Drinking While Pregnant : Populations at the Greatest Risk

Moderate vs. Binge Drinking in Women

According to The National Institute on Alcohol Abuse and Alcoholism, at risk alcohol use for healthy nonpregnant women is more than three drinks per single occasion or more than 7 drinks per week. However, it is important to note that any amount of drinking for women who are pregnant or at risk of pregnancy is deemed dangerous and can pose a great amount of threats to the developing fetus.¹

The United States Drug Administration defines moderate drinking in women as one drink per day. Beyond moderate drinking, there is binge drinking, which is defined by the United States Drug Administration as more than three drinks per occasion for women or “alcohol consumption that results in a blood alcohol concentration of 0.08% or above.”² Moderate drinking and binge drinking are not mutually exclusive classifications, as data from the scientific journal, Pediatrics, revealed that close to half of binge drinking occurs in moderate drinkers.³ Both classifications of alcohol consumption are not advisable to those experiencing pregnancy.

Recognizing the Health Risks Associated With Drinking Whilst Pregnant

Does it matter if a woman is considered an at risk alcohol user prior to her pregnancy? Does past use have an impact on future health conditions like pregnancy?

During pregnancy, no matter the term, any alcohol ingested by the mother is able to pass through the placenta and reach the developing fetus. It can be truly impactful for the fetus to be exposed to alcohol in the womb, especially at critical points in the natural development of the fetus. One decision to have a drink has fast consequences for the unborn child. In just a couple of hours, the fetal blood alcohol levels approach maternal levels within two hours of maternal intake. It has been made clear that drinking any amount of alcohol during pregnancy is not recommended due to the toxic effects on the mom and baby. Alcohol is a known teratogen “that can impact fetal growth and development during all stages of pregnancy.”⁴ To date, the American College of Obstetricians and Gynecologists, Center for Disease Control (CDC), Surgeon General, and medical societies from other countries including the Society of Obstetricians and Gynecologists of Canada stand by their strong recommendations for complete abstinence during pregnancy.⁵

Who is Most at Risk of Drinking Whilst Pregnant?

Despite the consistent recommendations for abstinence during pregnancy, there are populations that are at greater risk for ignoring the recommendation and drinking anyway. Such populations may depend on alcohol use for a variety of external factors and personal issues. In the Archives of Gynecology and Obstetrics, the presence of “social stressors also seemed to correlate with ongoing alcohol use during the third trimester of pregnancy.”⁶

The Link Between Marital Status and Drinking Whilst Pregnant

Other social and demographic factors to consider when looking at the populations at greatest risk of drinking while pregnant include marital status. Drinking and binge drinking during pregnancy has been largely associated with the impact of the significant demographic factor: marital status. Unmarried status, next to a multitude of socioeconomic factors, has shown a prevalence of 4.6 times greater likelihood to drink while pregnant than married pregnant women.⁷

The Link Between Ethnicity and At Risk Drinking During Pregnancy

Who is categorized as at-risk for alcohol consumption during pregnancy? In 2013 a Substance Abuse and Mental Health Services Administration survey found that “of women who consume alcohol during pregnancy, those at greatest risk of alcohol use disorder were most likely American Indian and Alaska Native women (13.7%) compared with white non-Hispanic women (5.6%), Hispanic or Latino women (3.8%), and black non-Hispanic women (3.5%).”⁸ This points to the fact that ethinic background plays a role in the patterns of pregnant women. Further, it is evident that minorities experience a higher risk of drinking alcohol whilst pregnant, which is a statistic that is important to acknowledge when seeking change.⁹

The Link Between Age and At Risk Drinking During Pregnancy

Age is another influential factor that contributes to the risk of alcohol use during pregnancy. From 2011-2013, data from a CDC surveillance system found that “the characteristics associated with the highest prevalence of prenatal alcohol use were age between 35 – 44 (18.6%), non-Hispanic black (13.9%), college degree (13%), and employment (12%).”¹⁰ Age group has become a clear indicator for populations at greatest risk of prenatal alcohol use. Data from the reputable journal, Obstetrics & Gynecology, showed that “of women drinking in late-pregnancy, a previous large survey found that the highest prevalence was among women who are white non-Hispanic, college graduates, and aged 35 years or older.” This ethinic and age group of pregnant women has also been reported by health care providers as having the least screening and counseling for alcohol use.¹¹

