West Australian women: Drinking before, and during, pregnancy

January 25, 2007

Complications due to drinking during pregnancy can range from the very serious Fetal Alcohol Syndrome to the less severe and possibly greater-occurring Fetal Alcohol Spectrum Disorders. The timing of alcohol consumption, its frequency, the beverage size and type, all appear to be crucial elements of identifying risk. A new survey has found that nearly 80 percent of non-Indigenous West Australian women consumed alcohol during the three months before pregnancy; nearly half had not planned their pregnancies; and more than half drank alcohol during pregnancy despite recommendations of abstinence.

Results are published in the February issue of Alcoholism: Clinical & Experimental Research.

"There is a lack of information as it relates to the measurement of alcohol consumption during the periconceptional period of pregnancy," said Lyn Colvin, a researcher at the Telethon Institute for Child Health Research at The University of Western Australia and corresponding author for the study. "In particular, information on specific alcoholic beverage consumed, frequency, timing during pregnancy, and volume in standard drinks are rare."

Colleen O'Leary, a research associate at the Telethon Institute for Child Health Research, concurs. "The most vulnerable period for the fetus is during the first trimester," she said, "although there is potential risk to the baby from drinking throughout pregnancy. It is important to know how much alcohol women are drinking both during the periconceptional period and throughout pregnancy, as well as more about the relationship between alcohol consumption during the periconceptional period and unplanned pregnancy. This information is important for women and men, policy makers and researchers."

Researchers analyzed data from a survey of 4,839 women 12 weeks after delivery. The women had agreed to participate in the 1995 - 1997 West Australian Pregnancy and Infancy Survey, created from a 10-percent random sample of all non-Indigenous women giving birth in Western Australia. Each participant was asked questions about alcohol consumption during four time periods: the periconceptional period, and each trimester of pregnancy. Questions were designed to measure the volume and type of alcoholic beverage consumed, as well as frequency of consumption. "Of those 3,860 women consuming alcohol in the three months before pregnancy," said Colvin, "the majority (55.6%) drank more than one type of alcoholic beverage. Once pregnant, the majority (65.5%) drank only one type of alcoholic beverage." "These data are in agreement with other Australian studies, and studies from the United States and Britain," said O'Leary. "It is concerning, however, that with the range of contraceptive options available to women that such a high proportion of pregnancies are unplanned." Furthermore, she added, the women who had planned their pregnancies were significantly less likely to drink alcohol during the first trimester than women who did not plan their pregnancy. "This would indicate that many pregnancies may be exposed to high levels of alcohol during the periconceptional period, prior to pregnancy awareness." "It is interesting to note that the number of women who consumed alcohol during the 2nd trimester (42.4%) was similar to the number during the 1st trimester (42.1%)," said Colvin. "This probably indicates that the pregnant women were unaware of the recommendation of abstinence."

"Until 2001," added O'Leary, "the Australian guideline for alcohol consumption during pregnancy was abstinence. However, to my knowledge, there was no health promotion campaign in WA to educate women of this policy during or prior to the period these data were collected. Furthermore, a survey of health professionals conducted in WA during 2002 - 2003 found that fewer than half of health professionals surveyed routinely provided information to pregnant women about alcohol consumption during pregnancy."

'Despite what initially appears alarming, said Colvin, "it is actually encouraging that many women who drank alcohol reduced their consumption in the first trimester of pregnancy. With appropriate information, they and others may be able to further reduce or abstain from consuming alcohol when they are pregnant or might soon become pregnant. The challenge is to develop effective health promotion messages to reach women of child-bearing age before they consider pregnancy so they can make informed decisions." She added that involving health-promotion practitioners, medical practitioners and obstetricians would be key.

Both Colvin and O'Leary were concerned about "binge" drinking among women of childbearing age. "The findings that 14.2 percent of women surveyed consumed five or more standard drinks per occasion during the three months prior to pregnancy, and that almost half of the pregnancies were unplanned pregnancies, indicate that many women may have exposed their babies to high levels of alcohol before they were aware of their pregnancy," said O'Leary. In addition, she observed, "the percentage of Australian teenagers who binge drink has increased over the past decade since these data were collected. We need to find ways to reduce the very culture of binge drinking which is particularly concerning in young people as this is when drinking patterns are established."

O'Leary spoke of the need to educate both men and women. "We need to be careful how we frame our health-promotion messages since many women may have consumed alcohol prior to pregnancy awareness and unintentionally exposed their baby to alcohol," she said. "It is important not to generate undue fear and/or guilt. In addition, it is important not to place all the responsibility onto women alone: both women and men need to know about the risks to the baby from the consumption of alcohol during pregnancy; and many women and men need to take better precautions to prevent unplanned pregnancies."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Alcohol Consumption During Pregnancy in Non-Indigenous West Australian Women," were: Jan Payne, Deborah E. Parsons, and Carol Bower of the Telethon Institute for Child Health Research at The University of Western Australia; and Jennifer J. Kurinczuk of the National Perinatal Epidemiology Unit at the University of Oxford. The study was funded by the Health Promotion Foundation of Western Australia.

Alcoholism: Clinical & Experimental Research

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