Understanding drinking behaviors among women with unwanted pregnancies

Most women reduce or stop drinking alcohol upon discovery of pregnancy. However, little information exists about changes in alcohol use, and factors contributing to these changes, among women with unwanted pregnancies. A new study examines changes in alcohol use from before pregnancy recognition to during pregnancy among women with unwanted pregnancies – meaning women who tried, but were unable, to terminate their pregnancies. Findings indicate that most women with unwanted pregnancies quit or reduce alcohol consumption once they discover their pregnancies, and that some may be substituting alcohol for drugs once they discover their pregnancies.

Results will be published in the November 2014 online-only issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"More than half of pregnancies in the U.S. are unintended, which is significantly higher than the rate in many other developed countries," said Sarah C.M. Roberts, assistant professor at Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco. "To our knowledge, our study is the first to examine changes in use among with 'unwanted' pregnancies, defined here as a pregnancy women sought to terminate."

"Half of are terminated," added Lee Ann Kaskutas, a research scientist with the Alcohol Research Group at Berkeley, "yet more than a quarter of births are from unintended pregnancies. Thus, this study makes a huge contribution because this is not a small, 'fringey' understudied population—it is 27 percent of the live births in the country!"

Roberts and her colleagues analyzed data gathered from a study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010. "The Turnaway Study examines how terminating an unwanted pregnancy versus being unable to terminate an affects women's mental and physical health and socioeconomic status," explained Roberts. "In particular, this five-year study follows a group of about 1,000 women who were seeking abortion, most of whom received the abortion and some of whom were denied the abortion and then continued the pregnancy."

"Women with unintended and unwanted pregnancies appear to have higher levels of binge drinking before pregnancy recognition, but once they discover their pregnancies, they appear to behave similarly to other pregnant women in terms of quitting and reducing alcohol use," said Roberts. "There is also some evidence that women may be substituting alcohol for drugs once they discover their pregnancies."

"Since some binge drinkers continued to drink, and obviously were not open to abstention, we need interventions to help such women reduce their drinking while they are pregnant," said Kaskutas. "There are a few effective interventions that deliver both abstention and reduction messages, but providers are reluctant to deliver anything but an abstention message because no safe lower level of drinking has been determined. However, we do know that binge drinking is especially harmful to the fetus, so helping women to drink less of that can only be a good thing."

One reason for the high proportion of binge drinking before pregnancy recognition may be age-related.

"The age distribution of women in our sample differs from that of women of childbearing age," said Roberts. "There are many more women 20 to 24 and fewer women 35 to 46 in our sample than among women of childbearing age. More women aged 20 to 24 in our sample and also in national samples of women of binge drink than women over 35. The over-representation of younger women in our sample also reflects the population of women who have abortions in the U.S."

"Women may be substituting alcohol for drugs once they discover their pregnancies for two reasons," noted Kaskutas. "They could be thinking that drugs are worse than alcohol—in which case we need interventions that clarify these risks, especially pertaining to marijuana use. We know that there are no serious negative effects to marijuana on the fetus. Secondly, many are probably worried about getting punished for getting caught using drugs during pregnancy, for example, having their infant taken away. We don't know for sure if our policies related to use during pregnancy are causing pregnant women to substitute alcohol for drugs, but if our policies are leading women towards alcohol use during pregnancy then that is misdirected."

Both Roberts and Kaskutas have concerns about the relevance of official recommendations about alcohol use during pregnancy in the U.S. for women with unwanted pregnancies in particular, and unintended pregnancies in general.

"These recommendations advise complete abstinence from alcohol during pregnancy," said Roberts. "These messages seem less relevant for women who have consumed alcohol after conception, but prior to discovering pregnancy – especially women who thought they would terminate their pregnancies, but were unable to. Health-education messages for women who have already consumed alcohol during their pregnancies need to focus on changes women can make in their alcohol use moving forward, and also on helping women understand the risks associated with the amount of alcohol they've already consumed during their ."

"Binge drinking isn't good for anyone," said Kaskutas. "Women of child-bearing age should be thoughtful about , especially if they are not using contraception and especially if they live in an area of the country where access to abortion is limited or nil. They also should be conscious of how big their drinks are, because they might think they aren't drinking that much even though they are having more drinks than they think, that is, their glass of wine is 10 ounces or their liquor drinks are double shots, each of which count as two standard drinks, not one. There are available interventions that help women recognize their drink size and help them cut down; they should ask for such help, even if they have no intention of becoming pregnant."

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