[Prevalence and factors associated with alcohol use during pregnancy in a maternity hospital in Goiás, Central Brazil]

Development and psychometric evaluation of a questionnaire to measure university students' knowledge on the effects of alcohol use during pregnancy

Introduction

Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders. This study developed and validated a questionnaire to assess university students' knowledge regarding the effects of alcohol during pregnancy.

Methods

We designed an instrument with true-false-I do not know statements. Initially, 45 true statements were formulated and subjected to content validation by 19 experts. Based on the Content Validity Index (CVI), 17 items were selected. The instrument, called the Fetal Alcohol Consequences Test (FACT), was first assessed by 31 university students for the level of understanding. Then, the questionnaire was administered to a national Brazilian sample of university students, and an Exploratory Factor Analysis (EFA) was conducted. Each correct FACT answer was worth 1 point, and the knowledge was categorized as high (total score ≥ 80%), moderate (score between 60 and 79%), and low (score ≤ 59%).

Results

When the questionnaire was being designed, the CVI values ranged from 0.779 to 1.0, and all statements were considered suitable by the target audience. For psychometric evaluation, 768 students from 24 Brazilian states participated. In the EFA, five statements were removed, revealing a tool with 12 items and two latent factors: "fetal alcohol spectrum disorders" and "conceptions and guidance on alcohol consumption during pregnancy." The KMO index (0.76426) and Bartlett's sphericity test (6362.6, df = 66, p < 0.00001) both supported the final EFA model. The goodness-of-fit indices for the factor structure were adequate: χ2 = 119.609, df = 43, p < 0.00001; RMSEA = 0.048; CFI = 0.977; TLI = 0.965. The mean total FACT score among participants was 7.71 ± 2.98, with a median of 8; 32.03% of the students had high (10-12 points), 24.09% moderate (8-9 points), and 43.88% low knowledge (<8 points). The questionnaire proved reliable, with a floor effect of 1.17%, a ceiling effect of 9.25%, and a Cronbach's alpha index of 0.798.

Conclusion

The FACT can be utilized in university students' health education processes, contributing to greater knowledge and information dissemination about the effects of alcohol during pregnancy, in addition to the formulation of policies on the subject directed to this group of young adults.

Prevalence of alcohol use during pregnancy, Brazil, 2011-2012

This is a national cross-sectional, hospital-based study, which interviewed 23,894 postpartum women in 2011-2012 aiming to estimate the prevalence of alcohol use during pregnancy and identifying more vulnerable groups. Alcohol use during pregnancy was identified using the TWEAK scale, and women with a score of ≥ 2 were classified as having a "presumable diagnosis of inadequate alcohol use". The national prevalence of alcohol use and the prevalence in subgroups were calculated according to maternal characteristics, with respective 95% confidence intervals (95%CI). Coexistence of smoking, inadequate prenatal consultations, and alcohol use during pregnancy were graphically identified. The prevalence of alcohol use was 14% (95%CI: 13.3-14.7), with 10% (95%CI: 9.3-10.6) of women presenting presumable diagnosis of inadequate alcohol us during pregnancy. Higher prevalence of alcohol use and presumable diagnosis of inadequate alcohol us was observed in black women, aged 12-19 years, with lower educational level, from a lower economic class, without a partner, without paid work, with more than three previous births, who did not want to get pregnant, with inadequate prenatal care, with previous delivery in public services, and who reported smoking during pregnancy. Among the interviewees, 1.2% presented all three risk factors for negative perinatal outcomes at the same time: smoking, alcohol use, and inadequate prenatal care. The results showed a high prevalence of alcohol use during pregnancy and presumable diagnosis of inadequate alcohol us, especially among women with worse social conditions. These data are relevant for the formulation of public policies to prevent alcohol use and provide support services to help this population stop alcohol use during pregnancy.

