Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental Hygiene
Dec 23, 2015
Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005
Diana Cheng, M.D.Medical Director, Women’s Health
Maryland Department of Health and Mental Hygiene
2005 Maryland Births (74, 880 Births)• Race/Ethnicity
– 49% White Non-Hispanic – 33% Black Non-Hispanic– 6% Asian Non-Hispanic – 12% Hispanic
• Age– 19% age 35+– 9% age <20
• Other– 37% unmarried– 42% first birth, 10% 4th+ birth– 32% Medicaid
• Collaborative agreement between CDC and state health departments
• Ongoing mail/phone survey of Maryland women each year, 2 to 6 months after delivery– Random sample– Stratified for birth weight and maternal age– Data collected for 2001-2005 births so far
• Over 7,500 completed surveys
• Response rate over 70% each year
OK
AK
GA
FL
SCAL
NCCO
NM AR
IL
NY
ME
WV
WA
LA
UT OHNE
HI
VT
MDNYC
MS
OR MN
MI
TX
RINJ
Maryland Topics• assisted reproduction • reproductive health• vaccination• automobile safety• depression• oral health• bed-rest during pregnancy• circumcision• infections• neighborhood safety
PRAMS Core Topics• alcohol and tobacco use• feelings about pregnancy• quality of prenatal care• physical abuse • infant health• stressors• medical disorders • living conditions• breastfeeding• folic acid use
PRAMS Survey Question, 2001-2005
“During the last 3 months of your pregnancy, how many alcoholic drinks did you have in
an average week?
14 drinks or more a week 7-13 drinks a week 4 to 6 drinks a week 1-3 drinks a week Less than 1 drink a week I don’t know I didn’t drink then”
(“A drink is 1 glass of wine, wine cooler, can or bottle of beer, shot of liquor,
or mixed drink” was added as an explanation to a previous question.)
1
Drink=
12 oz. can or bottle of beer (4.5% alcohol)
4-5 oz. wine (12% alcohol)
1.25 oz. liquor (80 proof/
40% alcohol)
4 - 6 drinks/wk0.2%
1 - 3 drinks/wk1.2%
7 - 13 drinks/wk
0.1%
< 1 drink/wk6.2%
Nondrinkers92.3%
Drinkers 7.7%
Number of Alcoholic Drinks Consumed During the Last 3 Months of Pregnancy, 2001-2005 PRAMS
1.9
1.1
1.0 1.1 1.7
1.1
1.1
1.1
8.3
3.3
3.1
6.5
10.7
7.7
3.7 3.9
9.8
3.8
7.5
2.1
1.63
.3
0
2
4
6
8
10
12
14W
hite
Non-H
isp
Bla
ck N
on-H
isp
<25
25-3
4
+35
Marr
ied
Unm
arr
ied
<16
+16
<$20,0
00
+$20,0
00
Per
cent
Light drinker, <1 drink/wkRegular drinker, 1-14 drinks/wk
Percent Mothers Who Reported Alcohol Use During the Last 3 Months of Pregnancy, 2001-2005 PRAMS
10.77.2
25.4
19.8
13.8
32.4
0
10
20
30
40
NondrinkerLight drinker
Regular Drinker
Prenatal Cigarette Use Postpartum Depression
Percent Prenatal Smoking and Postpartum Depression by Alcohol Use, 2001-2005 PRAMS
7.9
12.5
6.5
0
5
10
15
Nondrinker Light Drinker RegularDrinker
Perc
ent
Percentage of Low Birth Weight Infants by Alcohol Use, 2001-2005 PRAMS
PRAMS Survey Question, 2001-2003
Yes 81%
No 19%
“At any time during your prenatal care, did a doctor, nurse, or other health care worker ask if you were drinking alcoholic beverages (beer, wine, wine cooler, or liquor)?”
PRAMS Survey Question, 2001-2005
“ During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? Please count only discussions, not reading materials or videos.
How smoking during pregnancy could affect my babyBreastfeeding my babyHow drinking alcohol during pregnancy could affect my babyUsing a seat belt during my pregnancyBirth control methods to use after my pregnancyMedicines that are safe to take during my pregnancyHow using illegal drugs could affect my babyDoing tests to screen for birth defects or diseases that run in my
familyWhat to do if my labor starts earlyGetting tested for HIVPhysical abuse to women by their husbands or partners”
Prenatal Counseling Reported 2001-2005 PRAMS
42.5
48.1
61.9
69.1
70.5
78.4
79.9
83.4
84.8
87.8
88
0 20 40 60 80 100
Violence
Seatbelt
Illegal drugs
Smoking
Alcohol
Birth control
Breastfeed
HIV test
Preterm labor
Meds
Birth defects
percentage
Percentage of Women Not Receiving Counseling About Alcohol
34
23
38
19
13
28
39
12
24
35
18
34
0
20
40W
hit
e
Bla
ck
Asia
n
His
pan
ic
Ag
e <
20
20-3
5
35+
Ed
u <
12
12
>12
Med
icaid
No
Med
icaid
pe
rce
nt
“… I drank 7 times a week, I was instructed by my doc to drink one wine cooler at night to relax my cervix and to
stop me from going into labor.”
PRAMS mother
PRAMS Survey Question, 2001-2005
“During the last 3 months of your pregnancy, how many times did you drink 5 alcoholic drinks or more in one sitting?
14 drinks or more a week 7-13 drinks a week 4 to 6 drinks a week 1-3 drinks a week Less than 1 drink a week I don’t know I didn’t drink then”
(“A drink is 1 glass of wine, wine cooler, can or bottle of beer, shot of liquor, or mixed drink” was added as an explanation to a previous question.)
No binges99.5% >=1 binge
0.5%
Number of Binge Episodes During the Last 3 Months of Pregnancy, 2001-2005 PRAMS
Alcohol Use* Among Women Ages 18-44, Maryland
1.1
4.95.9
7.2
10.7
14
0
4
8
12
16
'95,'97,'99 '01-'04 '06
pe
rce
nta
ge
chronicbinge
*preliminary Maryland BRFSS ’95-’06 data, binge definition change in 2006
Chronic Drinking Trends, MarylandMale and Female
4.6
5.6
1.1
5.9
0
2
4
6
'95,'97,'99 '06
per
cen
t
malefemale
*preliminary Maryland BRFSS ’95-’06 data
Binge* Drinking Trends, MarylandMale and Female
22
25.8
7.2
14
0
10
20
30
'95,'97,'99 '06
per
cen
t
malefemale
*preliminary Maryland BRFSS ’95-’06 data, binge definition change in 2006
Alcohol Use 3 Months Before Pregnancy 2001 and 2005 PRAMS
Chronic Drinking, 7+ Drinks/week
1.8
3
0
2
4
2001 2005
per
cen
t
Binge Drinking, 5+ Drinks/time
13.214
0
5
10
15
2001 2005
perc
ent
Limitations of PRAMS
• Self-report• Recall bias• Responder bias• Social desirability bias• Definition of drink • 3-month prenatal period• Quality of counseling • Sample size small for
many indices
Alcohol Use During PregnancyMaryland, 2001-2005 PRAMS
• During the last 3 months of pregnancy– 8% of mothers reported alcohol consumption– <1% reported binge drinking
• *Consumption of 1+ drink per week was associated with– prenatal smoking– postpartum depression– infant low birth weight
• During prenatal visits– 30% were not counseled about alcohol effects– 19% were not asked about alcohol consumption
• Preconceptional alcohol use increasing– Family planning important
• Need for more research, education, advocacy, support
*restricted results due to small PRAMS data sample