Most women who consume alcohol pre-pregnancy will continue to consume alcohol throughout their pregnancy even when healthcare guidelines promote abstinence, suggests a new study published today in BJOG: An International Journal of Obstetrics and Gynaecology.
The study, which included 1,969 women from the Australian Longitudinal Study on Women’s Health (ALSWH), aimed to gauge the predictors of antenatal alcohol use, among women who usually consume alcohol, to identify those most at risk of an alcohol-exposed pregnancy.
In addition to pre-pregnancy alcohol consumption, other predictors investigated included socio-economic status, reproductive health, mental health, physical health, alcohol guidelines and healthcare variables.
The women completed five surveys in 1996, 2000, 2003, 2006 and 2009 (referred to as survey one to five respectively), but for this study researchers focused on women who reported being pregnant in surveys two to five and then used surveys one to four, respectively, to gauge pre-pregnancy behaviours.
Of the 1,969 women, 82% reported consuming some alcohol during pregnancy, although most reported low alcohol usage with 77% of these women consuming one or two drinks per drinking day and 90% drinking no more than once or twice a week.
The findings showed that women who drank weekly prior to pregnancy were 50% more likely to continue to drink during pregnancy, compared to those who drank less than weekly. Furthermore, women who reported prior binge drinking behaviour were more than twice as likely to continue to consume alcohol during pregnancy.
Researchers, from the University of Newcastle in Australia, also identified the presence of alcohol guidelines as an important factor in antenatal alcohol use, especially during the periods where the Australian healthcare guidelines changed throughout the study.
Women who reported a pregnancy at survey two (2000) or five (2009) were classified under the ‘no alcohol’ guidelines (promoting abstinence), whereas women who reported a pregnancy in surveys three (2003) and four (2006) were categorised under the ‘low alcohol’ guidelines (which condoned light drinking). Of the women who were pregnant during the times that alcohol guidelines promoted abstinence, 22% did not drink compared to 14.7%, who refrained under the low alcohol guidelines.
Other factors that influenced antenatal alcohol consumption included women with fertility problems, who were 36% less likely to consume alcohol than those who had no trouble conceiving, and women with a Health Care Card (indicating lower socio-economic status), who were 37% less likely to drink during pregnancy.
Amy Anderson, Priority Research Centre for Gender, Health and Ageing, University of Newcastle and lead author of the study, said:
“Most women who drank alcohol prior to pregnancy, especially those who drank weekly or reported binge drinking behaviour, continued to drink during their pregnancy indicating that pre-pregnancy alcohol consumption was a significant risk factor for antenatal alcohol use.
“Our results also suggest that more conservative drinking guidelines may influence the behaviour of pregnant women. However, even under guidelines promoting abstinence, the majority of women continued to consume alcohol while pregnant.
“These findings suggest that to avoid alcohol-exposed pregnancies, risky episodic and regular alcohol use by women of childbearing age should be addressed prior to conception. More effective dissemination of guideline recommendations may also be useful in reducing the high prevalence of antenatal alcohol use among Australian women.”
John Thorp, BJOG Deputy-Editor-in-Chief added:
“Heavy antenatal alcohol use has been shown to cause a number of adverse health outcomes but the effects of low to moderate alcohol use are less clear.
“While it is important to gauge pre-pregnancy behaviour and make clear the intent of alcohol guidelines relating to pregnant women, this study further verifies that socio-economic factors can also influence antenatal alcohol use.
“The fact that women identified as lower-income earners (Health Care Card holders) were found to drink less needs to be considered by antenatal healthcare professionals when informing pregnant women of alcohol use. Clinicians should not assume patient knowledge based on socio-economic status.
“Advice for women managing or planning a pregnancy should focus on the fact that the first trimester is a particularly sensitive time and alcohol should be avoided to prevent risks to crucial development at this stage. Women concerned about alcohol consumption during pregnancy should consult their midwife or GP.”
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Please include a link to the paper in online coverage: http://dx.doi.org/10.1111/1471-0528.12356
Amy E Anderson, Alexis J Hure, Peta Forder, Jennifer R Powers, Frances J Kay-Lambkin, Deborah J Loxton. Predictors of antenatal alcohol use among Australian women: a prospective cohort study. BJOG 2013; http://dx.doi.org/10.1111/1471-0528.12356