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Focus on Alcohol Use and Binge Drinking Among Maryland Women Giving Birth 2001-2008 April 2010*

Alcohol use during may cause a No known level of alcohol use during pregnancy wide range of harmful effects on the is considered safe. For this reason, the Surgeon developing . It is the leading General Advisory on Alcohol Use in Pregnancy Alcohol consumption preventable cause of mental retardation in urges “women who are pregnant or who may during pregnancy increases the United States and is also associated with become pregnant to abstain from alcohol”. the risk of alcohol-related many other physical, cognitive, and birth defects, including growth deficiencies, facial behavioral disabilities known collectively as The Maryland PRAMS survey includes the abnormalities, central Fetal Alcohol Spectrum Disorder (FASD). following two questions: Adverse outcomes caused by FASD include 1) During the last 3 months of your pregnancy, impairment, behavioral those of Fetal Alcohol Syndrome (FAS), a disorders, and impaired disorder marked by growth deficiency, how many alcoholic drinks did you have in an intellectual development. abnormal facial features, and central nervous average week? system abnormalities. In addition to FAS, No amount of alcohol disabilities associated with FASD include mild 2) During the last 3 months of your pregnancy, consumption can be to severe deficits in attention, intellect, how many times did you drink 5 alcoholic considered safe during impulse control, judgment, and memory. drinks or more in one sitting pregnancy. Approximately 40,000 babies are born in the (A drink is 1 glass of wine, wine cooler, can or Alcohol can damage a U.S. every year with FASD, with the cost for fetus at any stage of their care estimated to be $4 billion. bottle of beer, shot of liquor or mixed drink). pregnancy. Damage can occur in the earliest weeks of pregnancy, even before Prevalence of Alcohol Use During Late Pregnancy a woman knows that she is pregnant. Figure 1. Number of Alcoholic Drinks Consumed by Nearly 8% of Maryland Mothers During the Last Three Months of Pregnancy, women reported drinking The cognitive deficits and 2001-2008 during the last 3 months behavioral problems resulting from prenatal of pregnancy (Figure 1). 7 or more Of those who consumed alcohol exposure are 4 - 6 0.1% alcohol during pregnancy, lifelong. drinks/wk the vast majority (80%) Drinkers 0.2% Alcohol-related birth Nondrinkers reported that they had less defects are completely 7.7% 1 - 3 92.3% than one drink per week preventable. drinks/wk (“light drinkers”). The 1.1% < 1 drink/wk remaining 20% consumed

6.3% one or more drinks per U.S. Surgeon General week (“regular drinkers”). Advisory on Alcohol Use During Pregnancy, 2005

Figure 2. Binge Drinking During Last Prevalence of Binge Drinking 3 Months of Pregnancy, 2001-2008 During Late Pregnancy

Less than 1% of those surveyed reported one or Non- Binge more episodes of binge drinking, defined as five binge drinkers drinkers or more drinks on one occasion, during the last 0.5% 99.5% three months of pregnancy (Figure 2).

* Replaces May 2007 Focus on Alcohol Use Page 2 Maryland PRAMS Focus on Alcohol Use During Pregnancy

Maternal Characteristics Associated with Prenatal Alcohol Use and Binge Drinking

Figure 3. Mothers Who Reported Alcohol Figure 4. Mothers Who Reported Binge Drinking Use Last 3 Months of Pregnancy, 2001-2008 Last 3 Months of Pregnancy, 2001-2008 10 10 9 1.1 Percent Percent 0.9 0.9 8 0.8 7 7 0.6 4 0.5 3 3 3 0.3 3 2 2 0.2 0.2 1 1 1 1 1 1 1 0.1 +16 >25 +35 +16 >25 +35 13-15 25-34 13-15 25-34 Married Married up to 12 up to 12 Unmarried Unmarried Black Non-Hisp Black White Non-HispWhite Black Non-Hisp Black White Non-HispWhite Light drinker, <1 drink/wk Regular drinker, 1 or more drinks/wk

Both light and regular drinking during pregnancy were most In contrast to any alcohol use, binge drinking was most prevalent among mothers who were 35 or more years of prevalent among mothers who were unmarried, Black non- age, college graduates, White non-Hispanic, and married Hispanic and did not attend college (Figure 4). (Figure 3).

