Predictors of Alcohol Use during Pregnancy among Women Attending Midwife Obstetric Units in the Cape Metropole, South Africa

ABSTRACT

Introduction: Little is known about the nature and extent of substance use among pregnant women in Cape Town (South Africa) despite the very high levels of substance use and related consequences such as FASD in this part of the country. The aim of the study was to determine predictors of alcohol use among pregnant women. Methods: A cross-sectional survey was conducted among pregnant women attending 11 Midwife Obstetric Units (MOUs) in greater Cape Town. A two-stage cluster survey design was used. In total, 5231 pregnant women were screened to assess self-reported prevalence estimates. Of these, 684 (13.1%) were intentionally sub-sampled and completed an interviewer-administered questionnaire and provided a urine sample for biological screening. Univariate and multivariate statistical procedures were used to determine factors predictive of alcohol use. Results: Findings highlight various demographic, social and partner substance use predictors for both self-reported and biologically verified alcohol use in two different models. Being Coloured, having a marital status other than being married, experiencing violence or aggression in the past 12 months compared to more than 12 months ago, having a partner who drinks, and partner drug use are all independently associated with higher odds of self-reported alcohol use. In contrast, only partner tobacco use is independently associated with higher odds of biologically verified alcohol use. Conclusion: Knowing the risk factors for alcohol use in pregnancy is important so that intervention efforts can accurately target those women in need of services. Intervention programs addressing risk factors of high-risk pregnant women are needed.

KEYWORDS:

• Pregnancy
• risk factors
• biomarkers

Acknowledgments

This research was funded by the US President's Emergency Fund for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC) under the terms of 5U2GPS001137-05. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or PEPFAR. The CDC had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The research reported in this publication was also supported by the South African Medical Research Council. The authors would like to acknowledge the support of our field work staff, in particular Elmarie Nel and Nomtha Madlingozi, and the staff and patients at the various Midwife Obstetric Units (MOUs) where data were collected. The authors further wish to thank the Western Cape Provincial Department of Health for granting permission to conduct the survey in the antenatal facilities.

Declaration of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the article.

Notes

1 The terms “White”, “Black”, and “Colored”, refer to demographic markers and do not signify inherent characteristics. They refer to people of European, African and mixed (African, European and/or Asian) ancestry, respectively. The continued use of these markers in South Africa is important for monitoring improvements in health and socio-economic disparities, identifying vulnerable sections of the population, and planning effective prevention and intervention programs.

2 The term “township” has no formal definition but is commonly understood to refer to the underdeveloped, usually (but not only) urban, residential areas that during Apartheid were reserved for non-whites (Africans, Coloreds, and Indians) who lived near or worked in areas that were designated ‘white only’(Pernegger & Godehart, 2007).