancy can cause a range of physical and neurodevelopmental problems in the child including the Fetal Alcohol Spectrum Disorders (FASD). In order to improve prevention strategies, we sought to describe the knowledge and attitudes of women of childbearing age regarding alcohol consumption during pregnancy and its effects on the fetus.

Methods

We conducted a national cross-sectional survey via computer assisted telephone interview of 1103 Australian women aged 18 to 45 years. Participants were randomly selected from the Electronic White Pages. Pregnant women were not eligible to participate. Quotas were set for age groups and a minimum of 100 participants per state to ensure a national sample reflecting the population. The questionnaire was based on a Health Canada survey with additional questions constructed by the investigators. Descriptive statistics were calculated and logistic regression analyses were used to assess associations with participants' knowledge and attitudes.

Results

Of women surveyed, 61.5% had heard about effects of alcohol on the fetus and 55.3% had heard of Fetal Alcohol Syndrome. Although 92.7% agreed alcohol can affect the unborn child, 16.2% did not agree that the disabilities could be lifelong. Most women agreed that pregnant women should not drink alcohol (80.2%) and 79.2% reported having negative feelings towards pregnant women drinking alcohol. Women with higher education levels were more likely to know the effects of alcohol consumption in pregnancy (adjusted OR 5.62; 95% CI 3.20 to 9.87) but education level and knowledge were not associated with attitude.

Conclusions

There was a disjunction between knowledge and attitudes towards alcohol consumption in pregnancy. These findings will assist in developing effective health promotion campaigns to reduce fetal alcohol exposure and subsequent fetal damage.

Pregnant women's attitudes towards alcohol consumption

Background

There is uncertainty as to whether there is a safe threshold for drinking alcohol during pregnancy. We explored pregnant women's attitudes towards drinking alcohol in pregnancy and their attitudes towards sources of information about drinking in pregnancy following recent changes in UK government guidance.

Methods

A qualitative study involving individual, semi-structured interviews with 20 pregnant women recruited from community organisations in the UK. Interview transcripts were analysed qualitatively using thematic analysis.

Results

Most women found information and advice about safe levels of drinking in pregnancy confusing and lacking in evidence and detail. Although most women considered that there were risks involved with drinking in pregnancy and these perceptions influenced their behaviour, only six women reported abstinence. Women reported being influenced by advice from family and friends and their experiences of previous pregnancies. Many had received no individual advice from general practitioners or midwives relating to drinking during pregnancy.

Conclusion

Pregnant women wished to take responsibility for their own health and make choices based on informed advice. In order to do so, they require clear and consistent advice about safe levels of drinking from policy makers and health professionals. This is an important issue as women might drink socially during their pregnancy.

Repeated ethanol exposure during late gestation decreases nephron endowment in fetal sheep

Maternal alcohol consumption during pregnancy can affect fetal development, but little is known about the effects on the developing kidney. Our objectives were to determine the effects of repeated ethanol exposure during the latter half of gestation on glomerular (nephron) number and expression of key genes involved in renal development or function in the ovine fetal kidney. Pregnant ewes received daily intravenous infusion of ethanol (0.75 g/kg, n=5) or saline (control, n=5) over 1 h from 95 to 133 days of gestational age (DGA; term is approximately 147 DGA). Maternal and fetal arterial blood samples were taken before and after the start of the daily ethanol infusions for determination of blood ethanol concentration (BEC). Necropsy was performed at 134 DGA, and fetal kidneys were collected for determination of total glomerular number using the physical disector/fractionator technique; at this gestational age nephrogenesis is completed in sheep. Maximal maternal and fetal BECs of 0.12+/-0.01 g/dl (mean+/-SE) and 0.11+/-0.01 g/dl, respectively, were reached 1 h after starting maternal ethanol infusions. Ethanol exposure had no effect on fetal body weight, kidney weight, or the gene expression of members of the renin-angiotensin system, insulin-like growth factors, and sodium channels. However, fetal glomerular number was lower after ethanol exposure (377,585+/-8,325) than in controls (423,177+/-17,178, P<0.001). The data demonstrate that our regimen of fetal ethanol exposure during the latter half of gestation results in an 11% reduction in nephron endowment without affecting the overall growth of the kidney or fetus or the expression of key genes involved in renal development or function. A reduced nephron endowment of this magnitude could have important implications for the cardiovascular health of offspring during postnatal life.

