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Survey finds ongoing concerns with alcohol use during pregnancy - January 2014

Findings indicate many women still need to get the message about alcohol use

A recent survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) found ongoing concerns about the number of women who drink alcohol during pregnancy. According to SAMHSA’s National Survey on Drug Use and Health (NSDUH) for 2011-12, 18 percent of pregnant women age 15 to 44 reported at least some consumption of alcohol during their first trimester, a time when many women may not yet know they are pregnant. In addition, almost 7 percent reported an episode of binge drinking (five or more drinks within a couple of hours) during their first trimester, which may be especially harmful to the developing fetus.

However, the survey also found that alcohol use dropped to around 4 percent among women in their second and third trimesters. This result suggests that many women are heeding the message to avoid alcohol once they know they are pregnant.

Drinking at any time during a pregnancy is problematic. Exposure to alcohol places the developing fetus at risk for the wide range of physical, intellectual, developmental, or behavioral problems known as Fetal Alcohol Spectrum Disorders (FASD). The survey results indicate that almost one in five pregnant women drinks alcohol early in pregnancy and some continue to drink throughout their pregnancy, so there remains much work to do to reduce the risk of FASD.

Drs. Margaret Mattson and Rachel Lipari are researchers at SAMHSA’s Center for Behavioral Health Statistics and Quality. We have asked them to give us some more insight into the survey results.

Questions

Q: What other information does the NSDUH tell us about women and alcohol use during pregnancy? According to the survey results, what age range of women who are pregnant had the highest rate of alcohol use?

Overall, about 8.5 percent of pregnant women reported having a drink of alcohol in the past 30 days, and 2.7 percent reported binge drinking.

By race and ethnicity, non-Hispanic whites and blacks are similar with 9-10 percent drinking any amount and roughly 3 percent binge drinking. Hispanic drinking rates are about half that of non-Hispanic, with 5.5 percent of pregnant Hispanic women drinking any alcohol and 1.5 percent binge drinking.

Young pregnant girls were at the greatest risk of an alcohol-affected pregnancy, with 13 percent of pregnant girls between 15 and 17 years of age reporting they drank in the past 30 days. Among pregnant women in the 18-25 and 26-44 age groups, between 7-9 percent reported some alcohol use, with 2-3 percent reporting binge drinking.

Q: What does the NSDUH show about women of childbearing age and drinking?

Among women between 18 and 44 years of age, the rate of drinking among nonpregnant women is much higher than among pregnant women, showing that many women have gotten the message to cease drinking while pregnant. Among pregnant women age 15 to 44, an annual average of 8.5 percent reported current alcohol use, 2.7 percent reported binge drinking, and 0.3 percent reported heavy drinking. These rates were lower than the rates for nonpregnant women in the same age group (55.5, 24.7, and 5.2 percent, respectively). As encouraging as this difference is, the 18 percent of women drinking during that important first trimester are a concern. Since FASD is 100 percent avoidable in the absence of alcohol exposure, we still need to continue reaching women in this age group.

Q: What is the public health significance of alcohol use during pregnancy?

The established public health message is that pregnant women should not drink any alcohol during their pregnancy, and that women of childbearing age who drink should take effective steps to avoid pregnancy. Because the exact amount and timing of alcohol’s deleterious effect on the fetus are not yet understood, abstinence throughout pregnancy is by far the safest course.

Q: What do you feel is the impact of the survey results? What are some of the strengths and weaknesses of this survey?

The annual NSDUH provides unparalleled information on substance use and mental health among persons age 12 and older in households in the United States. This survey interviews over 67 thousand people each year and uses population-based weights to provide prevalence estimates representative of the United States as a whole as well as at the state level. Data from the survey is widely used to establish benchmarks for the prevalence of mental disorders as well as substance use and substance use disorders, including the use of illicit drugs, alcohol, and prescription drugs.

The NSDUH is not designed to collect information on some populations, such as homeless people, and those in long-stay hospitals, prisons or other institutions, or the military.

Also, the NSDUH defines binge drinking for both men and women as consuming five or more drinks within about a two hour period. However, alcohol affects women differently than men. For women, binge drinking is generally considered to mean four drinks within two hours.



About the Experts

Margaret E. Mattson, Ph.D., is a research scientist in the Center for Behavioral Statistics and Quality at SAMHSA. Before coming to SAMHSA, she worked in program development and research for several Institutes at the National Institutes of Health. She received her doctorate in Neurobiology and Behavior from Cornell University. Her major interest is in developing interventions to address behavioral risk factors in chronic disease. She has published over 100 articles and book chapters, and has taught internationally on the effects of alcohol during pregnancy and early childhood, with an emphasis on fetal alcohol spectrum disorders (FASD).


Rachel Lipari, Ph.D., is a military sociologist currently serving as a statistician at the Center for Behavioral Health Statistics and Quality in SAMHSA. Before coming to SAMHSA, she was the lead overseeing gender, race/ethnicity, and military family research for the Office of the Secretary of Defense until 2011. Her research interests include mental health, family issues, substance abuse, diversity, and sexual assault. Dr. Lipari is an expert in military research and is applying her knowledge of survey design and analysis to the NSDUH.


DISCLAIMER: The views, opinions, and content of this column are those of the authors/experts and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.