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Prenatal Alcohol Exposure in the Republic of the Congo: Prevalence and Screening Strategies
Abstract
Objective:
To determine prevalence of prenatal alcohol use in Brazzaville, Congo and to evaluate a prenatal screening tool for use in this population.
Methods:
A prospective population screening program of 3099 women at 10 prenatal care clinics in Brazzaville, Congo using the 1-Question screen. To validate the 1-Question screen in this population we screened 764 of these women again using the T-ACE as a gold standard for comparison study. The study outcomes were as follows: prevalence of self-reported prenatal alcohol use in Brazzaville using the 1-Question screen, estimation of number of drinking days, drinks per drinking day, most drinks on any one occasion. We also estimated the epidemiologic performance criteria for the 1-Question screen.
Results:
The 3099 women screened were classified as follows: no risk 77% (n=2,384); at risk 3.7% (n=115); and as high risk 19.3% (n=600). Of the women reporting drinking during pregnancy, 87.4% reported drinking 4 or more drinks on any occasion. The agreement for detection of alcohol use during pregnancy by the 1-Question Screen and a positive T-ACE score was 94.7%.
Conclusions:
23.3% of women attending prenatal care in Brazzaville reported alcohol use during pregnancy and 83% of them continued to drink after recognition of pregnancy. Prenatal alcohol exposure should be the focus of efforts to improve identification of alcohol use prior to and during pregnancy to improve maternal and child health. Birth Defects Research (Part A) 97:489-496, 2013. © 2013 Wiley Periodicals, Inc.
... Only 5 of these tools have been specifically developed and/or validated for alcohol use screening in pregnant women. These 5 tools are the T-ACE (Tolerance, Annoyance, Cut Down, Eye-opener), TWEAK (Tolerance, Worried, Eye-opener, Amnesia, K/Cut Down), Alcohol Use Disorders Identification Test-consumption subset (AUDIT-C), the 4P's Plus, and the 1-Question Screen (WHO, 2014b;Poole et al., 2019;Chasnoff et al., 2005;Williams et al., 2013;Montag, 2016). Based on individualized assessment needs, prenatal care providers may choose to screen for other substances in pregnancy as well, which can be done using the 4Ps Plus, ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), HSQ (Hospital Screening Questionnaire), PIP (Pregnancy Information Program), and SURP-P (Substance Use Risk Profile in Pregnancy) screening instruments. ...
... A recently developed tool, the "1-Question screen," can also be used to screen pregnant women for alcohol with only one clinician-directed question that assesses the timing of the last drink consumed. This questionnaire has been compared to the T-ACE and had a 94.7% rate of agreement (Williams et al., 2013). The 1-Question screen has the added benefit of saving clinicians' time, which makes this less burdensome when considered for implementation on a population level (Williams et al., 2013). ...
... This questionnaire has been compared to the T-ACE and had a 94.7% rate of agreement (Williams et al., 2013). The 1-Question screen has the added benefit of saving clinicians' time, which makes this less burdensome when considered for implementation on a population level (Williams et al., 2013). ...
Global trends of increasing alcohol consumption among women of childbearing age, social acceptability of women’s alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, screening of pregnant women for alcohol use has become more important than ever and should be a public health priority. This narrative review presents the state of the science on various existing prenatal alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for alcohol use screening in pregnancy, such as practitioner constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy, providing recommendations to address these barriers. By implementing consistent alcohol use screening, prenatal care providers have the opportunity to facilitate access to counseling and brief interventions and thus, to prevent new cases of FASD and improve maternal and child health.
... Inter-rater agreement for inclusion and quality assessment was excellent (j = 0.976 and j = 0.918, respectively). Data from published studies on the prevalence of alcohol consumption during pregnancy were available from 12 of the 54 countries in the WHO African Region: Botswana (n = 1) [35], Democratic Republic of the Congo (n = 1) [36], Ethiopia (n = 1) [37], Ghana (n = 2) [38,39], Kenya (n = 1) [40], Mozambique (n = 1) [41], Nigeria (n = 7) [42][43][44][45][46][47][48], South Africa (n = 6) [49][50][51][52][53][54], Republic of the Congo (n = 1) [55], Tanzania (n = 1) [56], Uganda (n = 1) [57] and Zambia (n = 20) [58,59]. A flow diagram of the search strategy is depicted in Figure 1. ...
... The prevalence of alcohol consumption during pregnancy among the general population in the 25 identified studies ranged from 2.5% (Nigeria) [42] to 32.5% (Democratic Republic of the Congo) [36] (Table 1). Five studies [36,51,52,55,57] reported the prevalence of binge drinking during pregnancy among the general population, which ranged from 3.8% (South Africa) [52] to 25.4% (Democratic Republic of the Congo) [36] (Table 1). ...
... Fourth, the meta-analyses on the consumption of any amount of alcohol consumed during pregnancy for both Ghana and Zambia and for binge drinking during pregnancy for South Africa were based on only two studies. It should also be noted that the prevalence of alcohol use during pregnancy reported among the general population for both the Democratic Republic of Congo and the Republic of Congo is exceptionally high [36,55] and far exceeds the prevalence of current female drinkers among the general population in these countries (see Appendix). ...
Objective:
To estimate the prevalence of alcohol consumption and binge drinking during pregnancy among the general population in the WHO African Region, by country.
Methods:
First, a comprehensive systematic literature search was performed to identify all published and unpublished studies. Then, several meta-analyses, assuming a random-effects model, were conducted to estimate the prevalence of alcohol consumption and binge drinking during pregnancy among the general population for countries in the WHO African Region with two or more studies available. Lastly, for countries with scarce or no known data predictions were obtained using regression modelling.
Results:
The estimated prevalence of alcohol consumption during pregnancy among the general population ranged from 2.2% (95% confidence interval [CI]: 1.6%-2.8%; Equatorial Guinea) to 12.6% (95% CI: 9.9%-15.4%; Cameroon) in Central Africa, 3.4% (95% CI: 2.6%-4.3%; Seychelles) to 20.5% (95% CI: 16.4%-24.7%; Uganda) in Eastern Africa, 5.7% (95% CI: 4.4%-7.1%; Botswana) to 14.2% (95% CI: 11.1%-17.3%; Namibia) in Southern Africa, 6.6% (95% CI: 5.0%-8.3%; Mauritania) to 14.8% (95% CI: 11.6%-17.9%; Sierra Leone) in Western Africa, and 4.3% (95% CI: 3.2%-5.3%; Algeria) in Northern Africa.
