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

Discussion

During 2015–2017, approximately one in nine pregnant women reported drinking alcohol in the past 30 days, and among those, about one third reported binge drinking. High blood alcohol concentrations among pregnant women might be particularly harmful to the brain of a developing fetus[3] and could occur even before pregnancy is recognized.[4] A study using data from the Pregnancy Risk Assessment Monitoring System (https://www.cdc.gov/prams/index.htm) found that women who binge drink before pregnancy are more likely to drink and binge drink during pregnancy than are women who do not binge drink before pregnancy.[4]

The overall estimates of current drinking and binge drinking among pregnant women were slightly higher during 2015–2017 (11.5% and 3.9%, respectively) than were the estimates during 2011–2013 (10.2% and 3.1%, respectively).[5] Although the frequency of binge drinking among pregnant women during 2015–2017 (4.5 episodes) was similar to that in the 2011–2013 BRFSS report (4.6 episodes), the intensity estimate for the 2015–2017 report (6.0 drinks) was lower than that in the earlier report (7.5 drinks).[5] The higher prevalences of current drinking and binge drinking among pregnant women who are not married compared with the prevalences among married women might be related to the financial stress associated with being the sole provider as well as lack of social support.[6]

The findings in this report are subject to at least five limitations. First, data are self-reported and therefore subject to recall and social desirability biases, likely leading to underreporting of alcohol consumption during pregnancy.[7] Second, the estimates might be affected by selection bias because the median response rates were less than 50% for all 3 years of the survey. Third, some prevalence and prevalence ratio estimates were suppressed, or flagged as possibly being unstable, because of relatively large standard errors. Fourth, pregnancy status might be inaccurate or underestimated because some pregnancies might not have been recognized at the time of interview.[8] The percentage of currently pregnant women who reported drinking in the past 30 days and before they were pregnant likely is small because the mean gestational age of pregnancy awareness is 5.5 weeks.[8] Finally, information on trimester of pregnancy was not available. The prevalence of drinking in pregnancy varies by trimester and is higher in the first trimester than in the second and third trimesters.[9]

The Community Preventive Services Task Force** recommends several community-level interventions to reduce excessive drinking, such as regulating alcohol outlet density (the number of physical locations where alcohol is sold within a geographic area) through zoning and business licensing or state alcohol control agencies, implementing commercial host liability laws, and maintaining limits on hours and days of sale. The U.S. Preventive Services Task Force recommends screening and brief behavioral counseling in primary care settings for all adults aged ≥18 years, including pregnant women, to reduce unhealthy alcohol use, which includes any alcohol use by pregnant women.[10] An American College of Obstetricians and Gynecologists Committee Opinion†† recommends alcohol use screening for all women seeking obstetric-gynecologic care, including counseling patients that there is no known safe level of alcohol use during pregnancy, and recommends that women who are pregnant or who might be pregnant be advised to avoid alcohol use. The combination of evidence-based community-level interventions and alcohol screening and brief counseling might decrease alcohol consumption during pregnancy, and ultimately the prevalence of FASDs, as well as other adverse pregnancy and birth outcomes.

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