FASDs, which include fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental disorder, are estimated to affect at least 1% of all births in the United States. FASDs have been associated with alcohol consumption patterns that produce high blood alcohol concentrations, such as binge drinking. Animal studies have found that binge-like drinking patterns are particularly dangerous, especially to fetal brain development, even if the total amount of alcohol consumed is less than that consumed in a more continuous drinking pattern. Although the prevalence of binge drinking is much lower among pregnant women than among nonpregnant women (1.4% versus 15.0%), those who did report binge drinking in the past 30 days did so with similar frequency (average of approximately three times a month) and similar intensity (average of approximately six drinks on an occasion) to nonpregnant women. These frequency and intensity estimates for pregnant and nonpregnant women of childbearing age are similar to the findings previously reported for all adult women (6).
Women who binge drink in the preconception period are more likely than non–binge drinkers to continue drinking, even after becoming pregnant. Among nonpregnant binge drinkers, binge drinking prevalence, frequency, and intensity were highest among those aged 18–24 years. Alcohol screening and brief interventions (SBI) among nonpregnant women, which include short counseling sessions, feedback, advice, and goal-setting conducted by health-care providers, might be helpful for reducing alcohol misuse§ among women at risk for an AEP.
For 2001–2005, CDC previously estimated binge drinking at 1.8% among pregnant women and 12.6% among nonpregnant women. For the 2006–2010 period, estimated binge drinking among pregnant women was lower (1.4%), but higher among nonpregnant women (15.0%). Until 2004, binge drinking was defined for men and women as five or more drinks on an occasion. In 2004, the National Institute on Alcohol Abuse and Alcoholism changed the definition of binge drinking for women to four or more drinks on an occasion to account for physiologic differences between men and women that affect the absorption of alcohol. BRFSS adopted the new sex-specific definition in 2006. This definition change sets a lower threshold for binge drinking among women, and therefore has the effect of increasing the prevalence estimate. A possible reason this increase is not observed in the pregnant population for the 2006–2010 data might be a change in the BRFSS questionnaire. Beginning in 2006, pregnancy status was asked before the alcohol consumption questions; the order was reversed in earlier questionnaires. Women who already have disclosed that they are pregnant might be less likely to report alcohol use in the past 30 days. Regardless of the binge drinking definition change and questionnaire change, these results indicate that binge drinking during pregnancy continues to be a concern.
The findings in this report are subject to at least three limitations. First, BRFSS data are self-reported and subject to misclassification, recall, and social desirability biases, which can lead to underestimates of alcohol consumption. Second, the prevalence of households without landline telephones and only cellular telephones is increasing, which excludes persons from landline-only surveys such as BRFSS who only use cellular telephones and might be more likely to consume alcohol and binge drink. BRFSS will include data for respondents with cellular telephones beginning with the 2011 data set. Finally, BRFSS also does not collect information from persons living in institutional settings (e.g., on college campuses), and so data might not be representative of those populations.
Pregnant and nonpregnant women of childbearing age who misuse alcohol might benefit from public health interventions. SBI and community level policy interventions, such as increased alcohol excise taxes and limiting alcohol outlet density¶ might be effective in reducing alcohol misuse among women and help to achieve the Healthy People 2020 goals of 98.3% abstinence from any alcohol use and 100% abstinence from binge drinking among pregnant females aged 15–44 years. Alcohol SBI is an evidence-based approach to address alcohol misuse in adults, including pregnant women, that has been recommended by the U.S. Preventive Services Task Force. CDC currently supports FASD Regional Training Centers to provide training to medical and allied health students, residents, and practitioners regarding prevention, identification, and management of FASDs. This includes teaching how to screen and intervene with women at risk for an AEP. CDC also is developing a guide for implementing SBI in primary-care settings and promoting public health efforts based on adaptations of Project CHOICES (Changing High-Risk Alcohol Use and Improving Contraception Effectiveness Study), an effective intervention that uses motivational interviewing to aid women of reproductive age in reducing their risk for an AEP. Widespread adoption of SBI in primary care settings, including obstetricians' offices, and community interventions might help reduce FASDs and other adverse pregnancy outcomes.
Behavioral Risk Factor Surveillance System state coordinators. Oak Ridge Institute for Science and Education.
Morbidity and Mortality Weekly Report. 2012;61(28):534-538. © 2012 Centers for Disease Control and Prevention (CDC)