Sociodemographic and Behavioral Characteristics Associated with Alcohol Consumption During Pregnancy -- United States, 1988

Identification of women at risk for consuming alcohol during pregnancy is critical to the design of interventions for reducing the adverse effects of alcohol on both women and their children. This report uses data from the 1988 National Maternal and Infant Health Survey (NMIHS) -- the most recent vital records survey for which a population-based sample of this size was available -- conducted by CDC's National Center for Health Statistics to analyze characteristics of women who drink alcohol during pregnancy.

The NMIHS was a mail survey of a stratified systematic sample of 13,417 women who had a live-born infant during 1988 (1); data from the survey became available in 1991. A total of 9953 (74%) responded. Maternal characteristics analyzed included age, race/ethnicity, education, household income, marital status, parity, smoking status, prenatal care, and alcohol drinking patterns during the 3 months before respondents learned of their pregnancy and during their pregnancy (i.e., prenatal drinkers) *. Data were further analyzed for women who reported having had six or more drinks per week during their pregnancy (i.e., frequent drinkers). The sample data were weighted to reflect general population estimates, and standard errors were calculated using SUDAAN (2).

Overall, 45.4% of the respondents reported drinking alcohol during the 3 months before they learned of their pregnancy, 20.7% reported drinking alcohol after they learned of their pregnancy, 16.8% reported drinking three or fewer drinks per month during pregnancy, and 0.6% reported having had six or more drinks per week during pregnancy.

The likelihood of any reported prenatal drinking increased directly with age through age group 30-34 years Table_1. The race/ethnicity-specific proportion of prenatal drinkers was highest among white, non-Hispanic women (25.4% {95% confidence interval (CI)=23.9%-27.0%}). The likelihood of prenatal drinking was higher among women with greater than or equal to 16 years of education (30.8% {95% CI=28.3%-33.2%}) than among women in other educational groups and higher among women with annual household incomes of greater than or equal to $40,000 (29.1% {95% CI=26.5%-31.7%}) compared with women in other income groups. Prenatal drinking was reported by 38.2% (95% CI=33.5%-42.9%) of women who smoked greater than 10 cigarettes a day and by 17.2% (95% CI=16.0%-18.4%) of women who were nonsmokers.

Frequent prenatal drinking was more prevalent among women aged greater than or equal to 35 years (1.4% {95% CI=0.2%-2.5%}) than among younger women Table_1. The race/ethnicity-specific proportion of frequent drinkers was higher among all racial/ethnic groups other than white. The likelihood of frequent drinking was higher among women with annual household incomes less than or equal to $10,000 (1.3% {95% CI=0.7%-1.9%}). The proportion of frequent drinkers increased as smoking level increased, and was more than three times higher among women receiving no prenatal care than among those who received prenatal care (2.2% {95% CI=0.9%-3.6%} compared with 0.6% {95% CI=0.4%- 0.8%}). Reported by: Fetal Alcohol Syndrome Prevention Section, Developmental Disabilities Br, Div of Birth Defects and Developmental Disabilities, National Center for Environmental Health; Followback Survey Br, Div of Vital Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: An advisory both for women who are pregnant and for those trying to become pregnant not to drink alcohol was issued by the U.S. Surgeon General in 1981 (3) and was reiterated in 1990 by the Secretary of Health and Human Services (4). Although only a small proportion of the population surveyed reported frequent drinking during pregnancy, analyses of risk factors suggest these women have some different sociodemographic characteristics than those of all women who drink during pregnancy; however, the number of frequent drinkers in the survey was small, producing unstable population estimates that require further evaluation. The findings in this report are consistent with selected findings in previous studies (5,6) and can assist in targeting programs for the prevention of maternal alcohol consumption during pregnancy.

The findings in this report are subject to at least three limitations. First, alcohol drinking was self-reported and could not be verified. Disclosure of prenatal alcohol consumption may have been underreported because of increasing awareness of the dangers of alcohol consumption during pregnancy (7). Second, NMIHS data do not include a question about "binge" drinking (i.e., consuming five or more drinks on any one occasion), which has been associated with neurodevelopmental deficits (8). Third, drinking patterns may have changed since these data were collected. Analyses of more recent data from CDC's Behavioral Risk Factor Surveillance System may provide information about recent trends in maternal alcohol consumption during pregnancy.

The high prevalence of alcohol drinking by women during pregnancy in 1988 (21%) underscores the need to sustain efforts by public health agencies and health-care providers to advise women against drinking if they are trying to become pregnant or are likely to become pregnant. Although in this study frequent alcohol drinkers were a small proportion of all women who consumed alcohol during pregnancy, they are at greater risk than infrequent drinkers for delivering infants with alcohol-related disorders (9,10). Although previous studies documented adverse fetal effects of prenatal alcohol at relatively high thresholds, more recent studies have found adverse physical and neurobehavioral effects at lower exposure levels. Population-based surveys that oversample women with characteristics described in this and other studies may assist in better defining women who drink alcohol frequently during pregnancy because they may account for a disproportionately larger number of children affected by in utero alcohol exposure.

References

1. NCHS. National Maternal and Infant Health Survey {Machine-readable public-use data tape}. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1988.

2. Shah BV. Software for survey data analysis (SUDAAN) version 5.5 {Software documentation}. Research Triangle Park, North Carolina: Research Triangle Institute, 1991.

3. Office of the U.S. Surgeon General. Surgeon General's advisory on alcohol and pregnancy. FDA Drug Bulletin 1981;11:9-10.

