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1ALCOHOL CONSUMPTION OF PREGNANT WOMEN

Alcohol Consumption of Pregnant WomenHannah JohnsonClemson University

Health 240 sec-001: Determinants of HealthSpring 2014

Health Behavior

The consumption of alcohol during pregnancy has been ill advised by the Surgeon General since 1981 (Alcohol Policies Project), yet there are a large percentage of women who still consume alcohol during pregnancy. Many women are under the impression that alcohol is safe after the first three months of pregnancy; however, there is no known safe amount of alcohol that can be consumed during pregnancy (Albersten, Anderson, Olsen & Gronbaek, 2004). Warnings against alcohol consumption are in place because of the risk of termination of the fetus and ill effects that can occur to the fetus that can last throughout the childs life. Alcohol consumption may encompass having beer, wine, liquor, or wine coolers and is regarded as unsafe regardless of the frequency or amount consumed (Centers for Disease Control and Prevention, 2014). Women may also participate in binge drinking, which is defined as having 5 or more drinks on a single occasion (Chen, Rosner, Hankinson, Colditz & Willet, 2011). This behavior of drinking alcohol while pregnant is affected by both the personal cognition of the woman, by her environment, and by the cognitions of those in her environment. It is behavior whose alteration could provide financial benefits to the healthcare and school systems, as well as provide other societal benefits. StatisticsDrinking habits among women are typically collected by use of surveys. One survey, performed by the CDC through the years of 2006 2010 showed that 1 in 13 women, or 7.6%, of pregnant women had drank within the past 30 days of being surveyed. This number can be compared to the number of non-pregnant women who drank within 30 days of being surveyed which amounts to 51.5%. Of the pregnant women who partook in drinking, 14.3% were between the ages of 35 and 44 years of age, 8.3% where white, and 10% were college graduates. The percentage of women who reported binge drinking while pregnant amounted to 1.4% and of that percentage of women, most women binge drank 3 times and consumed around 6 drinks on each occasion (Marchetta et al., 2012). In a more recent survey, performed by Substance Abuse and Mental Health Services Administration (SAMHSA), 18% of pregnant women reported drinking in their first trimester. This survey, the National Survey on Drug Use and Health (NSDUH) was conducted between 2011 and 2013 revealing an increase in the percentage of women partaking in drinking during pregnancy from 2006-2010. This study also showed that 6% of pregnant women had binge drank during their first trimester. The percentage of pregnant women who drank did decrease as their pregnancies progressed with 4.2% in the second trimester and 3.7% in the third trimester reporting drinking (Substance Abuse and Mental Health Services Administration, 2013). Health OutcomesWomen who consume alcohol during pregnancy put both themselves and their future children at risk for health problems. The fetus, in particular, is at risk for problems that range in severity. It has been shown by the American Academy of Child and Adolescent Psychology that alcohol is the number one cause of birth defects (American Academy of Child and Adolescent Psychiatry, 2011). Any alcohol that the mother consumes goes into the bloodstream and, therefore, into the bloodstream of the fetus (Vorvick & Storck, 2012). Fetal Alcohol Spectrum Disorder describes five different levels of problems that can develop from a fetus exposure to alcohol. The most severe of these disorders is Fetal Alcohol Syndrome (FAS) with confirmed alcohol exposure. This diagnoses requires that the child have facial deformities, prenatal or postnatal growth retardation and evidence of neurocognitive defects. These defects may include, but are not limited to, issues involving attention and hyperactivity, memory difficulties, a lower IQ, and difficulties in arithmetic, verbal processing, and social understanding (Mukherjee, Hollins & Turk, 2006). The facial deformities are illustrated in Figure 1 from the National Institute of Alcohol Abuse and Alcoholism (NIAAA). In one of the most recent studies conducted in 2009, the prevalence rate of FAS in the United States was estimated to be between 2-7 per 1000. This same study showed that among younger school aged children, 2-5% have a FASD (May et al., 2009). These other disorders include fetal alcohol syndrome with no confirmed alcohol exposure, partial fetal alcohol syndrome, alcohol related neurodevelopment (ARND), and alcohol related birth defect (ARBD). Partial fetal alcohol syndrome has some symptoms seen in FAS and the child must have neurocognitive disabilities and some sort of facial deformities. Children with ARND have no growth problems no do they poses facial deformities; however, these children must have clear neurocognitive disabilities. Lastly, children with ARBD may have some of the facial features associated with FAS and behavioral features and structural abnormalities that are more distinct (Mukherjee et al., 2006). The latest estimates of the cost of FAS were determined in 2002 and were said to be 2 million for one individual over the course of his or her lifetime (Lupton, Burd & Harwood, 2004). Inflation has only caused this number to increase since then. There is also the risk of pregnancy termination and a risk for preterm delivery when alcohol is consumed during pregnancy (Albertson et al., 2004; Anderson, Anderson, Olsen, Gronbaek & Strandberg-Larsen, 2012).Figure 1: Facial Features of FAS and FASDssour