Conclusions:
The high prevalence of alcohol consumption and binge drinking during pregnancy in some African countries calls for educational campaigns, screening and targeted interventions for women of childbearing age. This article is protected by copyright. All rights reserved.
... The pathophysiology of prenatal alcohol exposure is an important public health issue since 50% of pregnancies are complicated by alcohol exposure and adverse outcomes from exposure affect at least 1% of live births. 35 In response, numerous professional societies have developed warnings about the risks from drinking prior to and during pregnancy often emphasizing that no amount of alcohol is safe during pregnancy. [36][37][38][39] A more complete understanding of the complex interactions between exposure and development provides clinicians with a physiological rationale for discouraging maternal alcohol use at any time during pregnancy. ...
... This strategy should include ongoing study of strategies for prenatal alcohol detection that are deployed for routine use across prenatal care settings. 35,45 Where possible these tools should be brief and built into the electronic medical record. 5. The exposure detection panels should also include studies of markers for both alcohol exposure and smoking since the interactions are not additive, but multiplicative. ...
... This is a worldwide problem especially in the developing world, with high rates in Africa. 35 Prenatal alcohol exposure, and its sequela of stillbirth, prematurity, infant mortality, and the lifelong neuropsychiatric impairments must not be overlooked in pregnancies complicated by other substance abuse. In these pregnancies, alcohol use is very likely present and may be the underlying teratogen accounting for a considerable proportion of the phenotype. ...
William D Longhurst,1 Jordan Ernst,2 Larry Burd3 1Center for Emergency Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA; 2University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA; 3Department of Pediatrics, North Dakota Fetal Alcohol Syndrome Center, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA Background: The physiology of fetal alcohol exposure changes across gestation. Early in pregnancy placental, fetal, and amniotic fluid concentrations of alcohol exposure are equivalent. Beginning in mid-pregnancy, the maturing fetal epidermis adds keratins which decrease permeability resulting in development of a barrier between fetal circulation and the amniotic fluid. Barrier function development is essential for viability in late pregnancy and in the extra-uterine environment. In this paper we provide a selected review of the effects of barrier function on fetal alcohol exposure. Methods: We utilized a search of PubMed and Google for all years in all languages for MeSH on Demand terms: alcohol drinking, amnion, amniotic fluid, epidermis, ethanol, female, fetal development, fetus, humans, keratins, permeability, and pregnancy. We also reviewed the reference lists of relevant papers and hand-searched reference lists of textbooks for additional references. Results: By 30 gestational weeks, development of barrier function alters the pathophysiology of ethanol dispersion between the fetus and amniotic fluid. Firstly, increases in the effectiveness of barrier function decreases the rate of diffusion of alcohol from fetal circulation across fetal skin into the amniotic fluid. This reduces the volume of alcohol entering the amniotic fluid. Secondly, barrier function increases the duration of fetal exposure by decreasing the rate of alcohol diffusion from amniotic fluid back into fetal circulation. Ethanol is then transported into maternal circulation for metabolism or elimination. Conclusion: In late pregnancy, barrier function modifies alcohol diffusion rates across the epidermis back into fetal circulation. This increases the duration of exposure from each episode of drinking. This information may be useful for clinicians who care for women with alcohol use disorders during pregnancy, and may also be useful in explaining the rationale for avoiding alcohol use throughout pregnancy, including late pregnancy. Keywords: fetal, exposure, ethanol, integument, fetal alcohol spectrum disorders, amniotic fluid, alcohol
... Recent data on PAE in the Congo are alarming. Among pregnant women, 23% reported drinking during pregnancy and 87% of them also reported binge drinking in 2012 [20]. Among women who were drinking during pregnancy 83% continued to drink after recognition of pregnancy [20]. ...
... Among pregnant women, 23% reported drinking during pregnancy and 87% of them also reported binge drinking in 2012 [20]. Among women who were drinking during pregnancy 83% continued to drink after recognition of pregnancy [20]. Only one-in-six women (16.7%) quit drinking after recognition of pregnancy. ...
... Each pregnant woman was interviewed in French or a local language. At the most recent prenatal care visit we utilized the 1-Question screen (When was your last drink?) to identify women who were drinking during pregnancy [20] [25] [26]. The 1-Question screen has been validated in prenatal care clinics in the Congo [20]. ...
Objective: Determine the effectiveness of an intervention to reduce prenatal alcohol exposure in the Congo. Methods: We utilized a screening tool validated in the Congo to identify women who were drinking during pregnancy. The intervention was implemented by prenatal care providers comparing 162 women receiving the intervention with 58 (controls) who did not. The study end-points were proportion of women who quit drinking, drinking days per week, drinks per drinking day, most drinks on any day, and number of binge episodes per week. Results: In the control group 36% of the women quit drinking compared to 54% in the intervention group (Chi-square 5.61; p = 0.02). The number of drinking days per week for the controls decreased by 50.1% compared to 68% for the intervention group (p = 0.008); drinks per drinking day for the controls decreased by 37% compared to 60.1% for the intervention group (p = 0.001); and most drinks on any occasion in the controls decreased by 38% compared to 61% for the intervention group (p = 0.004). Con-clusions: This study demonstrates the effectiveness of a low cost in-office intervention to reduce prenatal alcohol exposure in the Congo. At $1.50 per beer, the reduction in drinks per week would more than pay for the cost of the intervention. In addition to efforts to reduce alcohol use prior to pregnancy in the Congo, providers can now offer an evidence based intervention to reduce expo-sure for women who continue to drink during pregnancy.
... Similarly, studies conducted on the prevalence of binge drinking among pregnant women showed between 3% in Canada and 25% in Congo [3,[27][28][29][30][31]. A study in New Zealand also revealed 10% of pregnant women drank seven and more units of alcohol per week which is the other clinically significant patterns of alcohol use [30]. ...