4. US Department of Agriculture/US Department of Health and Human Services. Nutrition and your health: dietary guidelines for Americans. 3rd ed. Washington, DC: US Department of Agriculture/US Department of Health and Human Services, 1990:25-6.

5. Streissguth AP, Grant TM, Barr HM, et al. Cocaine and the use of alcohol and other drugs during pregnancy. Am J Obstet Gynecol 1991;164:1239-43.

6. Serdula M, Williamson D, Kendrick J, Anda RF, Byers T. Trends in alcohol consumption by pregnant women, 1985 through 1988. JAMA 1991;265:876-9.

7. Dufour MC, Williams GD, Campbell KE, Aitken SS. Knowledge of FAS and the risks of heavy drinking during pregnancy, 1985-1990. Alcohol Health Res World 1994:18;86-92.

8. Streissguth AP, Bookstein FL, Sampson PD, Barr HM. Neurobehavioral effects of prenatal alcohol, part III: PLS analyses of neuropsychologic tests. Neurotoxicol Teratol 1989;11:493-507.

9. Day NL, Richardson GA, Geva D, Robles N. Alcohol, marijuana, and tobacco: effects of prenatal exposure on offspring growth and morphology at age six. Alcohol Clin Exp Res 1994;18:786-94.

10. Jacobson JL, Jacobson SW. Prenatal alcohol exposure and neurobehavioral development: where is the threshold? Alcohol Health Res World 1994;18:30-6.

* Women who responded yes to "Did you drink any alcoholic beverages during the 12 months before your delivery?" were asked "How many drinks did you have on average during the 3 months before you found out you were pregnant?" and "How many drinks did you have on average after you found out you were pregnant?" One drink was defined as 12 oz of beer, 4 oz of wine, or 1 1/2 oz of liquor.

TABLE 1. Percentage of women who self-reported drinking alcohol during pregnancy,
by selected characteristics -- National Maternal and Infant Health Survey, United
States, 1988
========================================================================================================
                     Prenatal * drinkers (n=1738)  Frequent + drinkers  (n=102)
                     ----------------------------  ----------------------------
Characteristic            %     (95% CI &)              %       (95% CI%)
-------------------------------------------------------------------------------
Age group (yrs)
   <=19                   9.5  ( 7.2%-11.9%)           0.2     (0.1%-0.3%)
  20-24                  16.7  (14.6%-18.7%)           0.7     (0.3%-1.2%)
  25-29                  22.9  (20.8%-25.0%)           0.4     (0.1%-0.6%)
  30-34                  28.7  (25.9%-31.5%)           0.6     (0.2%-1.1%)
   >=35                  21.9  (17.8%-26.0%)           1.4     (0.2%-2.5%)

Race/Ethnicity
  White, non-Hispanic    25.4  (23.9%-27.0%)           0.5     (0.2%-0.7%)
  White, Hispanic        10.6  ( 7.9%-13.3%)           0.3     (0   -0.6%)
  Black, non-Hispanic    12.2  (11.2%-13.1%)           1.1     (0.8%-1.5%)
  Black, Hispanic         8.2  ( 3.5%-12.9%)           1.1     (0   -2.8%)
  Other @                10.0  ( 6.0%-13.9%)           1.1     (0   -2.5%)

Education (yrs)
   0-11                  10.5  ( 8.7%-12.3%)           0.7     (0.3%-1.1%)
     12                  18.7  (17.0%-20.4%)           0.6     (0.3%-0.9%)
  13-15                  24.8  (22.3%-27.3%)           0.3     (0   -0.7%)
   >=16                  30.8  (28.3%-33.2%)           0.6     (0   -1.2%)

Total annual
  household income
         <$10,000        17.1  (15.0%-19.2%)           1.3     (0.7%-1.9%)
  $10,000-$24,999        15.8  (14.0%-17.7%)           0.4     (0.1%-0.7%)
  $25,000-$39,999        21.9  (19.5%-24.4%)           0.3     (0   -0.5%)
        >=$40,000        29.1  (26.5%-31.7%)           0.4     (0.1%-0.7%)

Marital status
  Married                22.1  (20.7%-23.5%)           0.4     (0.2%-0.6%)
  Unmarried              16.7  (14.8%-18.7%)           1.0     (0.5%-1.5%)

Parity
    1                    20.5  (18.8%-22.1%)           0.4     (0.1%-0.6%)
    2                    20.5  (18.5%-22.6%)           0.5     (0.2%-0.8%)
  >=3                    21.9  (19.5%-24.2%)           1.1     (0.6%-1.7%)

Cigarette smoking status
  during pregnancy
     0                   17.2  (16.0%-18.4%)           0.2     (0.1%-0.4%)
  1-10 per day           30.0  (26.6%-33.4%)           1.2     (0.6%-1.9%)
   >10 per day           38.2  (33.5%-42.9%)           2.7     (1.3%-4.1%)

Prenatal care
  Yes                    20.7  (19.6%-21.9%)           0.6     (0.4%-0.8%)
  No                     20.6  (13.1%-28.2%)           2.2     (0.9%-3.6%)

Total                    20.7  (19.6%-21.9%)           0.6     (0.4%-0.8%)
-------------------------------------------------------------------------------
* Women who reported drinking at any time during pregnancy.
+ Women who reported consuming six or more drinks per week during pregnancy.  One drink was defined as
  12 oz of beer, 4 oz of wine or 1 1/2 oz of liquor.
& Confidence interval.
@ Number of women in other specific racial/ethnic groups was too small for meaningful analysis.
========================================================================================================

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