Survey Shows More Women Drinking During Pregnancy

John Dillon

January 20, 2022

More pregnant Americans indulged ― and overindulged ―- in alcohol from 2018 to 2020 than in previous years, but researchers found no sharp increase associated with the first wave of COVID-19 lockdowns, according to a new report from the Centers for Disease Control and Prevention (CDC).

The pandemic notwithstanding, health officials worry about a rising tide of pregnant women using alcohol and binge drinking since the CDC survey began in 2011. In the period ending in 2013, 1 in 10 women reported having had a drink in the previous 30 days; by 2017, that figure was 1 in 9; and in the latest survey, the number had risen to 1 in 7.

That mark is "the highest to date," said Lucas Gosdin, PhD, MPH, an epidemic intelligence officer at the CDC's National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, and first author of the report, which was published on January 7 in Morbidity and Mortality Weekly Report.

"We're concerned that this number has been slowly increasing," Amanda Cohn, MD, director of the CDC's Division of Birth Defects and Infant Disorders, told Medscape Medical News. "We need to be doing more outreach, both to pregnant persons as well as healthcare providers who are caring for them."

Exposure to alcohol in the womb has been linked to a wide range of neurologic and physical problems in children, ranging from fetal alcohol syndrome to stunted learning abilities. Even if these problems are unlikely, experts insist there's no known "safe" amount of alcohol a pregnant woman can have.

Cohn likened alcohol use to that of tobacco. "Lots of people smoke who don't get lung cancer. Still, everyone is at an increased risk," she said. "The safest way to not get lung cancer is to not smoke at all. It's a behavior that can prevent additional harm."

The report summarizes the results of a phone survey of 6327 pregnant Americans between the ages of 18 and 49. The survey asked whether women had consumed an alcoholic beverage or had at least four drinks on one occasion ― a common definition of binge drinking ― in the past 30 days.

According to the report, 13.5% of women reported using alcohol, and 5.2% said they had binged on alcohol. Women who experienced frequent mental distress ― describing their mental health as "not good" for 14 or more days in the past month ― were twice as likely to drink and three times likelier to binge drink, the researchers found.

The increase within the 3-year period was roughly the same as in previous surveys.

"There was no evidence of increased alcohol consumption by pregnant adults in 2020 relative to 2019, despite possible increased alcohol sales and consumption among the general population during the first months of the Covid-19 pandemic," the report states.

"That is one finding that was unexpected but that we were pleased to see," Gosdin said.

Experts stressed that the survey covered only the first 9 months of the COVID-19 pandemic. "We're still in the depths of it," Samuel T. Bauer, MD, associate professor of obstetrics and gynecology at Duke University Medical Center, Durham, North Carolina, told Medscape Medical News. "People with alcohol use disorders certainly have been challenged during COVID. I think this is a preliminary answer."

Gosdin said the effects of the pandemic on drinking habits bear watching. "We are concerned about the impacts of COVID-19," he said. "We know it's affected how people access regular care."

Although virtual care has "exploded during COVID," Bauer said, insurers have "turned off reimbursing" for doctor-patient visits via telephone, but not for visits by Internet-based video platforms like Zoom.

That split creates equity issues in many parts of the country, including his home state of North Carolina, where broadband is scarce, and patients may live 100 miles or more away from caregivers.

The "full-blown birth defect" of fetal alcohol syndrome is just the most visible hazard of drinking. Other medical and developmental issues include speech delays, slower learning and reading skills, attention-deficit and hyperactivity disorders, and problems with the heart and kidneys.

So, when Bauer encounters patients who believe that a few drinks will not harm their baby, he says he tells them: "'Why is this going to be where you put your flag?' That leads to a different form of conversation."

Morb Mortal Wkly Rep. Published online January 7, 2022. Full text

John Dillon is a medical writer in Boston.

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