... It was similar to the findings to the studies in America (3.1%) [28], Canada (3%) [27], and South Africa (4.6%) [29]. However, it was much lower than the findings from studies in New Zealand (9%) [30], Uganda (10%), Congo (20.16%) [31], and Congo (25.42%) [23]. ...
Introduction
People in Ethiopia, including pregnant women, highly consume both home-made and manufactured alcohol beverages due to lack of awareness about the harmful effect of risky alcohol use, and cultural acceptance of alcohol consumption. Alcohol consumption and other hazardous patterns of use like binge drinking have tremendous adverse effects on fetus and mothers. Therefore, this study aimed to assess the magnitude of alcohol consumption, binge drinking and its determinants among pregnant women residing in Kolfe sub-city, Addis Ababa, Ethiopia.
Methods
Institutional based cross-sectional study was conducted among a total of 367 pregnant women. The participants were selected using a systematic random sampling method. Data were collected through a structured questionnaire. A binary logistic regression was conducted using SPSS version 20 software to identify determinants of alcohol consumption and binge drinking. A p-value < 0.05 was used to declare a statistical significance in multiple logistic regression. The results were described using adjusted odds ratio with a 95% confidence interval.
Results
This study revealed that the prevalence of alcohol consumption, binge drinking, and weekly alcohol consumption of four or more units among pregnant women was 39.78%, 3.54% and 4.9%, respectively. Not having formal education [AOR 95% CI = 8.47 (2.42, 29.62), having primary education [AOR 95% CI = 4.26 (1.23, 14.74), being a housewife [AOR 95% CI = 4.18 (2.13, 8.22), having an unplanned pregnancy [AOR 95% CI = 2.47(1.33, 4.60), having a history of abortion [AOR 95% CI = 3.33 (1.33, 6.05)], not having awareness about the harmful effect of alcohol consumption [AOR 95% CI = 4.66 (2.53, 8.61)], and not having family social support [AOR 95% CI = 2(1.14,3.53) were determinants of alcohol consumption among pregnant women.
Conclusions
This study found a high level of alcohol consumption among pregnant women. Interventions to create awareness on the harmful effects of alcohol are needed. Moreover, strengthening social support during pregnancy and family planning services to reduce unplanned pregnancy and abortion should be considered.
... This result is within the prevalence range of sub-Saharan African countries (2.2 and 59.28% to 87%) (15)(16)(17). In contrast, the prevalence of alcohol consumption in this survey was excessively higher than surveys conducted in Ethiopia (21,(24)(25)(26)(27), Burkina Faso (28,29), Republic of Congo (30,31), Uganda (32-36), South Africa (37), Nigeria (12,7%) (17,(38)(39)(40), Ghana (48%) (41) e Tanzania (42). This variation in prevalence may be due to sociocultural and contextual differences, as it is a rural setting and the tendency of alcohol consumption is higher in these areas. ...
Background: Alcohol consumption during pregnancy is a significant public health and pregnancy-related problem, such as spontaneous abortion, stillbirth or low birth weight. According to the WHO, there is no safe amount of alcohol consumption during pregnancy. Studies show high rates of alcohol consumption during pregnancy in sub-Saharan African countries with a prevalence range (2.2-87%). This research aimed to determine the prevalence and factors associated with alcohol consumption among pregnant women attending antenatal care in a rural district of Tete, Mozambique. Methods: A cross sectional survey was conducted between May and June 2022. The non-probability convenience method was applied for sample selection. Prevalence was determined using a 95% CI. binary logistic Regression was used to determine the factors associated with alcohol consumption. Data were analysed using statistical SPPS v26 and Stata.
Results: a total of 177 pregnant women participated in the survey. The prevalence of alcohol consumption during pregnancy was 85.9% (152/177; 95% CI: 80.7-91.0), which was associated with increasing age (OR= 8.86; 95% CI: 2.646-29.687; p-value = 0.00 and OR= 9.81; 95% CI: 2.262-42.576; p-value = 0.002) respectively. In addition, another associated factor was following some religion (OR= 0.07; 95% CI: 0.020-0.246; p-value = 0.00).
Conclusion: The survey significantly reveals a high prevalence of alcohol consumption among pregnant women attended in a antenatal care in Chitima. Maternal age and religion were the variables that have some significant association with alcohol consumption during pregnancy. Therefore, interventions for behavioural change to reduce alcohol consumption during pregnancy are needed, especially in all age groups.
... This result is within the prevalence range of sub-Saharan African countries (2.2 and 59.28% to 87%) (15)(16)(17). In contrast, the prevalence of alcohol consumption in this survey was excessively higher than surveys conducted in Ethiopia (21,(24)(25)(26)(27), Burkina Faso (28,29), Republic of Congo (30,31), Uganda (32-36), South Africa (37), Nigeria (12,7%) (17,(38)(39)(40), Ghana (48%) (41) e Tanzania (42). This variation in prevalence may be due to sociocultural and contextual differences, as it is a rural setting and the tendency of alcohol consumption is higher in these areas. ...
Background: Alcohol consumption during pregnancy is a significant public health and pregnancy-related problem, such as spontaneous abortion, stillbirth or low birth weight. According to the WHO, there is no safe amount of alcohol consumption during pregnancy. Studies show high rates of alcohol consumption during pregnancy in sub-Saharan African countries with a prevalence range (2.2-87%). This research aimed to determine the prevalence and associated factors of alcohol consumption among pregnant women attending antenatal care in a rural district of Tete, Mozambique.
Methods: A cross sectional survey was conducted between May and June 2022. The non-probability convenience method was applied for sample selection. Prevalence was determined using a 95% CI. binary logistic Regression was used to determine the factors associated with alcohol consumption. Data were analysed using statistical SPPS v26 and Stata.
Results: The prevalence of alcohol consumption during pregnancy was 85.9% (152/177; 95% CI: 80.7-91.0), which was associated with increasing age (OR= 8.86; 95% CI: 2.646-29.687; p-value = 0.000 and OR= 9.81; 95% CI: 2.262-42.576; p-value = 0.002) respectively. In addition, another associated factor was following some religion (OR= 0.07; 95% CI: 0.020-0.246; p-value = 0.000).