The Connection Between Education and At Risk Drinking During Pregnancy

The CDC data offers the idea that education level and the amount of experience in the workplace could explain why particular populations are more likely to disregard important health advice.¹² Education and the amount of experience in the workplace are thought to be influential in prenatal health because findings have demonstrated that “women who were older and/or more educated had greater discretionary income and those who attended college might have a greater acceptance of alcohol consumption and binge drinking.”^{13 14}

Seeking Help at Boardwalk Recovery Center

At Boardwalk Recovery Center, we deeply understand alcohol use disorders and the power they have over individuals. It is no surprise that these populations are at a greater risk of continuing alcohol use despite the professional recommendation to terminate use. While we are an all men’s facility, we acknowledge the devastating impact uncontrollable alcohol use has on the health of our entire society. We support sobriety and are optimistic in the positive transformation abstinence has on the health of individuals and their families. We continue to do research to better understand what populations are at the greatest risk of being impacted by alcohol use disorders.

Resources

1. American College of Obstetricians and Gynecologists. Committee on Health Care for Underserved Women. Committee opinion no. 496: at-risk drinking and alcohol dependence obstetric and gynecologic implications. Obstet Gynecol. 2011; 118(pt 1):383–388.
2. Bowman SA, Clemens JC, Friday JE, et al. Food Patterns Equivalents Database 2011-12: methodology and user guide. Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Beltsville, Maryland: 2014.
3. Carson G, Cox LV, Crane J, et al. Alcohol use and pregnancy consensus clinical guidelines. Society of Obstetricians and Gynecologists of Canada. J Obstet Gynaecol Can. 2010;32(suppl 3):S1–S31.
4. Carson G, Cox LV, Crane J, et al. No. 245-Alcohol use and pregnancy consensus clinical guidelines. J Obstet Gynaecol Can. 2017;39:e220–e254.
5. Centers for disease control and prevention: fetal alcohol spectrum disorders (FASDs). 2018. Available at: www.cdc.gov/ncbddd/fasd/alcohol-use.html Accessed June 18, 2018.
6. Cheng D, Kettinger L, Uduhiri K, et al. Alcohol consumption during pregnancy: prevalence and provider assessment. Obstet Gynecol. 2011;117 (pt 1):212–217.
7. Dejong, Katherine, et al. “Alcohol Use in Pregnancy.” Clinical Obstetrics and Gynecology, U.S. National Library of Medicine, Mar. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061927/.
8. Floyd RL, O’Connor MJ, Sokol RJ, et al. Recognition and prevention of fetal alcohol syndrome. Obstet Gynecol. 2005;106(pt 1): 1059–1064.
9. Kitsantas P, Gaffney K, Wu H, et al. Determinants of alcohol cessation, reduction and no reduction during pregnancy. Arch Gynecol Obstet. 2014;289:771–779.
10. Naimi TS, Lipscomb LE, Brewer RD, et al. Binge drinking in the preconception period and the risk of unintended pregnancy: implications for women and their children. Pediatrics. 2003; 111(pt 2):1136– 1141.
11. “National Institute on Alcohol Abuse and Alcoholism (NIAAA).” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, https://www.niaaa.nih.gov/.
12. Substance Abuse and Mental Health Services Administration, Results From the 2013 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-49, HHS Publication No (SMA) 14-4887. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
13. Tan CH, Denny CH, Cheal NE, et al. Alcohol use and binge drinking among women of childbearing age—United States, 2011-2013. MMWR Morb Mortal Wkly Rep. 2015;64:1042–1046.
14. Williams JF, Smith VC. Committee on substance abuse. Fetal alcohol spectrum disorders. Pediatrics. 2015;136:e1395–e1406.