Reduced alcohol use in pregnancy and changed attitudes in the population

A review of factors associated with patterns of drinking during pregnancy

Purpose

The purpose of this paper is to identify factors associated with drinking patterns during pregnancy.

Design/methodology/approach

A rapid evidence assessment was undertaken, scanning multiple databases for studies examining factors associated with alcohol consumption in pregnancy. Studies were included if they stratified data according to quantity of alcohol consumed and identified relevant associated factors. Drinking patterns were classified as light/moderate and heavy/binge.

Findings

In total, 15 studies were included (N=7 light/moderate; N=15 heavy/binge drinking). Factors associated with alcohol consumption during pregnancy included: smoking, age, SES, marital status, pre-pregnancy substance use and parity. While few studies reported an association between heavy/binge drinking and maternal mental health, none of the studies included explored the association between mental health and light/moderate drinking.

Research limitations/implications

Relatively few studies have looked at the association between psychological characteristics of women and their drinking patterns. There is a lack of articles examining light/moderate drinking in pregnancy compared to heavy/binge drinking. Moreover, there is marked variation in how alcohol use is measured. Further studies are needed to increase understanding of the association between psychological factors and patterns of drinking during pregnancy, and how health professionals might support women in this context.

Originality/value

The authors expand on previous work by examining two different patterns of alcohol consumption in pregnancy, rather than alcohol use simply as an isolated concept. The two groups were found to differ in a number of demographic and social factors. This information could be used to aid healthcare professionals in targeting specific interventions to those women most at risk.

Informal Alcohol Control in Six EU Countries

This article describes differences between Finland, Sweden, Germany, the United Kingdom, France and Italy regarding having influenced someone to drink less alcohol. Representative samples of around 1,000 respondents 18–64 years old in each country were analyzed. Informal alcohol control was measured by questions on whether the respondent reported having influenced someone in any of eight categories of family members and friends to drink less. People in Italy significantly more often reported having pressured someone to drink less (38%) compared with the average rate (32%). In multivariate logistic regressions, people in France and Sweden were significantly less likely to report this. The higher rate in Italy was due to Italian men's high likelihood of trying to persuade both friends and family members to drink less compared with men in other countries. Differences among these six European countries regarding informal control of alcohol appear to be greater among men than among women.

Do attitudes and knowledge predict at-risk drinking among Russian women?

BACKGROUND

Drinking patterns among Russian women indicate substantial risk for alcohol-exposed pregnancies. Data about women's knowledge and attitudes related to alcohol consumption during pregnancy and the extent to which women's knowledge and attitudes affect their alcohol use remain limited.

OBJECTIVES

To describe Russian women's knowledge and attitudes and assess whether women's knowledge and attitudes were associated with their risky drinking.

METHODS

A cross-sectional survey was administered to women of childbearing age (n = 648). Participants were recruited at women's health clinics and asked about their alcohol consumption, pregnancy status, attitudes, and knowledge about effects of alcohol and Fetal Alcohol Syndrome (FAS).

RESULTS

40% of the women surveyed believed or were uncertain whether alcohol consumption during pregnancy was acceptable. Although 34% had heard of FAS, only 8% possessed accurate knowledge. Correct knowledge was associated with decreased alcohol consumption among pregnant women, but there was no association between knowledge and risky drinking in nonpregnant women, including those who were at risk for an unplanned pregnancy or were trying to conceive. However attitudes were strongly associated with risky drinking by nonpregnant women across levels of knowledge about FAS and any alcohol use by pregnant women.

CONCLUSIONS

Russian women had limited knowledge and several misconceptions about the effects of alcohol on the fetus, and risky alcohol consumption was strongly associated with women's attitudes and knowledge. The study provides strong evidence to support continuing public health education about effects of alcohol use during pregnancy. Correcting specific misconceptions and targeting the preconceptional period in health communications are necessary to reduce at-risk drinking and the risk for alcohol-exposed pregnancies.

Pregnant and non-pregnant women with substance use disorders: the gap between treatment need and receipt

Differences in pregnant and non-pregnant women's alcohol and drug use, substance treatment need, and treatment receipt were examined using The National Survey of Drug Use and Health (2002-2006). Treatment need and receipt were defined by either self-report or DSM-IV criteria. Pregnant women were less likely to use alcohol and drugs than non-pregnant women. Among women who use drugs, pregnant women were more likely to need treatment (odds ratio (OR) = 1.92; 95% confidence interval (CI): 1.46, 2.52), however they were not more likely to receive treatment (OR = 0.90; 95% CI: 0.54, 1.51). Overall, there is an unmet need for treatment among reproductive-aged substance users.

Use of alcohol and illicit drugs among pregnant Danish women, 1998

AIMS

In 1999 the Danish National Board of Health adjusted its recommendation concerning alcohol in pregnancy: "Avoid alcohol in pregnancy if possible; If you drink, drink no more than 1 drink per day; do not drink every day". In this paper frequency and pattern of alcohol consumption and the use of illicit drugs during early pregnancy among pregnant Danish women are described.

METHODS

From October to December 1998, 432 Danish-speaking pregnant women referred to the Midwife Centre in Aarhus, Denmark, for routine antenatal care were interviewed at their first visit at 15-16 weeks of gestation. The women were interviewed about average alcohol intake before pregnancy, binge drinking (intake of > or =5 drinks on a single occasion), and the use of illicit drugs in pregnancy. They subsequently filled in a two week diary on current alcohol intake.

RESULTS

Nearly 90% of the women reduced their alcohol intake when they became pregnant. A total of 92% of women reported a maximum intake of three drinks/week, and only 1% exceeded the recommendations of average alcohol intake of six drinks/week. Nevertheless, 25% exceeded the recommended maximum daily intake of one drink in the second trimester, and 40% of the women reported at least one binge episode since conception. Binge drinkers tended to be smokers and primiparous women.

CONCLUSIONS

Consumption peaks were a major problem in the first and second trimester. Midwives and doctors should pay special attention to binge drinking when inquiring about alcohol consumption and providing information on alcohol to pregnant women.

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.

A multiple-level, comprehensive approach to the prevention of fetal alcohol syndrome (FAS) and other alcohol-related birth defects (ARBD)

A comprehensive program for the prevention of fetal alcohol syndrome (FAS) and alcohol-related birth defects (ARBD) must consider multiple approaches and utilize knowledge from a variety of academic disciplines. Issues related to culture, society, behavior, belief systems, and medicine must all be considered for both etiology and solutions. A broad paradigm such as a public health model integrates various elements of approach. Because FAS and other levels of ARBD form a spectrum, from severe to negligible damage, a variety of drinking patterns with various characteristics and etiologies have to be addressed. This paper describes a multiple-level, comprehensive program with primary, secondary, and tertiary prevention components. Practical recommendations are proposed for addressing ARBD in a variety of arenas. While secondary and tertiary prevention hold promise for short-term reduction of FAS and ARBD prevalence, comprehensive prevention serves both short- and long-term effects. Multiple level prevention efforts are well served by clear and compelling vision and mission statements, and require careful evaluation.