Conclusion: The survey significantly reveals a high prevalence of alcohol consumption among pregnant women attended in a antenatal care in Chitima. Maternal age and religion were the variables that have some significant association with alcohol consumption during pregnancy. Therefore, interventions for behavioural change to reduce alcohol consumption during pregnancy are needed, especially in all age groups.
... Some suspected cases of fetal alcohol spectrum disorders were observed, though this is yet to be studied systemically. The only published investigation into prenatal alcohol exposure in Congo found that 23.3% of women attending prenatal care in Brazzaville reported consuming alcohol whilst pregnant [40]. Our results therefore indicate that alcohol-related harm to pregnant women and their babies may be higher among BaYaka populations. ...
Ethnographers frequently allude to alcoholism and related harms in Indigenous hunter-gatherer communities, but very few studies have quantified patterns of alcohol consumption or its health and social impacts. We present a case study of the Mbendjele BaYaka, a Congolese population undergoing socioeconomic transition. 83 adults answered questions about their frequency and quantity of alcohol consumption, underwent biometric measurements and reported whether they were currently experiencing a cough or diarrhoea; 56 participated in structured interviews about their experiences with alcohol. Based on WHO standards, we found 44.3% of the full sample, and 51.5% of drinkers (excluding abstainers), had a hazardous volume of alcohol consumption; and 35.1% of the full sample, and 40.9% of drinkers, engaged in heavy episodic drinking; consumption habits varied with sex and age. Total weekly consumption was a positive predictor of blood pressure and the likelihood of experiencing diarrhoea; associations with other biometric variables were not statistically significant. Interview responses indicated numerous other economic, mental and physical health harms of alcohol use, the prevalence of which demonstrate some variability between forest camps and permanent village settlements. These include high rates of drinking during pregnancy and breastfeeding (~40%); frequent alcohol-induced violence; and considerable exchange of foraged foods and engagement in exploitative labour activities to acquire alcohol or repay associated debts. Our findings demonstrate the prevalence of hazardous alcohol consumption among transitioning hunter-gatherers is higher than other segments of the Congolese population and indicate negative impacts on health and wellbeing, highlighting an urgent need for targeted public health interventions.
... According to the result of the respective literature, alcohol consumption among pregnant women ranged from 8.1% [22] to 59.28% [54]. The prevalence of this study is higher than studies that have been reported in Southern Ethiopia [22], Burkina Faso [55], Zambia [56], Republic of Congo [57], Uganda [58,59] South Africa [60][61][62], and Tanzania [63]. On the other hand, it is comparable with studies conducted in South Africa [64], and DR Congo [65]. ...
Abstract Background Prenatal alcohol consumption is a serious public health concern that is considered as one of the preventable risk factors for neonatal and childhood morbidity and several adverse pregnancy outcomes. This study aimed to determine the individual- and community-level predictors of maternal alcohol consumption during pregnancy in Gondar town, Northwest Ethiopia. Methods A community-based cross-sectional study was conducted among pregnant women in Gondar town from 13 June to 24 August 2019. A cluster random sampling technique was used to select 1237 pregnant women. Data collection was carried out using the AUDIT-C pretested standard questionnaire. Bivariable and multivariable multilevel logistic regression analyses were computed to identify predictors of alcohol consumption using the odds ratio, 95% CI, and p-value
... Worldwide studies show that between 5% and 48% of women consume alcohol during pregnancy (Assanangkornchai et al., 2016;Ceccanti et al., 2014;Hotham et al., 2008;Tan et al., 2015;Williams et al., 2013;Williams et al., 2014;van der Wulp et al., 2014). ...
The aim is to test the reliability of two alcohol screening instruments: (1) The Parent Alcohol Screening Questionnaire (PASQ5), and (2) the Social Support for an Alcohol-free Pregnancy (SSAFP) questionnaire. This is a cohort study from the south of Sweden using repeated surveys during pregnancy. To examine if responses differed according to different data collection methods, two cohorts consisting of 289 expectant mothers and 141 fathers completed the PASQ5 both verbally (weeks 6-7) and in writing (week 12) within regular antenatal visits. One of the cohorts (n = 137/64) also completed the SSAFP in week 12 and later in week 33. The third cohort, consisting of 179 and 133 expectant mothers and fathers, respectively, completed the PASQ5 and the SSAFP twice in late pregnancy (week 31 + 33). Eight of 10 items in the PASQ5 were stable for both expectant mothers and expectant fathers when comparing verbal versus written-delivered formats. Eight of 10 questions in the PASQ5 were stable when assessing the items in a test-retest analysis in late pregnancy for expectant mothers and nine of 10 questions were stable for fathers. The SSAFP items showed high internal consistency (0.86) for expectant mothers and excellent internal consistency (0.94) for expectant fathers. Most SSAFP items (17 of 21 for expectant mothers and 18 of 22 for expectant fathers) were also stable in a test-retest scenario in late pregnancy. Both the PASQ5 and SSAFP are reliable tools and may be helpful for clinicians who aim to have a deeper dialogue about alcohol consumption during pregnancy. These tools may also be helpful for researchers aiming to better understand a person's changes in alcohol intake and/or their social support network.
... In all studies, alcohol consumption data were taken from the self-report of pregnant women, which means no data was collected using biomarkers or meconium tests. Lists of self-reporting questionnaires were: Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) [22,40,55], Tolerance, Worried, Eye-opener, Amnesia and, K/Cut-down (TWEAK) [57], Alcohol Use Disorders Identification Test (AUDIT) [39,41], Cutting down, Annoyance, Guilt, and Eye-opener (CAGE) [21], Alcohol Smoking and Substance Involvement Test (ASSIST) [44,50], Tolerance-Annoyed, Cut off, Eyeopening (T-ACE) [19], and 1-Question screen strategy [60]. Structured questionnaires were used in the rest of all studies (64%) to screen alcohol consumption during pregnancy. ...
