Alcohol consumption

Alcohol consumption increases during pregnancy

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Experts say that no amount of alcohol is acceptable during pregnancy. Abraham González Fernandez/Getty Images
  • A new report indicates that heavy drinking increased among pregnant women between 2011 and 2020.
  • Experts say this is a worrying trend because any amount of alcohol during pregnancy poses risks to the unborn child.
  • They say that stress, anxiety and depression can lead to alcohol use during pregnancy, but they add that there also seems to be a general relaxation about alcohol use during pregnancy.

Look, here’s the deal. If you drink alcohol while you’re pregnant, you may be ruining your baby’s chances of leading a normal life. All forms of alcohol are dangerous, even beer and wine. Play smart. Alcohol and pregnancy don’t mix.

This is the message of a Message of public interest the federal government issued in 2015. Even before that, the warnings have been around for decades.

Despite these warnings, however, a new study published in JAMA Network reports that over a decade, binge drinking has increased nearly 9% per year and binge drinking has increased over 11% per year among pregnant women.

The team of public health researchers looked at data on pregnant women aged 18 to 44 from the Behavioral Risk Factor Surveillance System (BRFSS) from January 2011 to the end of 2020. The BRFSS is a national cross-sectional sample of American adults that measures alcohol consumption. The information comes from participants’ 30-day recall.

“Excessive alcohol consumption” was defined as 4 or more drinks on one occasion. “Heavy drinking” was defined as 8 or more drinks per week.

Jeffrey T. HowardPhD, associate professor of public health at the University of Texas at San Antonio and lead author of the study, said his team was looking at the causes of maternal deaths and came across some unexpected numbers involving alcohol.

“What really surprised me the most was what happened in maternal mortality. We really didn’t expect to see this big increase in drug and alcohol poisoning in this group” , he told Healthline.

“It was disheartening to see that binge drinking and binge drinking had increased among pregnant women over the past decade. I’m not particularly surprised by that, unfortunately,” said Dr Vanessa ParisiOB-GYN, president of the New Jersey OBGYN Society and member of the American College of Obstetricians and Gynecologists (ACOG) Fetal Alcohol Spectrum Disorder team (FASD) Prevention program.

“The work should start with training the medical provider,” she told Healthline. “How to ask open-ended questions without stigma. To tell our patients that there is no safe amount, type or time of alcohol during pregnancy.

“Providers need to screen and intervene when we have at-risk or high-risk patients and refer them to treatment,” she added.

The study did not look into possible reasons for the increase in numbers.

It’s something Dr. G. Thomas Ruizan OB-GYN at MemorialCare Orange Coast Medical Center in California, would have liked to see.

“The study doesn’t really expand on why we’re seeing this type of behavior more. It’s up to us to draw our own conclusions,” he told Healthline.

“What we do know is that when it comes to mental health, high anxiety, depression and social stressors, people often turn to alcohol or drugs for self-care and feel better,” Ruiz said. “It’s part of one of the things in the human condition. Stressors like not being able to buy a house, high student debt, making ends meet, trying to decide if you’re going to start a family, all of these social stressors can create a state of anxiety.

Howard says that’s what the research team is currently working on.

“We are currently engaged in a larger study to understand their stressors and other types of factors,” he explained. “Financial hardship, potential exposure to domestic violence, access to health care, things that put a lot of stress on pregnant women in particular.”

Apart from socio-economic factors, experts say there is a growing phenomenon they have noted that may also be at work.

“I think there’s a counter-narrative there, not necessarily in the scientific literature, but in the popular self-help literature,” Howard said. “There are people who trivialize that and you know, ‘it’s okay.’ They’re not necessarily saying it’s okay to drink alcohol…but it’s more of a message of acceptance of alcohol consumption in general as something okay and not a big deal.

“I don’t know how important it is and I’m not trying to attribute it all to that. I’m just saying there’s kind of a counter-speech there,” he said. added.

“We want our patients to be empowered and ask lots of questions,” Parisi said. “Patients are reading and being influenced by the media, friends and family more than ever before, and not all of these sources are created equal or evidence-based.”

“A lot of things have changed in medicine. It used to be “Yes, doctor, whatever you say.” I’m not saying go back to that,” Parisi said. “But as physicians, we need to build rapport with our patients, de-stigmatize care, and patients need to find providers they can work with and rebuild trust.”

“As providers, we must fight recommendations that are not evidence-based and always promote shared decision-making,” she added.

Ruiz says he believes one of the most important ways to get the message out is through one-on-one relationships.

“It has a lot to do with the relationship between provider and patient,” he said. “In my practice, everyone in early pregnancy, we do kind of general counseling and we try to contact them before the pregnancy.”

“When this patient is in the office, we go through and discuss, as part of counseling a newly pregnant woman, what is safe behavior during pregnancy. We also discuss smoking and THC use during those first early prenatal visits,” he explained.

Ruiz says they also provide patients with a web app so they can access the information they need to guide them through their pregnancy.

“Our FASD task force at ACOG works to educate patients about the risks of prenatal alcohol exposure,” Parisi said. “There have been studies showing that not all providers ask their patients to abstain completely and that’s unfortunate.”

But she says finding the time to spread the information can be a problem.

“We are all strapped for time, especially those in private practice. I was in solo private practice for many years,” she explained. “It can be very difficult to properly screen patients while taking their history, addressing their intimate needs and concerns, and doing a directed medical examination.”

“We should all be using a validated screening tool like AUDIT-US,” she added. “Addressing this problem properly during preconception and annual visits can solve the problem and significantly reduce the incidence of FASD.”