Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18–44 Years — United States, 2015–2017

Clark H. Denny, PhD; Cristian S. Acero, MPH; Timothy S. Naimi, MD; Shin Y. Kim, MPH

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(16):365-368. 

In This Article

Abstract and Introduction

Introduction

Drinking alcohol during pregnancy can cause fetal alcohol spectrum disorders (FASDs), including birth defects that involve central nervous system impairment, behavioral disorders, and impaired intellectual development, which can lead to difficulties with school and employment. A recent study in four U.S. communities found a 1.1%–5.0% prevalence of FASDs among first-grade students.[1] Drinking during pregnancy might also be a risk factor for other adverse pregnancy and birth outcomes, including miscarriage and stillbirth.[2] CDC estimated the prevalence of self-reported current drinking (at least one alcohol drink in the past 30 days) and binge drinking (consuming four or more drinks on at least one occasion in the past 30 days) among pregnant women aged 18–44 years, using 2015–2017 data from the Behavioral Risk Factor Surveillance System (BRFSS). Current drinking and binge drinking in the past 30 days were reported by 11.5% and 3.9% of pregnant women, respectively. Among pregnant women who binge drink, the average frequency of binge drinking in the past 30 days was 4.5 episodes, and the average intensity of binge drinking (the average largest number of drinks reported consumed on any occasion among binge drinkers) was 6.0 drinks. Increased implementation of evidence-based community-level and clinic-level interventions, such as universal alcohol screening and brief counseling in primary and prenatal care, could decrease the prevalence of drinking during pregnancy, which might ultimately reduce the prevalence of FASDs and other adverse pregnancy and birth outcomes.

BRFSS is a random-digit–dialed landline and cellphone telephone survey that measures behavioral risk factors from a representative sample of civilian, noninstitutionalized adults aged ≥18 years, conducted by all U.S. states and participating U.S. territories, in collaboration with CDC (https://www.cdc.gov/brfss/index.html). For this report, CDC analyzed 2015–2017 BRFSS data from 6,814 pregnant women aged 18–44 years from all 50 states and the District of Columbia. Women reported if they were currently pregnant at the time of the interview, although information about the gestational week of pregnancy was not collected. The annual median response rate* for the combined landline and cellphone sample ranged from 45.8% to 47.0%.

This report focuses on current drinking and binge drinking among pregnant women, two measures of excessive drinking in the 2015–2020 Dietary Guidelines for Americans.§ Respondents were asked "During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor?" Response choices were as follows: number of days per week, number of days in past 30 days, no drinks in past 30 days, don't know/not sure, and refused. In addition, women respondents were asked "Considering all types of alcoholic beverages, how many times during the past 30 days did you have four or more drinks on an occasion?" Response options were as follows: number of times, none, don't know/not sure, and refused. Finally, the intensity of binge drinking was based on the question "During the past 30 days, what is the largest number of drinks you had on any occasion?" Response choices were as follows: number of drinks, don't know/not sure, and refused.

Prevalences and 95% confidence intervals (CIs) for current drinking and binge drinking by pregnant women were estimated overall and by sociodemographic characteristics (age group, race/ethnicity, education, employment status, and marital status). Adjusted prevalence ratios (aPRs) and CIs were calculated to examine the associations between sociodemographic characteristics and current and binge drinking, while controlling for other characteristics. Finally, frequency and intensity of binge drinking were estimated for all pregnant women who reported binge drinking. Data were weighted to represent state-level population estimates and aggregated to represent a nationwide estimate. Analyses were conducted using SAS (version 9.4; SAS Institute) with SUDAAN (version 11.0; RTI International) to account for the complex sampling method used in BRFSS.

Among pregnant women, the prevalences of reported current drinking and binge drinking in the past 30 days were 11.5% and 3.9%, respectively (Table). The prevalence of current drinking among pregnant women who were not married (15.2%) was nearly double that among those who were married (8.6%; aPR = 2.2). The prevalence of binge drinking among pregnant women who were not married (6.1%) was nearly triple the prevalence among those who were married (2.2%; aPR = 2.7). Women categorized as "other, non-Hispanic," which included American Indian/Alaska Native, Asian/Pacific Islander, and multiracial respondents, reported a significantly higher prevalence of current drinking (18.5%) than did Hispanics, who had the lowest prevalence (8.9%; aPR = 2.0). Among pregnant women who reported binge drinking in the past 30 days, the average frequency was 4.5 (CI = 3.1–5.9) episodes, and the average largest intensity was 6.0 (CI = 5.0–7.0) drinks.

*Calculated using the American Association for Public Opinion Research guidelines. The response rate is the number of respondents who completed the survey as a proportion of all eligible and likely eligible persons.
Excessive drinking by women includes binge drinking (four or more drinks per occasion for women), heavy drinking (more than one drink per day on average for women), any drinking by pregnant women, and drinking by women aged <21 years. https://www.cdc.gov/alcohol/fact-sheets/prevention.htm.
§ https://health.gov/dietaryguidelines/2015/External.
https://www.cdc.gov/brfss/questionnaires/pdf-ques/2017_BRFSS_Pub_Ques_508_tagged.pdfCdc-pdf.

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