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Alcohol consumption during pregnancy: Prevalence, predictors and prevention
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

It is well established that fetal alcohol exposure can disturb the development of the fetus and cause a range of effects for the affected child. However, research on the effects of exposure to lower levels is inconclusive and the subject is debated. Based on the precautionary principle women in many countries, Sweden included, are advised to maintain total abstinence throughout pregnancy. Regardless, studies have shown that a significant proportion of women consume alcohol around conception and throughout pregnancy. The overall aim of this thesis was to generate knowledge about the prevalence, predictors and prevention of alcohol consumption among women before and during pregnancy.

The aim was addressed in five studies using several datasets and methods. A systematic review of the international literature was undertaken to identify predictors of alcohol consumption during pregnancy (Study I). Questionnaires to midwives were used to investigate the alcohol-preventive work in antenatal care in Sweden (Study II). Questionnaires were also used to gather data on alcohol consumption before and during pregnancy from pregnant women across Sweden and from women who had given birth to a child in one area of Sweden (Study III and IV). Focus group interviews were used to assess non-pregnant women’s voices on alcohol consumption and pregnancy in Sweden (Study V).

The results from the studies showed that alcohol consumption was common among women of childbearing age in Sweden (Study III-V) and that there were social expectations for women to drink (Study V). During pregnancy, the expectation was the opposite, as pregnant women were expected to abstain from all alcohol consumption (Study V), which is in line with the total abstinence recommendation from antenatal care. The national “Risk Drinking” project led to revised alcohol-preventive routines in Swedish antenatal care, including screening of all pregnant women for hazardous alcohol use in the year preceding pregnancy, an important predictor of drinking during pregnancy (Study II). A great majority of pregnant women and new mothers reported abstinence from alcohol after pregnancy recognition (Study III and IV), yet the level of reported alcohol consumption during pregnancy appeared to be affected by formulation of the question (Study IV). Factors associated with more drinking during pregnancy in Sweden were: living in a major city, older maternal age, tobacco use, low social support, stronger pre-pregnancy drinking habits and stronger social drinking motives (Study III). In the international research, pre-pregnancy drinking habits, exposure to abuse or violence, high income or social class and positive screen for dependence were the factors most consistently reported to be associated with more drinking during pregnancy (Study I). Women of childbearing age were uncertain about the potential effects of drinking in the period around conception and the social expectations to abstain did not seem to be as strong in this period as after pregnancy  recognition (Study V). A majority of women reported having reduced their alcohol consumption only after they became aware that they are pregnant, meaning that they could have been dinking for several weeks in early pregnancy (Study III).

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. , 127 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1470
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-122375DOI: 10.3384/diss.diva-122375ISBN: 978-91-7519-024-2 (print)OAI: oai:DiVA.org:liu-122375DiVA: diva2:865990
Public defence
2015-11-20, Belladonna, Hus 511-001, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2015-11-12Bibliographically approved
List of papers
1. Predictors of Drinking During Pregnancy: A Systematic Review
Open this publication in new window or tab >>Predictors of Drinking During Pregnancy: A Systematic Review
2011 (English)In: Journal of Women's Health, ISSN 1540-9996, E-ISSN 1931-843X, Vol. 20, no 6, 901-913 p.Article, review/survey (Refereed) Published
Abstract [en]

Background: Many pregnant women continue to drink alcohol despite clinical recommendations and public health campaigns about the risks associated with alcohol use during pregnancy. This review examines the predictors of prenatal alcohol use, with the long-term goal of developing more effective preventive efforts. Methods: A literature search of several databases for relevant articles was undertaken. Studies were included if they occurred in the context of antenatal care, collected data during the womans pregnancy (between 1999 and 2009), investigated predictors of any drinking, had a population-based orientation (e. g., did not focus only on high-risk drinkers), and were published in English in a scientific peer-reviewed journal between 1999 and 2009. Results: Fourteen studies published between 2002 and 2009 fulfilled the inclusion criteria (United States, 4; Europe, 4; Australia and New Zealand, 3; Japan, 2; and Uganda, 1). The predictors of prenatal alcohol use most consistently identified were prepregnancy alcohol consumption and having been abused or exposed to violence. Less consistent predictors of drinking during pregnancy were high income/social class and positive dependence screen. Unemployment, marital status, and education level were examined in many studies but found to be predictive only infrequently. Conclusions: Womens prepregnancy alcohol consumption (i.e., quantity and frequency of typical drinking) and exposure to abuse or violence were consistently associated with drinking during pregnancy. Antenatal care providers should assess these factors for improved detection of women at risk for alcohol-exposed pregnancies.

