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

AKGA

FL

SCAL

NCCO

NM AR

IL

NYME

WV

WA

LA

UT OHNE

HI

VT

MDNYC

MS

OR MNMI

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

-His

p

Bla

ck N

on-H

isp

<25

25-3

4

+35

Mar

ried

Unm

arrie

d

<16

+16

<$20

,000

+$20

,000

Perc

ent

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 drinkerRegular 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

42.548.1

61.969.170.5

78.479.9

83.484.8

87.888

0 20 40 60 80 100

ViolenceSeatbelt

Illegal drugsSmokingAlcohol

Birth controlBreastfeed

HIV testPreterm labor

MedsBirth 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

hite

Bla

ck

Asi

an

His

pani

c

Age

<20

20-3

5

35+

Edu

<12

12 >12

Med

icai

d

No

Med

icai

d

perc

ent

“… 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

perc

enta

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

perc

ent

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

perc

ent

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

perc

ent

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