Factors Associated with Late-Pregnancy Alcohol Use and Binge Drinking Regular alcohol use (one or more drinks/week) Table 1. Perinatal Factors Associated with Late-Pregnancy Alcohol Prenatal tobacco use, abuse and postpartum de- Use and Binge Drinking, Maryland 2001-2008 pression were significantly more prevalent among regular drinkers than non-drinkers. Rates of pre- Self-Reported Alcohol Consumption conception multivitamin use, unintended preg- During Last 3 Months of Pregnancy nancy, and early prenatal care initiation did not vary significantly between regular drinkers and Factor None One or more Binge drinking nondrinkers. drinks/week† Any # of times % % % Binge drinking All unhealthy behaviors (non-daily folic acid use, Folic acid, daily, month pre-pregnancy 31 28 *7 , prenatal care initiation Unintended pregnancy 42 42 *66 after the 1st trimester, cigarette smoking, abuse, and ) were significantly First trimester prenatal care 76 71 *54 higher among binge drinkers than non-drinkers. Tobacco use, last 3 months pregnancy 9 *25 *36 Delivery Outcomes Abuse, during pregnancy 4 *10 *18 Low infants were significantly more prevalent among mothers who were regular and Postpartum depression 16 *28 *34 binge drinkers. Premature births were signifi- Infant 8 *12 *17 cantly more prevalent among mothers who binged. Premature delivery 10 14 *20 Note: Confounding factors (age, race, education, † Data on <1 drink/week is not presented income level) may be responsible for these asso- * Prevalence differed significantly from non-drinkers, p<0.05 ciations.

Maryland PRAMS Focus on Alcohol Use During Pregnancy Page 3

Prenatal Provider Screening and Counseling About Alcohol

The Maryland PRAMS survey included the The Maryland PRAMS survey (2001-2003 “...I drank 7 times question, only) included the question, a week. I was instructed by my “During any of your prenatal care visits, “At any time during your prenatal care, did a doctor, nurse, or other health care did a doctor, nurse, or other health care doc to drink one worker talk with you about any of the worker ask if you were drinking alcoholic wine cooler every things listed below?: beverages (beer, wine, wine cooler, or night to relax my How drinking alcohol during liquor)?” and to stop pregnancy could affect your baby” me from going into Nineteen percent of women reported that labor.” Twenty-eight percent of women reported no health care provider had assessed that no health care provider had spoken whether they drank alcohol during preg- PRAMS Mother to them during prenatal visits about the nancy. This percentage did not vary signifi- effects of alcohol on the baby. This per- cantly by nondrinkers and drinkers. centage was similar for nondrinkers and drinkers.

Summary

Nearly 8% of Maryland mothers The U.S. Preventive Services Task Force reported alcohol consumption during (USPSTF) “recommends screening and pregnancy. Although a substantial behavioral counseling interventions to “They said I could number of women continued to drink reduce alcohol misuse by adults, including have a drink after during pregnancy, 30% of Maryland pregnant women, in primary care the 3rd trimester...” mothers reported that they were not settings”. According to the U.S. Surgeon counseled about alcohol during their General (2005), “health professionals “My ob/gyn did not prenatal visits and 19% reported that they should inquire routinely about alcohol speak to me about were not asked how much they drank. consumption by women of childbearing alcohol … because age and inform them of the risks of she knows my Our Maryland PRAMS data showed that alcohol consumption during pregnancy, regular drinking (1 or more drinks a week) and advise them not to drink alcoholic religious beliefs.” ” during pregnancy was significantly beverages during pregnancy . In a 1996 associated with prenatal smoking, testimony to Congress, the Institute of postpartum depression, and infant low Medicine stated, “Of all the substances PRAMS Mothers birth weight. (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” Revisiting this analysis when additional years of data are available will further elucidate associations between maternal If you’re pregnant, don’t drink. and infant outcomes with alcohol use, especially that of heavy and binge drinking. If you drink, don’t get pregnant.

