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Research Update
Alcohol Use and Pregnancy: An Important Canadian Public Health and Social Issue
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7 Selective Prevention of Prenatal Alcohol Use Problems
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Binge Drinking – Does It Link to Unwanted, Unplanned, Unintended Pregnancy? Because of the prevalence of drinking and unintended pregnancies, there is a risk that a woman may consume alcohol before she is aware that she is pregnant. In the US, Naimi et al. found that 45% of more than 72,900 women who gave birth from 1996 to 1999 reported their pregnancy to be unintended (either unplanned or unwanted) and that those who engaged in binge drinking (5 or more drinks on an occasion) before conception (within three months prior to) were more likely to have an unintended pregnancy. Acknowledging that this is a complex issue, the authors also found that the more binge drinking episodes that a woman engaged in before conception, the more likely that the pregnancy was unintended.159 |
What the Studies Say Selective prevention measures select sub-populations that are seen as being of higher risk for more targeted attention, in this case, women of childbearing age who consume alcohol. Selective measures for this issue include outreach, screening, referral and brief intervention activities. Although some researchers have argued for routine alcohol use screening among all women of childbearing age, the consensus is stronger for routine alcohol screening of all pregnant women. Many women are able to stop using alcohol once they know they are pregnant or when planning pregnancy; for others, simply being asked screening questions will prompt action. Brief interventions consisting of one to three sessions by health or social service practitioners are showing evidence of effectiveness with nondependent alcohol-using pregnant women.
Selective prevention interventions are directed to people who are at greater risk for a particular outcome because they are members of a subgroup known to be at higher risk than the general population. Selective prevention for FASD is directed to women of childbearing age who drink alcohol. These interventions typically involve greater selection and intensity than universal prevention interventions and can include outreach, screening, referral and brief intervention activities with the intent of promoting the health of the mother and preventing or minimizing harm to the fetus. The selective prevention measures discussed here include targeted selective prevention messaging, identifying women with substance use problems and brief interventions.
In another large US population survey, 60% of women who reported frequent alcohol consumption (more than 6 drinks a week) during the three months prior to pregnancy recognition did not know that they were pregnant until after the fourth week of gestation. The vast majority of women stopped or significantly cut back their alcohol consumption when they realized they were pregnant.160 As noted earlier, Canadian studies have also shown that young people are more likely to engage in sex without the use of contraception when they are drinking.161
7.1 Targeted Selective Prevention Messaging
Given what is at stake, there is an argument for routinely screening all women of childbearing age for alcohol problems, but lack of training, as well as time and staffing pressures within the health care system, mean that screening is currently quite uneven.162 However, these women must be provided information clearly stating that: being sexually active, being even a moderate alcohol user (e.g. fewer than 7 standard drinks per week), and not using effective contraception places a woman at risk for having an alcohol-exposed pregnancy, which, in extreme circumstances, can result in fetal brain damage and other birth defects.163 Given the prevalence of binge drinking among adolescent and young adult women, the extent of their sexual activity, and their tendency to recognize pregnancy later in term,164 it would make sense to target messages to this population. However, no studies were found that examined messaging to this population on alcohol use and pregnancy issues. While necessary and likely sufficient for the vast majority of women of childbearing age who consume alcohol and are non-dependent, this knowledge is not sufficient for women who are alcohol dependent and living in difficult circumstances.
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