Background:
Alcohol consumption during pregnancy represents a significant public health concern. It has several adverse health effects for both the mother and the developing fetus. This study aimed to estimate the pooled prevalence and the effect size of associated factors of alcohol consumption during pregnancy in Sub-Saharan Africa countries.
Methods:
The results of the review were reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA) guideline and, it was registered in the Prospero database, number CRD42019127103. The available primary studies were collated from different databases: PubMed, CINAHL, Cochrane Library, PsycINFO, Google Scholar, African Journals Online and Centre for Addiction and Mental Health Library. The main search terms were [((alcohol consumption) OR (alcohol drinking) OR (alcohol use) OR (ethanol use) OR (alcohol exposure)) AND ((pregnant women) OR (pregnant mother) OR (during pregnancy)) AND (Sub-Saharan Africa)]. We used the Joanna Briggs Institute (JBI) for critical appraisal of studies. The random-effects model was computed to estimate the pooled prevalence. Heterogeneity between studies was checked using the I2 statistic and the Cochrane Q test.
Results:
The review resulted in 963 original studies after searching various databases, and finally 37 studies in qualitative synthesis and 30 articles in the systematic review and meta-analysis were included. The overall summary estimate of the prevalence of alcohol consumption during pregnancy was found to be 20.83% (95% CI: 18.21, 23.46). The pooled estimate of meta-analysis showed that depression (OR: 1.572; 95% CI: 1.34, 1.845), partners' alcohol use (OR: 1.32, 95% CI: 1.11, 1.57), knowledge on harmful effect of alcohol consumption (OR: 0.36, 95% CI: 0.29, 0.45) and, unplanned pregnancy (OR: 2.33, 95% CI: 1.17, 4.63) were statistically significant factors with alcohol consumption during pregnancy.
Conclusions:
The result showed that there was high alcohol consumption during pregnancy in Sub- Saharan Africa. Alcohol consumption during pregnancy was associated with depression, partners' alcohol use, unplanned pregnancy and knowledge of the harmful effects of alcohol consumption. Therefore, this will be a basis for public policy and resource allocation for prevention initiatives.
... However, recent research shows that non-probability sampling techniques (e.g., convenience sampling) can be a suitable sampling strategy when exploring exposures during pregnancy (64). Also, it has been shown that a single question can detect as many (if not more) women who drink as other commonly used prenatal screens (65). Second, data on alcohol consumption during pregnancy were obtained through self-reported measures; therefore, reporting and recall biases may be present. ...
Objective
To estimate the prevalence of alcohol consumption during pregnancy among the general population of Latin America and the Caribbean, by country, in 2012.
Methods
Three steps were taken: a comprehensive, systematic literature search; meta-analyses, assuming a random-effects model for countries with published studies; and regression modelling (data prediction) for countries with either no published studies or too few to obtain an estimate.
Results
Based on 24 existing studies, the pooled prevalence of alcohol consumption during pregnancy among the general population was estimated for Brazil (15.2%; 95% confidence interval [95%CI]: 10.4%–20.8%) and Mexico (1.2%; 95%CI: 0.0%–2.7%). The prevalence of alcohol consumption during pregnancy among the general population was predicted for 31 countries and ranged from 4.8% (95%CI: 4.2%–5.4%) in Cuba to 23.3% (95%CI: 20.1%–26.5%) in Grenada.
Conclusions
Greater prevention efforts and measures are needed in the countries of Latin America and the Caribbean to prevent pregnant women from consuming alcohol during pregnancy and decrease the rates of Fetal Alcohol Spectrum Disorder. Additional high quality studies on the prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean are also needed.
... Yet it has been shown that nonprobability sampling strategies can be an acceptable sampling technique when exploring exposures during pregnancy 61 and that a single question can detect as many (if not more) women who drink as can other commonly used prenatal screens. 62 Second, data on alcohol use during pregnancy were obtained through self-reported measures and as such, are vulnerable to reporting and recall biases. Therefore, the prevalence of alcohol use during pregnancy and, as a consequence, the prevalence of FAS, might be underestimated in the current study. ...
Background: Alcohol use during pregnancy is the direct cause of fetal alcohol syndrome (FAS). We aimed to estimate the prevalence of alcohol use during pregnancy and FAS in the general population and, by linking these two indicators, estimate the number of pregnant women that consumed alcohol during pregnancy per one case of FAS.
Methods: We began by doing two independent comprehensive systematic literature searches using multiple electronic databases for original quantitative studies that reported the prevalence in the general population of the respective country of alcohol use during pregnancy published from Jan 1, 1984, to June 30, 2014, or the prevalence of FAS published from Nov 1, 1973, to June 30, 2015, in a peer-reviewed journal or scholarly report. Each study on the prevalence of alcohol use during pregnancy was critically appraised using a checklist for observational studies, and each study on the prevalence of FAS was critically appraised by use of a method specifically designed for systematic reviews addressing questions of prevalence. Studies on the prevalence of alcohol use during pregnancy and/or FAS were omitted if they used a sample population not generalisable to the general population of the respective country, reported a pooled estimate by combining several studies, or were published in iteration. Studies that excluded abstainers were also omitted for the prevalence of alcohol use during pregnancy. We then did country-specific random-effects meta-analyses to estimate the pooled prevalence of these indicators. For countries with one or no empirical studies, we predicted prevalence of alcohol use during pregnancy using fractional response regression modelling and prevalence of FAS using a quotient of the average number of women who consumed alcohol during pregnancy per one case of FAS. We used Monte Carlo simulations to derive confidence intervals for the country-specific point estimates of the prevalence of FAS. We estimated WHO regional and global averages of the prevalence of alcohol use during pregnancy and FAS, weighted by the number of livebirths per country. The review protocols for the prevalence of alcohol use during pregnancy (CRD42016033835) and FAS (CRD42016033837) are available on PROSPERO.