Brief intervention for prenatal alcohol use: the role of drinking goal selection

The behavioral problems and cognitive deficits resulting from even small amounts of prenatal alcohol exposure can be significant and enduring but completely preventable. The purpose of this study was to examine the impact of a prenatal drinking goal selected during a brief intervention for 115 pregnant women and their partners on subsequent consumption. Higher proportions of women having their first pregnancy chose abstinence as a goal over drinking reduction. Goal selection was highly predictive of subsequent drinking behavior. Interestingly, the participants who were abstinent at enrollment and who chose to remain abstinent had the highest rates of abstinence. In contrast, the women who chose cutting down on drinking were the least likely to drink less subsequently, despite recognizing more situations putting them at risk for drinking and identifying more alternatives to consumption. We conclude that goal choice in behavioral self-management of alcohol use by pregnant women is critical.

Smoking cessation or reduction in women attempting to conceive after ectopic pregnancy

The relationship between smoking cessation or reduction and attempt to conceive was studied in 646 women treated for ectopic pregnancy (EP) (Auvergne register of EP, France). Women were prospectively followed. Tobacco consumption was recorded as the mean number of cigarettes smoked per day at the time of interview. Smoking reduction was defined as stopping smoking or decreasing tobacco consumption by at least 3 cigarettes per day. Statistical analysis was performed using conditional logistic regression. The results confirmed that women reduced tobacco consumption when they became pregnant. However, no association was found between smoking reduction and attempting to conceive again. These results suggest that both women and physicians need to be informed about the possible tobacco consumption effects of smoking on fertility.

[Determinant factors of smoking cessation during pregnancy]

BACKGROUND

To investigate sociodemographic factors and smoking habit characteristics associated with spontaneous smoking cessation during pregnancy.

DESIGN

SUBJECTS AND METHODS

Cross-sectional study including 726 pregnant smoking women who attended the antenatal clinic of the Vall d'Hebron University Hospital in Barcelona between July and December 1997 and who agreed to participate were studied. Information was obtained by a structured questionnaire which included items on age, educational level, marital status, previous and current smoking habit, partner smoking habit and partner's attitude towards the smoking habit of the pregnant woman.

RESULTS

At the first antenatal visit, 19.7% of women had given up smoking spontaneously. Light smokers (between 1 and 9 daily cigarettes; OR = 4.74) or moderate smokers (between 10 and 19 daily cigarettes; OR = 2.20) were more likely to stop smoking compared to heavy smokers (more than 20 daily cigarettes). If the partner did not smoke, smoking cessation was more likely among pregnant women (OR = 1.78). At the first antenatal visit, among those women who carried on smoking during pregnancy, there was a significative reduction in cigarette consumption of about half the usual daily number of cigarettes smoked.

CONCLUSIONS

One out of five pregnant women give up smoking spontaneously during pregnancy from the moment they know they were pregnant until the first antenatal visit. Women who are less likely to stop smoking during pregnancy are those who smoke a larger number of cigarettes. Family environment is an important influential factor in the smoking habit of the pregnant woman.

Is there evidence to show that fetal alcohol syndrome can be prevented?

Fetal Alcohol Syndrome (FAS) is currently the major cause of mental retardation in the Western world. Since FAS is not a natural phenomenon and is created by mixing alcohol and pregnancy, the solution to decreasing the incidence of all alcohol-related birth defects is therefore entirely preventable. To date, little is known about the effectiveness of prevention programs in reducing the incidence of FAS. Therefore, it is the intention of this article to review the effectiveness of prevention programs in lowering the incidence of FAS. The present review revealed that prevention programs, to date, have been successful in raising awareness of FAS levels across the groups examined. However, this awareness has not been translated into behavioral changes in "high risk" drinkers as consumption levels in this group have decreased only marginally, indicating prevention programs have had minimal or no impact in lowering the incidence of FAS. Urgent steps must now be taken to fully test prevention programs, and find new strategies involving both sexes, to reduce and ultimately eliminate the incidence of FAS.