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ANN ARBOR,
MI - Despite widespread warnings about the potential risk of
drinking alcohol during pregnancy, fifteen percent of pregnant women
in a newly published study said they had drunk alcohol at least
once during their pregnancies.
 And
although most of those women reported on an anonymous survey that
they'd had less than one drink a week, some acknowledged drinking
more than that on a regular basis, or said they'd had at least one
binge of five or more drinks at once.
The study,
published in the Jan. 2003 issue of the journal
Alcoholism: Clinical and Experimental Research by a team
from the University of Michigan
Health System, also found that women who smoke during pregnancy
were more likely to drink alcohol too - as were women in earlier
stages of pregnancy. And only about half of the women recalled being
asked about their drinking by their obstetric provider.
In all, the
authors say, the results suggest that doctors and other health care
providers should assess all women's drinking behavior during prenatal
visits, and counsel certain women more intensely about drinking
alcohol during pregnancy.
"The good
news is, most pregnant women aren't drinking, and those who do drink
aren't drinking much," says lead author Heather Flynn, Ph.D.,
an assistant research scientist at the University
of Michigan Addiction Research Center and a clinical associate
in the U-M Medical
School's Department of Psychiatry. "But there's a subgroup
that's at high risk, and we need to do more to understand and reach
them."
Flynn and her
colleagues are already tackling that next step, with a study that's
looking at the psychological and psychosocial factors that influence
a woman's tendency to drink alcohol during pregnancy. Through this
research, funded by the National
Institute on Alcohol Abuse and Alcoholism, they're examining
the interplay of drinking behavior with depression, stress, domestic
violence and other issues.
The specific
dose-related effects of alcohol exposure in the womb on a child's
mental and physical health have not been well documented. Still,
most medical authorities advise that pregnant women refrain from
drinking alcohol, though a few suggest that an occasional drink
may pose an acceptably low risk to the fetus.
The results
reported in the new paper document the incidence of alcohol use
among a large, diverse and general population of women, as well
as demonstrating the feasibility of surveying such a group for the
purposes of screening for alcohol use.
The study represents the largest and broadest assessment of drinking
in pregnancy since 1995; other studies have mainly focused on at-risk
populations or ethnic groups with a high risk of fetal alcohol syndrome,
a rare but devastating cause of birth defects and mental retardation
in children that has been shown to be brought on by heavy drinking
during a woman's pregnancy.
Flynn and her
colleagues surveyed 1,131 pregnant women, ranging in age from 18
to 46 years, while they were waiting for prenatal appointments at
eight obstetrics clinics in southeast Michigan. The women were between
3 and 41 weeks pregnant, and the racial makeup of the group was
similar to that of the regional population. The respondents were
assured that their answers would be anonymous and would not affect
their care. Only 8 percent of women approached declined to complete
the survey.
The women were
given written surveys that asked about a range of health and lifestyle
issues, including exercise and tobacco use, so that alcohol-related
questions blended in. The surveys included both direct questions
about drinking during pregnancy, and indirect questions about drinking
habits in the past year, using a validated survey instrument called
TWEAK. A TWEAK score of two or higher indicates a potential for
risky drinking behavior. All but 15 women answered the alcohol questions,
leaving 1,116 surveys to be analyzed.
The researchers
divided up the women who reported any alcohol use during pregnancy
into low- and high-risk groups. Eighty-six percent of the women
fell into the low-risk group, consuming less than one drink per
week and reporting no binges of five drinks or more at a time. The
remainder were those who drank one drink or more per week, or who
had one or more drinking binges during pregnancy. They account for
3 percent of the entire survey group.
Binge drinking
was uncommon, but measurable: Seven percent of the women using alcohol
reported one or more binge drinking episodes during their pregnancy.
Thirteen percent
of all women - whether or not they used alcohol during pregnancy
- scored two or higher on the TWEAK scale of drinking behavior.
But the proportion was higher among alcohol-using women, at 19 percent
of the low-risk group and 29 percent of the high-risk group.
There were
no significant differences in drinking behavior associated with
the women's marital status, race or education. But age, smoking
and earlier stages of pregnancy did correlate with a higher incidence
of alcohol use. Women in the high-risk group smoked twice as many
cigarettes per day than women in the low-risk group, and three times
as many cigarettes per day as women who didn't drink. Women in the
earlier stages of pregnancy were more likely to drink.
Among the women
who reported any drinking, just over 54 percent said their health
care provider had talked with them about drinking while pregnant.
This reflects known trends among clinicians, Flynn says - many feel
they don't have the time or training to address drinking with their
patients. But the results of the survey, she says, may help providers
see that their staff can screen their patients for alcohol use,
revealing which patients should receive further follow-up.
"We may
be able to identify, through quick screening, the women who may
be at highest risk for harmful outcomes for themselves and their
infants, and stop those potentially risky behaviors," says
Flynn. "But first, we need to better understand the relationships
between drinking, tobacco use, and other mental health issues in
pregnancy."
In addition
to Flynn, the research team includes U-M associate professor of
psychiatry Sheila Marcus, M.D.; Kristen Barry, Ph.D., senior associate
research scientist at UMARC; and Frederic Blow, Ph.D., associate
professor of psychiatry and senior associate research scientist
at UMARC. The survey was carried out by U-M psychology students,
with cooperation from the U-M Department of Obstetrics and Gynecology,
chaired by Timothy R. B. Johnson, M.D.
Alcoholism:
Clinical and Experimental Research, Vol. 27, No. 1, 2003, pp
81-87.
Written
by: Kara Gavin
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