Findings: Of 23 470 studies identified for the prevalence of alcohol use, 328 studies were retained for systematic review and meta-analysis; the search strategy for the prevalence of FAS yielded 11 110 studies, of which 62 were used in our analysis. The global prevalence of alcohol use during pregnancy was estimated to be 9·8% (95% CI 8·9–11·1) and the estimated prevalence of FAS in the general population was 14·6 per 10 000 people (95% CI 9·4–23·3). We also estimated that one in every 67 women who consumed alcohol during pregnancy would deliver a child with FAS, which translates to about 119 000 children born with FAS in the world every year.
Interpretation: Alcohol use during pregnancy is common in many countries and as such, FAS is a relatively prevalent alcohol-related birth defect. More effective prevention strategies targeting alcohol use during pregnancy and surveillance of FAS are urgently needed.
Funding: Centre for Addiction and Mental Health (no external funding was sought).
... The One-Question-Screen reduces provider burden by having them ask only one question (with follow-up questions required only if exposure is reported), rather than several (it should be noted that, in settings other than a prenatal care setting, a second question may be required-e.g., When did you become pregnant?). Preliminary data suggest that this strategy detects as many (if not more) women who drink as other commonly used prenatal screens (Williams, Nkombo, Nkodia, Nkodia, & Burd, 2013). This strategy also emphasizes the assessment and recording of exposure dosimetry for women who are drinking. ...
Damage to the central nervous system is a unifying concept for nearly all of the diagnoses that fall under the Fetal Alcohol Spectrum Disorders (FASD) umbrella. Thus, FASD are an important public health and social problem worldwide that consumes a large amount of resources, both economic and societal by imparting a large burden on society through such sectors as the healthcare system, mental health and substance abuse treatment services, foster care, the criminal justice system, and the long-term care of individuals with intellectual and physical disabilities. Existing estimates of the economic impact of FASD demonstrate significant cost implications on the individual, the family and society. Many of the costs associated with FASD can be reduced with the implementation of effective social policies and intervention programs.
Among 130 million live births each year globally, approximately 10% are exposed to alcohol during pregnancy, which increases risk of adverse neonatal outcomes and fetal alcohol spectrum disorders (FASD). Current estimates show that 1 of every 13 (7.7%) pregnant women who consumes alcohol during pregnancy delivers a child with FASD. The risk of FASD among infants is individualized and depends on variability of maternal-fetal protective and susceptibility factors for FASD. The factors include environmental risk modifiers such as smoking and other substance use and nutritional status. The role of paternal influences on FASD susceptibility requires additional research. Globally, prenatal alcohol exposure results in 1.04 million new cases of FASD each year. This equates to 86,000 new cases/month (20,000/week or 2849/day, 118/h or 2/min). It is estimated that less than 1 of every 800 people living with FASD have been diagnosed. The annual cost of care for children with FASD is $23,810 per child, and additional unreimbursed costs of $25,993 to the family (total $53,683). For adults, the annual cost is $49, 077. The high prevalence rate and costs of care underscores the potential benefits of targeted screening in high-risk populations. These populations include children of women in substance use disorder treatment, and all children entering foster care or juvenile corrections. Further research to improve routine screening in prenatal care, at delivery sites, and neonatal intensive care nurseries is needed. Every mother and child should be provided screening at least once during a well-child visit. Since FASD is a very common cause of birth defects and developmental disabilities, screening for FASD should be a routine part of the clinical assessment of these children. Importantly, the diagnosis of other chromosomal, metabolic, or syndromal disorders does not reduce the need to investigate both prenatal alcohol exposure and FASD. No known disorder provides protection from prenatal alcohol exposure. Recurrence among sibships accounts for nearly 20% of all cases of FASD. Identification of these women and intervention to prevent alcohol exposure during a subsequent pregnancy can prevent cases of FASD among younger siblings. Thus, proactive alcohol screenings and FASD diagnosis can be useful in prevention efforts by identification of risky alcohol behavior during pregnancy. Early identification of FASD also allows for early entry into diagnosis-informed care and can reduce excess disability in the future.
Global trends demonstrate increasing alcohol consumption among women of childbearing age, social acceptability of women’s alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic. Increasing levels of consumption may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, alcohol use screening of women who are or may become pregnant has become more important than ever and should be a public health priority. The current literature review presents the state of the science on various existing alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for decreasing alcohol use in pregnancy, such as low uptake of screening during prenatal care, practitioner beliefs and training/time constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy as well as recommendations to address these barriers. By implementing consistent alcohol use screening, health-care providers increase opportunities for pregnant women to access counseling, brief interventions, and referral for treatment. Increased use of these strategies would reduce risk of adverse outcomes to women and their children, decrease new cases of FASD and recurrence of FASD in families, and thus would improve maternal and child health.Key wordsAlcoholPregnancyScreeningFetal alcohol spectrum disorderFetal alcohol syndromePreventionChildbearing aged women
Objective
Assess the prevalence of prenatal alcohol exposure in the Republic of the Congo by measuring breath alcohol concentration (BrAC) levels using a breathalyzer device.
Methods
Pregnant women were assessed for alcohol use with a breathalyzer reading during two prenatal visits and during labor and delivery.
Results
Among 662 pregnant women consented and screened with a breathalyzer, 192 (29.0%) had a positive BrAC during 1st trimester. During the second assessment, approximately 69% (132) of the 192 pregnant women had a second positive BrAC. A third assessment during labor and delivery identified 60 women (31%) with a third positive BrAC. About 19% (36) of the 192 pregnant women had positive BrACs at all three times. Among women who were positive on the first and second assessments, 30% had a BrAC that was above 0.07, which is almost equivalent of binge drinking (four or more standard drinks in about 2 h). The mean BrAC reading decreased as the pregnancy progressed.
Conclusions
The results of this study utilizing a unique exposure detection methodology suggest that the use of BrAC may be a useful objective option to detect and quantify alcohol consumption during pregnancy. The prevalence of alcohol use identified during pregnancy in the Republic of the Congo was increased over 20% when compared to maternal reports from a previous study. Nearly one of every five women identified at the first prenatal visit continued drinking throughout pregnancy. Urgent measures are needed to reduce alcohol consumption among this population of pregnant women.