Place, publisher, year, edition, pages
Mary Ann Liebert, Inc., 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-69901 (URN)10.1089/jwh.2010.2216 (DOI)000291590700010 ()
Note

Original Publication: Janna Skagerstrom, Grace Chang and Per Nilsen, Predictors of Drinking During Pregnancy: A Systematic Review, 2011, Journal of Women's Health, (20), 6, 901-913. http://dx.doi.org/10.1089/jwh.2010.2216 Copyright: Mary Ann Liebert, Inc. http://www.liebertpub.com/

Available from: 2011-08-09 Created: 2011-08-08 Last updated: 2017-12-08
2. Towards improved alcohol prevention in Swedish antenatal care?
Open this publication in new window or tab >>Towards improved alcohol prevention in Swedish antenatal care?
Show others...
2012 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 3, 314-320 p.Article in journal (Refereed) Published
Abstract [en]

Objective: to evaluate an education effort and revised alcohol-preventive routine in Swedish antenatal care; to generate more knowledge for further development of alcohol issues in antenatal care. less thanbrgreater than less thanbrgreater thanDesign: two national cross-sectional surveys of Swedish midwives were conducted. Baseline data were collected in 2006 and follow-up data in 2009. less thanbrgreater than less thanbrgreater thanSetting: antenatal care centres in Sweden. less thanbrgreater than less thanbrgreater thanParticipants: 974 midwives in 2006 and 1108 midwives in 2009. less thanbrgreater than less thanbrgreater thanMeasurement: amount and content of continuing professional education, work with alcohol-related issues, identification of women with risky consumption of alcohol, and action after identifying women with risky consumption. less thanbrgreater than less thanbrgreater thanFindings: the amount of continuing professional education undertaken by midwives on handling risky drinking increased significantly between 2006 and 2009. The routine to detect risky drinking changed between the baseline and follow-up data collection, as nearly all midwives reported the use of an alcohol screening questionnaire in 2009. The most confident midwives in 2009 had taken part in more days of education, more often stated it was their own initiative to participate, and had more often taken part in education regarding MI, provision of advice and information on the health risks associated with alcohol and, screening. less thanbrgreater than less thanbrgreater thanKey conclusions: our results indicate that a broad, national education effort can be successful in enhancing knowledge and changing antenatal care practice. However, generalisation to other countries or cultures may be limited because the usage of new routines is affected by many organisational and contextual factors.

Place, publisher, year, edition, pages
Elsevier, 2012
Keyword
Antenatal care, Alcohol, Education
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-78573 (URN)10.1016/j.midw.2011.04.008 (DOI)000304441400006 ()
Note

Funding Agencies|Swedish National Institute of Public health||

Available from: 2012-06-15 Created: 2012-06-15 Last updated: 2017-12-07
3. Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden
Open this publication in new window or tab >>Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden
Show others...
2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 780Article in journal (Refereed) Published
Abstract [en]

Background

There is a paucity of research on predictors for drinking during pregnancy among women in Sweden and reported prevalence rates differ considerably between studies conducted at different antenatal care centres. Since this knowledge is relevant for preventive work the aim of this study was to investigate these issues using a multicenter approach.

Methods

The study was conducted at 30 antenatal care centers across Sweden from November 2009 to December 2010. All women in pregnancy week 18 or more with a scheduled visit were asked to participate in the study. The questionnaire included questions on sociodemographic data, alcohol consumption prior to and during the pregnancy, tobacco use before and during pregnancy, and social support.

