Risk factors for alcohol use among pregnant women, ages 15–44, in the United States, 2002 to 2017

Abstract

Fetal alcohol exposure can lead to severe birth and developmental defects. Determining which pregnant women are most likely to drink is essential for targeting interventions. In National Survey on Drug Use and Health data on pregnant women from 2002-2017 (N=13,488), logistic regression was used to produce adjusted odds ratios (aOR) indicating characteristics associated with two past-month outcomes: any alcohol use and binge drinking. Risk factors were sociodemographic (age, race/ethnicity, marital status, education level, income) and clinical (trimester, substance use, alcohol use disorder, major depression). Where associations differed by pregnancy stage (trimester 1 vs. trimesters 2 and 3), association was evaluated by stage. Overall, higher risk for any and binge drinking was observed among those with other substance use (aORs 2.9-25.9), alcohol use disorder (aORs 4.5-7.5), depression (aORs=1.6), and unmarried women (aORs 1.6-3.2). For any drinking, overall, higher risk was observed in adolescents (aOR=1.5) and those with higher education (aOR=1.4), while lower risk was observed in those with lower income (aORs=0.7). For binge drinking, associations differed by pregnancy stage. In trimester 1, lower risk was observed in middle ages (aOR=0.4). In trimesters 2/3, higher risk was observed in Blacks (aOR=3.3) and those with lower income (aORs 3.5-3.9), while lower risk was observed in those with higher education (aOR=0.3). To prevent severe prenatal harm, health care providers should focus on women at higher risk for binge drinking during pregnancy: women with tobacco or drug use, alcohol use disorder, or depression, and women who are unmarried, Black, or of lower socioeconomic status.

Fetal Alcohol Spectrum Disorders in a Pacific Southwest City: Maternal and Child Characteristics

“…The U.S. National Survey on Drug Use and Health survey reported on risk factors for alcohol use among 13,488 pregnant women, aged 15 to 44, in the United States from 2002 to 2014 (Shmulewitz and Hasin, ). Higher risk for any drinking and binge drinking was observed among pregnant women with other substance use including tobacco (aORs 2.9 to 25.9), depression (aOR 1.6), and unmarried status (aORs 1.6 to 3.2).…”

“…Higher risk for any drinking was observed in those with higher education and income. However, higher risk was observed for binge drinking in the second and third trimesters among Blacks (aOR 3.3) and those with lower income and less education (Shmulewitz and Hasin, ).…”

Social predictors of alcohol use and cessation during pregnancy among Japanese women: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

“…Higher education was also associated with alcohol cessation between early and middle pregnancy, and therefore education was not associated with alcohol use in middle pregnancy. There is some evidence that highly educated women were more likely to consume alcohol before becoming aware of their pregnancy, and more likely to continue or reduce rather than cease alcohol use during pregnancy in Western countries [12,14,[16][17][18]. Meanwhile, two studies in Japan showed that highly educated women were more likely to cease alcohol use after becoming aware of their pregnancy [9,19].…”

“…Differences in prevalence of alcohol use have been reported between early pregnancy and middle/late pregnancy [8][9][10][11][12]. Although this suggests that predictors of alcohol use may differ by pregnancy stage, very few studies have been conducted at different points during pregnancy [13][14][15][16].…”

A New Parental Mentalization Focused Ultrasound Intervention for Substance Using Pregnant Women. Effect on Self-reported Prenatal Mental Health, Attachment and Mentalization in a Randomized and Controlled Trial

“…First, maternal perinatal mental disorders have a wide spectrum of independent adverse effects on the developing fetus (Stein et al 2014;Waters et al 2014). Second, prenatal stress and depression have been found to predict unfavorable health practices (Alhusen et al 2016;Cannella et al 2018) and a higher risk of substance use in pregnancy (Alhusen et al 2016;Hyer et al 2019;Shmulewitz and Hasin 2019). Generally, stress associates with increased craving, and potentially with opioid use, among persons with an opioid use disorder (MacLean et al 2019).…”