Objective. To review the published literature on women who were intoxicated at delivery and outcomes for their infants. Methods. A systematic literature review was utilized to identify articles meeting our inclusion criteria. After screening using titles and abstracts, we identified 34 articles requiring full-text review. Each of these were reviewed by at least 2 of the authors. We identified 12 articles that met our inclusion criteria. Results. We identified case reports of 16 mothers who delivered with a blood alcohol concentration (BAC) ranging from 42.1 to 473 mg/dL. Three of the pregnancies (18.8%) ended with a stillbirth, 5 (31.3%) were infant deaths, 6 (37.5%) lived, and 2 (12.5%) had no fetal or infant outcome reported. The BAC for the stillborn infants ranged from 120 to 460 mg/dL. The BAC among the infant deaths ranged from 96 to 715 mg/dL. Among surviving infants, the BAC ranged from 38.4 to 246.5 mg/dL. Conclusion. We identified no deaths with a BAC <96 mg/dL. However, it is not clear if this represents the lower level of BAC where mortality risk increases. In this article, we present 9 suggestions to improve detection and management of these mothers and their infants.
Purpose of review:
This review aims to summarize data published in the scientific literature and available on official websites on fetal alcohol spectrum disorder (FASD) in Africa.
Recent findings:
There is a paucity of published literature and evidence-based information on prenatal exposure to alcohol in the African continent and the majority of the continent's literature on FASD emanates from South Africa. A small number of scientific publications document FASD and drinking in pregnancy in other Sub-Saharan African countries and these findings provide evidence that FASD occurs across the continent. Further evidence shows that the world's highest reported rates of FASD occur in South Africa and that this confers a significant public health and neurodevelopmental disability burden on the region. There is an established body of epidemiological, diagnostic, neurobehavioral and neuroscientific knowledge from studies in South Africa. Universal and indicated case method preventions are effective in reducing maternal alcohol consumption in high-risk areas. Throughout Africa, a policy and service implementation gap exists that impedes translation of generated knowledge into effective prevention and intervention strategies.
Summary:
FASD is likely a widely occurring and largely unrecognized neurodevelopmental disability in Africa. A key future direction for global agencies and research partnerships is to collaboratively address evidence gaps and knowledge translation through scalable approaches and strategies that aim to ameliorate the burden of FASD in African and other countries.
Prenatal exposure to alcohol is a major cause of birth defects and developmental disorders around the world. Prevention is a complex issue, with one factor being poor understanding of the risks of drinking during pregnancy. Awareness campaigns have emerged as an effective tool to increase knowledge of the risks in a manner which embraces the whole public and avoids creating stigma. Unfortunately many organizations lack the expertise or resources to develop, carry out, and evaluate such campaigns. The EUFASD Alliance, in collaboration with partners in health education from the Local Health Authority of Treviso, Italy, and a creative partner, Fabrica, propose to develop a campaign which can be adapted to countries and cultures around the world. A key goal is empowerment of individuals and local groups to make choices and change behaviors. A network of partners around the world is being developed to carry out the campaign. Most importantly, the effectiveness of the campaign will be evaluated in several key centers around the world.
Birth defects are an urgent global health priority. They affect millions of births worldwide. But their prevalence and impact are largely under-ascertained, particularly in middle- and low-income countries. Fortunately, a large proportion of birth defects can be prevented. This review examines the global prevalence and primary prevention methods for major preventable birth defects: congenital rubella syndrome, folic acid-preventable spina bifida and anencephaly, fetal alcohol syndrome, Down syndrome, rhesus hemolytic disease of the fetus and the newborn; and those associated with maternal diabetes, and maternal exposure to valproic acid or iodine deficiency during pregnancy. Challenges to prevention efforts are reviewed. The aim of this review is to bring to the forefront the urgency of birth defects prevention, surveillance, and prenatal screening and counseling; and to help public health practitioners develop population-based birth defects surveillance and prevention programs, and policy-makers to develop and implement science-based public health policies.
We reviewed the published literature on the relationship between childhood cancer and fetal alcohol spectrum disorders (FASD). A Pub Med search identified 12 subjects with the co-occurrence of FASD and cancer. We included an additional case from the author's institution. Neuroblastomas comprised 6 of the 13 (46%) case reports, yet neuroblastomas comprise only about 10% of childhood cancers (z = 4.1; P < 0.001). Other than rhabdomyosarcoma, no other cancer was reported more than once. Few cases of childhood cancer associated with FASD were identified likely due to under ascertainment of FASD. Pediatr Blood Cancer 2013;9999:1-3. © 2013 Wiley Periodicals, Inc.
Background: A study was completed in 2012 to determine the prevalence of Prenatal Alcohol Use (PAU) among pregnant women in Brazzaville, Congo. The screening tool collected data on number of drinks and binges during pregnancy to assess risk of negative pregnancy outcomes. Research assumed 1 drink of beer was the standard 12 ounces of beer used in the United States. It was later discovered that 65 centiliters of beer is commonly considered 1 drink in Brazzaville. This discrepancy guided a second study to gain a better understanding of alcohol consumption in this population. Purpose: To obtain an improved estimate of PAU in Brazzaville. Methods: 1283 pregnant women were screened using the 1 Question screen during prenatal visits. Women were asked how many centiliters they consider to be 1 drink. Adjusted results are reported according to the 12-ounce standard drink used in the United States. Results/Conclusions: Of the 1283 women, 232 (18.08%) reported PAU. Of those reporting PAU, 100% considered 65 cL to be 1 drink. 65 cL is 21.9791 ounces, or 1.8315 times larger than a standard 12-ounce drink. The unadjusted average drinks per day is 3.58 (sd=1.19) and the adjusted average drinks per day is 6.56 (sd=2.19). The adjusted drinks also estimate a new number of binge episodes in pregnancy, with a mean of 68.8 (sd=35.5) binges for the 232 women reporting PAU. These adjusted results help determine the actual alcohol consumption in this population. Future studies could use this adjustment to control for cultural differences in alcohol consumption.
Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time.
METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden.
FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania.
INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.
FUNDING Bill & Melinda Gates Foundation.
