Alcohol intake and pregnancy
- Grace Chang, MD, MPH
Grace Chang, MD, MPH
- Professor of Psychiatry
- Harvard Medical School
Women who drink alcohol come from all socioeconomic strata, ages, and races . These individuals may also be using other addictive or illicit substances. Both the gravida and her family benefit from factual, nonjudgmental information about the maternal and fetal risks of alcohol use and, if necessary, from counseling regarding strategies for cessation. Pregnant women are typically highly motivated to modify their behavior to help their unborn child. In one national survey from the United States, 87 percent of women who drank alcohol before pregnancy quit drinking during pregnancy, 6.6 percent reduced their alcohol intake, and about 6.4 percent reported no reduction .
EPIDEMIOLOGY OF ALCOHOL USE
Alcohol consumption during pregnancy is common. The prevalence of alcohol consumption prior to and during pregnancy highlights the need to educate all reproductive age women about the potential harms of alcohol exposure on the developing fetus.
As an example, in the United States from 2011 to 2013, the Centers for Disease Control and Prevention surveillance system reported that, within the month prior to being interviewed, 10.2 percent of pregnant women used alcohol and 3.1 percent acknowledged binge drinking . While both prevalence rates are somewhat increased compared with the rates reported between 2006 and 2010 (7.6 and 1.4 percent, respectively) , the increases may reflect methodologic changes in study design rather than a true increase in alcohol use. Of note, when the time period being studied is extended, pregnant women report higher rates of alcohol use. As an example, in the 2009 National Birth Defects Prevention Study of over 4000 women that asked women about drinking behavior for the entire duration of pregnancy, 30 percent of pregnant women reported any alcohol use and 8 percent reported binge drinking on at least one occasion . Additionally, in the 2004 Pregnancy Risk Assessment Monitoring System (PRAMS) survey that assessed preconception behavior, 50 percent of women reported alcohol use in the three months prior to pregnancy, which places them at risk for an alcohol-exposed conception .
Demographic factors associated with alcohol use during pregnancy vary. In the 2011 to 2013 United States survey, the characteristics associated with the highest prevalence of prenatal alcohol use were age between 35 and 44 years (18.6 percent), black (non-Hispanic) race (13.9 percent), college degree (13.0 percent), and employment (12.0 percent) . Hypotheses that may account for these findings include: (1) greater discretionary income for women who are older or have a college degree, and (2) women who attend college may have a greater acceptance of alcohol consumption and binge drinking. More studies are needed to elucidate these relationships and other potential contributors.
For binge drinking during pregnancy, the significant demographic factor in the 2011 to 2013 survey was non-married status. The prevalence of binge drinking among non-married pregnant women was 4.6 times the prevalence among married pregnant women . The explanation for this finding is not known, but may reflect a combination of socioeconomic factors. Of additional concern from the 2011 to 2013 survey, pregnant women who binge drank reported a significantly higher frequency of binge drinking (4.6 versus 3.1 episodes) and consumed more alcohol per episode (7.5 versus 6 drinks [although this was not statistically significant]) compared with non-pregnant binge drinkers. The increased frequency and volume of binge drinking reported by pregnant women may reflect a greater prevalence of alcohol dependence in women who continue to binge drink during pregnancy compared with non-pregnant women. Further data are needed.
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