Prospective Identification of Pregnant Women Drinking Four or More Standard Drinks (≥ 48 g) of Alcohol Per Day

Abstract

We aimed to identify drinking rates in a prospectively identified cohort of pregnant women, and subsequently, to identify the drinkers of 48 g or more alcohol/day among them, by using complementary methods for verifying self-reported drinking habits. A research team of social workers and health professionals at the Maipú Clinic, located in a lower middle class neighborhood of Santiago, Chile, conducted interviews of women attending a prenatal clinic between August 1995 and July 2000. Women whose interview responses met predefined criteria (identified in the text) were further evaluated by home visits. We interviewed 9,628 of 10,917 (88%) women receiving prenatal care. By initial interview, 42.6% of women reported no drinking, 57.4% some alcohol consumption, and 3.7% consuming at least one standard drink (15 mL of absolute alcohol) per day. Of the 887 women who had home visits, 101 were identified as consuming on average at least 4 drinks/day (48 g). To determine the best home visit questionnaire items for identifying those drinking at least 4 drinks per day, 48 women who openly admitted drinking this amount were compared with 786 women who were not considered drinkers after the home visit. The 48 self-reported 48 g/day drinkers were significantly more likely to get tipsy when drinking before (p = 0.01) or during (p < 0.0001) pregnancy, to have started drinking at a younger age (p = 0.007), or to exhibit signs of low self-esteem (p < 0.0001), sleep or appetite problems (p < 0.0001), bad interpersonal relationships (p < 0.0001) or having family members with fetal alcohol syndrome features (p < 0.009). In conclusion, using complementary methods of alcohol misuse ascertainment during pregnancy, we found that at least 1% of pregnant women in a Santiago, Chile, clinic population were drinking at levels that are clearly dangerous to the fetus (48 g/day or more). We identified specific interview questions that may help screen for alcohol use of 48 g/day or more in pregnant women.

Keywords:

• fetal alcohol syndrome
• screening
• alcohol
• pregnancy
• alcoholism
• risk

Notes

¹Editor's note: The journal's style uses the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused.

Additional information

Notes on contributors

Sofi˙Ia Aros

Sofía Aros, M.D. received her medical degree from the University of Chile in 1990. She completed her postgraduate training in pediatrics at the University of Chile San Borja Arriarán Clinical Hospital in Santiago, in 1993. She is currently an Assistant Professor in the Department of Pediatrics, University of Chile School of Medicine. Dr. Aros has served as Director of Research for her department, and has been the principal investigator of the Fetal Alcohol Syndrome Protocol in collaboration with the National Institute of Child Health and Human Development since 1995. In addition to fetal alcohol syndrome and prevention of perinatal neurological damage, her research interests include clinical detection of genetic alterations and inherited metabolic disorders.

James L. Mills

James L. Mills, M.D., M.S. received his undergraduate training at the University of Pennsylvania and his medical degree from New York Medical College. He trained in pediatrics at Cornell University and The University of Pennsylvania - Children's Hospital of Philadelphia. He completed a fellowship in pediatric endocrinology at the Children's Hospital of Philadelphia. While he was a Robert Wood Johnson Clinical Scholar at the University of Pennsylvania, he received a Master of Science degree in epidemiology. After completing his training, he moved to the National Institute of Child Health and Human Development. He is currently a Senior Biomedical Research Service scientist and Chief of the Pediatric Epidemiology Section at the National Institute of Child Health and Human Development. His research interests include genetic and biochemical causes of birth defects and problems associated with prenatal exposure to alcohol.

Mary Conley

Mary Conley, M.A. received her AB at Emmanuel College, Boston and her MA at St. John's University, New York. She has worked as a medical data analyst at the Albert Einstein College of Medicine of Yeshiva University and the University of Alabama Medical Center at Birmingham. Since 1991 she has been an Information Technology Specialist at the National Institute of Child Health and Human Development of the National Institutes of Health. Her research interests include the effects of prenatal exposure to alcohol and the biochemical and genetic causes of birth defects.

Christopher Cox

Christopher Cox, Ph.D. holds a Ph.D. in Mathematics from the University of Illinois. Before coming to the Division of Epidemiology, Statistics, and Prevention Research (DESPR) at the National Institute of Child Health and Human Development in 2002, he was a Full Professor in the Department of Biostatistics at the University of Rochester Medical Center. His principal research interest is the efficient computation of maximum likelihood estimates for single parameter exponential family regression models (generalized non-linear models), and in the practical application of these models in biomedical research. Dr. Cox is involved in a number of collaborative research projects within DESPR. His principal collaboration is with the Birth Defects Research Group (BDRG).

Caroline Signore

Caroline Signore, M.D., M.P.H., is a postdoctoral fellow in the Epidemiology Branch, National Institute of Child Health and Human Development, NIH. She received her medical degree and completed her residency training in obstetrics and gynecology at the University of Florida College of Medicine. She received an M.P.H. in maternal and child health from The George Washington University School of Public Health and Health Services. Her current research interests include identification of nutritional, biochemical, and genetic risk factors for birth defects and other pregnancy complications.

Mark Klebanoff

Mark Klebanoff, M.D., M.P.H. is the Director of the Division of Epidemiology, Statistics, and Prevention Research at the National Institute of Child Health and Human Development. He is a pediatrician who received his undergraduate and medical degrees at Johns Hopkins University and completed his pediatric training at the University of Rochester in upstate New York. Dr. Klebanoff has been at the NIH since 1983 and has done research on the causes and prevention of pregnancy complications and of various other conditions of childhood as well.

Fernando Cassorla

Fernando Cassorla, M.D. was born in 1948 in Santiago, Chile. He received his M.D. degree in 1973, at the University of Chile, and completed his pediatric residency at Albany Medical Center, New York, in 1976. Following a fellowship in pediatric endocrinology at The Children's Hospital of Philadelphia from 1976–1979, he was a Senior Investigator, Developmental Endocrinology Branch, at the National Institute of Child Health and Human Development (NICHD). From 1990–1993, he was Clinical Director, NICHD. He is currently Professor and Head of Pediatric Endocrinology at the Institute of Maternal and Child Research, University of Chile and served as the Director of the Institute of Maternal and Child Research from 1997–2001. He is a member of the American Academy of Pediatrics, Society for Pediatric Research, The Endocrine Society, Lawson Wilkins Pediatric and g Society, Latin American Society of Pediatric Endocrinology (President, 1994), Chilean Research Council, and Chilean Academy of Medicine. He has authored 153 original articles, 33 book chapters, and two books on pediatric endocrinology.