Peri‐conceptual and mid‐pregnancy drinking: a cross‐sectional assessment in two Scottish health board areas using a 7‐day Retrospective Diary

Abstract

Aims The aim of this study was to evaluate the use of a 7‐day Retrospective Diary to assess peri‐conceptual and mid‐pregnancy alcohol consumption. Background Alcohol consumption among women has increased significantly and is of international concern. Heavy episodic (‘binge’) drinking is commonplace and is associated with unintended pregnancy. Pre‐pregnancy drinking is strongly associated with continued drinking in pregnancy. Routine antenatal assessment of alcohol history and current drinking is variable; potentially harmful peri‐conceptual drinking may be missed if a woman reports low or no drinking during pregnancy. Design Cross‐sectional study (n = 510) in two Scottish health board areas. Methods Face‐to‐face Retrospective Diary administration from February to June 2015 assessing alcohol consumption in peri‐conceptual and mid‐pregnancy periods. Women were recruited at the mid‐pregnancy ultrasound clinic. Results Of 510 women, 470 (92·0%) drank alcohol before their pregnancy; 187 (39·9%) drank every week. Retrospective assessment of peri‐conceptual consumption identified heavy episodic drinking (more than six units on one occasion) in 52·2% (n = 266); 19·6% (n = 100) reported drinking more than 14 units per week, mostly at the weekend; ‘mixing’ of drinks was associated with significantly higher consumption. While consumption tailed off following pregnancy recognition, 5·5% (n = 28) still exceeded the recommended daily two‐unit limit in pregnancy. Multivariable logistic regression identified that women who ‘binged’ peri‐conceptually were 3·2 times more likely to do this. Conclusion Statistically significant peri‐conceptual consumption levels suggest a substantial proportion of alcohol‐exposed pregnancies before pregnancy recognition. Not taking a detailed alcohol history, including patterns of consumption, will result in under‐detection of alcohol‐exposed pregnancies. The Retrospective Diary offers practitioners a detailed way of enquiring about alcohol history for this population.

A utilitarian comparison of two alcohol use biomarkers with self-reported drinking history collected in antenatal clinics

“…In this study, the percentage of alcohol users reported by the respondents is higher than that detected by individual biomarkers, but similar to that reported as positive by the two biomarkers in combination. Other studies in other populations have also shown that a combination of biomarkers [33] and/or a combination of biomarkers and self-report yield the highest prevalence of alcohol use [44–45]. We maintain that accuracy of alcohol use reporting varies by population, particularly for quantity of drinking reported among heavy or binge drinkers.…”

“…This will shed further light on the accuracy question in the future. But, from this binary analysis and the results of three previous studies comparing biomarker results with self-report in Southern Africa [12,46,47], we can conclude that alcohol use reporting in this region is generally accurate, much more so than that reported in most comparative biomarker/self-report studies from Europe [40–45] and North America [13]. There has traditionally been a lack of stigma surrounding recreational binge drinking in this population and this may also make accurate reporting more likely [2].…”

Diagnosis of Fetal Alcohol Spectrum Disorders (FASDs): Guidelines of Interdisciplinary Group of Polish Professionals

“…Therefore, it is recommended to introduce questions about drinking alcohol to a broader medical interview (an example of such an interview is provided in the attachments); avoid closed questions, i.e., those to which the patient only answers YES or NO; collect information on frequency, quantity, heavy drinking episodes, and timing of alcohol use during pregnancy [ 28 , 30 ]; use a standardized tool—AUDIT-C [ 19 , 31 ]. In patients whose AUDIT-C result indicates an increased risk of prenatal alcohol exposure, it is advisable to complete the interview with the complete the full AUDIT test [ 32 , 33 ]; and asking about the period of 3 months before pregnancy (or learning about pregnancy) may be a better predictor of drinking alcohol during pregnancy than a direct question about drinking alcohol during pregnancy [ 34 ]. Indirect interview—based on information from other people who have contact with the mother during pregnancy.…”

“…asking about the period of 3 months before pregnancy (or learning about pregnancy) may be a better predictor of drinking alcohol during pregnancy than a direct question about drinking alcohol during pregnancy [ 34 ].…”

Peri‐Conceptual and Mid‐Pregnancy Alcohol Consumption: A Comparison between Areas of High and Low Deprivation in Scotland

“…These instruments correlated moderately well, but the Retrospective Diary elicited admissions of significantly higher consumption levels (41). Recall, denial, social desirability bias and stigma can all affect the reporting of alcohol consumption (42).…”