Healthy People 2020In the Healthy People 2020 objectives, there are two specific objectives under the Maternal, Infant, and Child Health category, which address the issue of alcohol consumption during pregnancy (U.S. Department of Health and Human Services, 2013). The first of these objectives is MICH- 11.1, which aims to increase abstinence from alcohol during pregnancy. The second of these objectives, MICH 11.2, goes hand in hand with the first but specifically addresses binge drinking during pregnancy. The existence of these two objectives shows that the consequences of the actions they address are severe enough, and prevalent enough, that they must be addressed at the national level. In addition, binge drinking while pregnant was given a separate objective, which shows that it requires specific attention. Binge drinking greatly increases a fetus exposure to alcohol and can only increase the fetus chance of developing health problems, if the pregnancy even makes it full term. With the risk of the child having moderate to severe physical and mental problems, and even the potential of death of the fetus, it is clear that there needs to be an intervening factor that aims to reduce, if not eliminate, the number of women who drink while pregnant. Intrapersonal factorsThere are many factors that have an influence on a womans choice to consume alcohol during her pregnancy. Some of these are internalized influences and are known as intrapersonal factors. Influences such as a womans attitude toward drinking during pregnancy, her knowledge of the risk and rewards of drinking during pregnancy, and even her personality and socio-economic status can play a role in her decisions as a mother-to-be.

AttitudesIt has been found that one of the strongest predictors of alcohol use during pregnancy is a womens attitude toward drinking while pregnant. An article published in BMC Public Health explains, women who disagreed with the statement that pregnant women should not drink were more likely to intend to drink alcohol during a future pregnancy as were women who had neutral or positive attitudes towards alcohol consumption in pregnancy, (Peadon et al., 2011). Even more so than attitudes, previous drinking habits is a very strong, if not the strongest, indicator of whether or not a woman will drink while pregnant. Women who consume alcohol on a regular basis before becoming pregnant are much more likely to continue drinking during their pregnancy (Chang, McNamara & Wilkins-Haung, 2006a). This may be due to an alcohol dependency that has formed or because of a belief that the risks are not significant enough to warrant quitting.KnowledgeAnother potential influence in a womans decision to consume alcohol during pregnancy is her knowledge of the risks, such as FAS or FASDs, associated with the behavior. Another BMC study, that was very similar to the one mentioned above, showed that 61.5% of women in the study knew the effects associated with alcohol consumption during pregnancy and 55.3% knew about FAS (Peadon et al., 2010). The amount of women that know and understand that risks associated with drinking while pregnant needs to increase from these current statistics, but that cannot be the complete solution to the problem. Many people assume that if there is sufficient knowledge of the potential health risks that can result from performing a behavior that there will be a change in the attitude toward that behavior; however, that is not always the case. In particular, this study showed that an increase in knowledge of the risks did not affect womens attitude towards drinking during pregnancy.Socio-economic Status and DemographicsAnother factor that can greatly affect this behavior are the socio-economic status (SES) and demographics of the woman. A study published in the American Journal of Public health on the influence of race and ethnicity on pregnant women showed that an African American womans education level did not affect her risk level for alcohol use during pregnancy, and that African American women at all levels of education were at equal risk (Perreira & Cortes, 2006). On the contrary, when the data collected from white women was a

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