Alcohol use during pregnancy: findings from a gender-based violence survey in Mongolia

This study aimed to explore the risk factors for alcohol use during pregnancy in Mongolia, wherein high-risk alcohol use is prevalent. We analyzed nationwide data from the Gender-Based Violence (GBV) Survey of Mongolia conducted in 2017. We conducted an analysis restricted to 2714 women who had given birth within 5 years of the survey and who had responded to questions about their health-related behaviors during pregnancy. We assessed the association between alcohol use during pregnancy and pregnancy-related factors, including maternal age, educational attainment, history of abortion, smoking during pregnancy, unintended pregnancy, prior experience of sexual and physical violence, physical violence during pregnancy, and current binge drinking while also considering their residential region. Alcohol use during pregnancy was reported in 5.4% of the participating women. Unintended pregnancy for women (OR = 1.95, 95% confidence interval [CI]: 1.60, 2.38), abortion history (1.89, 95% CI: 1.60, 2.24), smoking during pregnancy (8.30, 95% CI: 6.60, 10.43), physical violence during pregnancy (2.22, 95% CI: 1.75, 2.81), and being a binge drinker (6.05, 95% CI: 3.63, 10.10) were associated with higher odds of alcohol use during pregnancy. Associations with maternal age, marital status, higher education, or multiparity were not evident. Our finding provides knowledge of risk factors for alcohol drinking among pregnant women and evidence for another harm of gender-based violence. This would contribute to the development of effective strategies for preventing antenatal exposure to alcohol in Mongolia.

Breastfeeding patterns and factors associated with early weaning in the Western Amazon

OBJECTIVE

To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre.

METHODS

This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning.

RESULTS

The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06-3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59-3.94), pacifier use (HR = 6.23; 95%CI 4.52-8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25-2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10-1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34-2.90).

CONCLUSION

Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

Adverse Neonatal and Obstetric Outcomes in a 20-year Brazilian Retrospective Cohort of Pregnancies after Bariatric Surgery

PURPOSE

Evaluation of obstetric and neonatal outcomes in a Brazilian retrospective cohort of pregnancies after Roux-en-Y gastric bypass (RYGB), regarding the 2009 Institute of Medicine (IOM) recommendations about gestational weight gain (GWG) and RYGB-conception interval. Additionally, search for intrapopulation risk factors for small gestational age (SGA) offspring and mental health assessments.

MATERIAL AND METHODS

Retrospective analysis of 132 singleton pregnancies after RYGB. Obstetric and neonatal outcomes were analyzed with stratification in above, below, or meeting the target regarding GWG guidance, and 0-12, 12-47, and ≥48 months for RYGB-conception interval. SGA risk factors were identified through Poisson regression analysis.

RESULTS

GWG below the recommendations was associated with prematurity (p 0.003). Late conceptions (≥48 months) were associated with iron deficiency (p 0.025). Parenteral iron prescription was a protective factor for SGA, with a relative risk of 0.41 (95% CI, 0.20-0.85; p 0.017), and GWG below target was a SGA risk factor, with a relative risk of 4.68 (95% CI, 1.48-14.8; p 0.008). In all, 15.2% of patients had psychopharmacological treatment during pregnancy, and 7.6% received a diagnosis of postpartum depression. Any alcohol and tobacco consumption were reported in 3.8 and 6.8% of patients, respectively.

CONCLUSION

The recommendations regarding GWG apply to the RYGB population, and surgery-conception intervals should be individualized. The parenteral iron prescription was a protective factor for SGA, and GWG below the recommendations of the IOM was a risk factor for SGA. Psychological and psychiatric care should be offered to every possible pregnancy after RYGB.

Ciência & Saúde Coletiva - 25 years: contributions to pregnancy, delivery, and childhood studies

We reviewed the scientific production on maternal health and the health of children under ten years of age, published in Journal Ciência & Saúde Coletiva during the last 25 years, focusing on quantitative studies. The authors' characteristics, populations under study, thematic areas, and methodology are described. A total of 170 publications were identified and grouped into 12 major themes. Pregnancy, delivery, and puerperium were the subject of 47 studies, followed by child anthropometric assessments (29), breastfeeding (24), and mortality (13). The selected publications represented 3.5% of the total original papers published by the Journal since its creation in 1996 and about 5% of the publications in the 2015-2020 period. The primary data sources were health service records, information systems, and population surveys. The cross-sectional design was used in 113 of the 170 articles, and 70% covered only one municipality. The Southeast and Northeast Regions of Brazil were the target of most studies, and the North Region was the least represented. The publications reflect the complexity of maternal and child health themes, with a particular focus on the importance of the Unified Health System and showing how open access data can contribute to public health research.