Results

Questionnaires from 1594 women were included in the study. A majority, 84%, of the women reported alcohol consumption the year prior to pregnancy; about 14% were categorized as having hazardous consumption, here defined as a weekly consumption of > 9 standard drinks containing 12 grams of pure alcohol or drinking more than 4 standard drinks at the same occasion. Approximately 6% of the women consumed alcohol at least once after pregnancy recognition, of which 92% never drank more than 1 standard drink at a time. Of the women who were hazardous drinkers before pregnancy, 19% reduced their alcohol consumption when planning their pregnancy compared with 33% of the women with moderate alcohol consumption prior to pregnancy. Factors predicting alcohol consumption during pregnancy were older age, living in a large city, using tobacco during pregnancy, lower score for social support, stronger alcohol habit before pregnancy and higher score for social drinking motives.

Conclusions

The prevalence of drinking during pregnancy is relatively low in Sweden. However, 84% of the women report drinking in the year preceding pregnancy and most of these women continue to drink until pregnancy recognition, which means that they might have consumed alcohol in early pregnancy. Six factors were found to predict alcohol consumption during pregnancy. These factors should be addressed in the work to prevent alcohol-exposed pregnancies.

Place, publisher, year, edition, pages
BioMed Central, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97660 (URN)10.1186/1471-2458-13-780 (DOI)000323754500003 ()
Note

Funding Agencies|Swedish National Institute of Public Health||

Available from: 2013-09-19 Created: 2013-09-19 Last updated: 2017-12-06
4. Asking about alcohol consumption during pregnancy: how prevalence rate is affected by the formulation of the question
Open this publication in new window or tab >>Asking about alcohol consumption during pregnancy: how prevalence rate is affected by the formulation of the question
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Studies of alcohol consumption during pregnancy in Sweden have reported prevalence rates from 6% to 30%. The reason for these differences is unknown. The aim of this study was to compare how alcohol consumption is reported by pregnant women when asked explicitly to report drinking after pregnancy recognition compared with asking about drinking during pregnancy without stating if the time before pregnancy recognition should be included. Data were collected from two groups of women. The women in group A were asked to estimate their alcohol consumption during pregnancy and the women in group B were asked to estimate their alcohol consumption during pregnancy, after pregnancy recognition. There was a significant difference in the reported prevalence rate between the cohorts: 9.3% in cohort A (n=1041) and 6.8% in cohort B (n=933). The results from this study may explain some of the variations in previously reported prevalence rates. To be able to compare different studies, it is important to be clear about the methodological aspects.

Keyword
Prevalence rate, alcohol consumption, pregnancy
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-122373 (URN)
Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2015-10-30Bibliographically approved
5. The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden
Open this publication in new window or tab >>The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden
2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, 1193Article in journal (Refereed) Published
Abstract [en]

Background: Consensus is that fetal exposure to alcohol is harmful. Abstinence while trying to conceive and throughout pregnancy is recommended. Despite this, there are many women who consume alcohol around conception and until pregnancy recognition. The aim of this study was to explore the voice of non-pregnant women concerning alcohol consumption and its relation to pregnancy.

Methods: Data were collected through seven focus groups interviews with 34 women of fertile age, who were neither pregnant nor mothers. Semi-structured interviews were undertaken, recorded and transcribed verbatim and then analysed using thematic analysis.

Results: Three main themes were identified in the analysis: an issue that cannot be ignored; awareness and uncertainty concerning alcohol and pregnancy; and transition to parenthood. Alcohol was an integral part of the women’s lives. A societal expectation to drink alcohol was prevalent and the women used different strategies to handle this expectation. Most women agreed not to drink alcohol during pregnancy although their knowledge on the specific consequences was scanty and they expressed a need for more information. Most of the participants found drinking alcohol during pregnancy to be irresponsible and saw pregnancy as a start of a new way of life.

Conclusions: Social expectations concerning women’s alcohol use change with pregnancy when women are suddenly expected to abstain. Although most study participants shared an opinion for zero tolerance during pregnancy, their knowledge regarding consequences of drinking during pregnancy were sparse. In order for prospective mothers to make informed choices, there is a need for public health initiatives providing information on the relationship between alcohol consumption and reproduction.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keyword
Alcohol consumption, Pregnancy, Fertile age, Pregnancy planning, Health education, Focus group
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-122374 (URN)10.1186/s12889-015-2519-2 (DOI)000365477300002 ()
Note

On the day of the defence day the status of this article was Manuscript.

Funding agencies: Systembolaget Alcohol Research Council (Systembolagets alkoholforskningsrad)

Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2017-12-01Bibliographically approved

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