Page 4 Maryland PRAMS Website: www.marylandprams.org

PRAMS Methodology Data included in this report were collected Each month, a sample of 200 Maryland women through the Pregnancy Risk Assessment who have recently delivered live born infants Monitoring System (PRAMS), a surveillance are surveyed by mail or by telephone, and system established by the Centers for responses are weighted to make the results Disease Control and Prevention (CDC) to representative of all Maryland births. obtain information about maternal behaviors and experiences that may be associated with This report is based on the responses of adverse pregnancy outcomes. 12,611 Maryland mothers who delivered live Production Team: born infants between January 30, 2001 and In Maryland, the collection of PRAMS data is December 31, 2008 and were surveyed two to Diana Cheng, MD1 a collaborative effort of the Department of nine months after delivery. 2 Kelechi Uduhiri, M.D, MPH, MS Health and Mental Hygiene and the CDC. Laurie Kettinger, MS1 Lee Hurt, MS, MPH1

Limitations of Report

1. Center for Maternal and Child The Maryland PRAMS data on binge drinking to make a meaningful comparison with non- Health, DHMH and heavy (7 drinks/week) drinking is drinkers and light drinkers. The addition of 2. University of Maryland School of currently limited due to small numbers in several more years of data will likely yield Medicine, Preventive Medicine these categories. This, in turn, limits our more comprehensive associations with Residency Program [2007] analysis of heavy or binge drinking and its prenatal alcohol exposure. impact on various maternal behaviors and infant outcomes. For factors such as time of This report presents only basic associations

initiation of prenatal care, daily use of between risk factors and pregnancy intention. multivitamin, duration of breastfeeding, Interrelationships among variables are not For further information, timing of pregnancy, intention of pregnancy, described, and could explain some of the please contact: physical abuse, premature births, and other findings of the study. A retrospective survey morbidities or life stressors, more data is such as PRAMS is also subject to recall bias. Diana Cheng, M.D. needed for heavy and binge drinkers in order PRAMS Project Director Medical Director, Women’s Health Center for Maternal and Child Resources Health FASD (Fetal Alcohol Spectrum Disorder), Center for Excellence Maryland Department of Health Substance Abuse and Mental Health Services Administration (SAMHSA); U.S. Dept of Health and Human Services and Mental Hygiene www. fascenter.samhsa.gov 866-STOPFAS (786-7327) 201 W. Preston Street, Room 309 Baltimore, MD 21201 Maryland Fetal Alcohol Spectrum Disorder Coalition www.FASDMD.org 410-767-6713

Phone: (410) 767-6713 National Association Against Fetal Alcohol Syndrome (NOFAS) Fax: (410) 333-5233 www.NOFAS.org 202-785-4585/800-66NOFAS (666-6327)

or visit:

Maryland Department of Health and Mental Hygiene www.marylandprams.org Center for Maternal and Child Health • Vital Statistics Administration

Martin O’Malley, Governor; Anthony G. Brown, Lieutenant Governor; John M. Colmers, Secretary

The services and facilities of the Maryland Department of Health and Mental Hygiene (DHMH) are operated on a non- discriminatory basis. This policy prohibits discrimination on the basis of race, color, sex, or national origin and applies to the provisions of employment and granting of advantages, privileges, and accommodations.

The Department, in compliance with the Americans With Disabilities Act, ensures that qualified individuals with disabilities are given an opportunity to participate in and benefit from DHMH services, programs, benefits, and employment opportunities.

Funding for the publication was provided by the Maryland Department of Health and Mental Hygiene and by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement # UR6/DP-000542 for Pregnancy Risk Assessment Monitoring System (PRAMS). The contents do not necessarily represent the official views of the CDC.