Fetal alcohol spectrum disorders (FASD) are associated with an increase in risk for mortality for people with an FASD and their siblings. In this study we examine mortality rates of birth mothers of children with FASD, using a retrospective case control methodology. We utilized the North Dakota FASD Registry to locate birth certificates for children with FASD which we used to identify birth mothers. We then searched for mothers' death certificates. We then compared the mortality rates of the birth mothers with an age matched control group comprised of all North Dakota women who were born and died in the same year as the birth mother. The birth mothers of children with FASD had a mortality rate of 15/304 = 4.93%; (95% CI 2.44-7.43%). The mortality rate for control mothers born in same years as the FASD mothers was 126/114,714 = 0.11% (95% CI 0.09-0.13%). Mothers of children with an FASD had a 44.82 fold increase in mortality risk and 87% of the deaths occurred in women under the age of 50. Three causes of death (cancer, injuries, and alcohol related disease) accounted for 67% of the deaths in the mothers of children with FASD. A diagnosis of FASD is an important risk marker for premature death in the mothers of children diagnosed with an FASD. These women should be encouraged to enter substance abuse treatment.
Child undernutrition is a major public health problem in low income countries. Prospective studies of predictors of infant growth in rural low-income country settings are relatively scarce but vital to guide intervention efforts.
A population-based sample of 1065 women in the third trimester of pregnancy was recruited from the demographic surveillance site (DSS) in Butajira, south-central Ethiopia, and followed up until the infants were one year of age. After standardising infant weight and length using the 2006 WHO child growth standard, a cut-off of two standard deviations below the mean defined the prevalence of stunting (length-for-age <-2), underweight (weight-for-age <-2) and wasting (weight-for-length <-2).
The prevalence of infant undernutrition was high at 6 months (21.7% underweight, 26.7% stunted and 16.7% wasted) and at 12 months of age (21.2% underweight, 48.1% stunted, and 8.4% wasted). Significant and consistent predictors of infant undernutrition in both logistic and linear multiple regression models were male gender, low birth weight, poor maternal nutritional status, poor household sanitary facilities and living in a rural residence. Compared to girls, boys had twice the odds of being underweight (OR = 2.00; 95%CI: 1.39, 2.86) at 6 months, and being stunted at 6 months (OR = 2.38, 95%CI: 1.69, 3.33) and at 12 months of age (OR = 2.08, 95%CI: 1.59, 2.89). Infant undernutrition at 6 and 12 months of age was not associated with infant feeding practices in the first two months of life.
There was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.
The World Health Organization estimated alcohol consumption in Uganda to be one of the highest in the world. We examined alcohol consumption among Ugandan women prior to and after learning of pregnancy. We developed a screening algorithm using factors that predicted alcohol consumption in this study. In 2006, we surveyed 610 women attending antenatal care at the national referral hospital in Kampala, Uganda about consumption of traditional and commercial alcoholic beverages before and after learning of pregnancy. Predictors of alcohol consumption during pregnancy were examined and a practical screening algorithm was developed for use in antenatal clinics. One hundred eighty women (30%) drank alcohol at least monthly before learning of their pregnancy. Among these women, almost one-third reported usual consumption of at least one beverage type at quantities that equal binging levels for women. Overall, 151 women (25%) consumed alcohol after learning of pregnancy. Commercial beverages, particularly beer, were consumed more often than traditional drinks. A two-stage screening algorithm asking women about their religion, male partner or friends' drinking, and any lifetime drinking predicted self-reported consumption of alcohol during pregnancy with 97% sensitivity and 89% specificity. Alcohol consumption among pregnant Ugandan women attending antenatal care is high. A feasible screening algorithm can help providers target education and counseling to women who are likely drinking during pregnancy. Given the preference for commercial alcoholic beverages, it is recommended that labels be placed prominently on bottled alcoholic beverages warning of the adverse effects of consuming alcohol during pregnancy.
This review examines the relationship between maternal alcohol consumption during pregnancy and spontaneous abortions. Although very high spontaneous abortion rates have been reported for alcoholic women, it is still uncertain if this is due to the direct effects of alcohol or the indirect effects of alcoholism-related disorders such as cirrhosis. The higher rates of spontaneous abortion among alcoholics may also be due to their higher pregnancy rates. Studies in animals indicate that blood alcohol levels > 200 mg/dl can directly precipitate spontaneous abortion. The association between lower levels of maternal alcohol consumption and spontaneous abortion is much less clear. There is a definite effect of study site in these latter studies: those conducted in North America nearly always report statistically significant associations; those conducted in Europe or Australia nearly always report no significant associations. The reason for this difference is not related to differences in alcohol consumption. Possible explanations for this geographical difference include difference in the socioeconomic status of the women being studied and artefacts associated with the designs used to study these relationships.
The authors evaluated the association between alcohol intake during pregnancy and risk of stillbirth and infant death in a cohort of pregnant women receiving routine antenatal care at Aarhus University Hospital (Aarhus, Denmark) between 1989 and 1996. Prospective information on alcohol intake, other lifestyle factors, maternal characteristics, and obstetric risk factors was obtained from self-administered questionnaires and hospital files, and 24,768 singleton pregnancies were included in the analyses (116 stillbirths, 119 infant deaths). The risk ratio for stillbirth among women who consumed > or =5 drinks/week during pregnancy was 2.96 (95% confidence interval: 1.37, 6.41) as compared with women who consumed <1 drink/week. Adjustment for smoking habits, caffeine intake, age, prepregnancy body mass index, marital status, occupational status, education, parity, and sex of the child did not change the conclusions, nor did restriction of the highest intake group to women who consumed 5-14 drinks/week (risk ratio = 3.13, 95% confidence interval: 1.45, 6.77). The rate of stillbirth due to fetoplacental dysfunction increased across alcohol categories, from 1.37 per 1,000 births for women consuming <1 drink/week to 8.83 per 1,000 births for women consuming > or = 5 drinks/week. The increased risk could not be attributed to the effect of alcohol on the risk of low birth weight, preterm delivery, or malformations. There was little if any association between alcohol intake and infant death.
About three days after a human egg is fertilized, it passes through the fallopian tunnel and reaches the uterus, where it spends about four days floating in the uterus’s fluids, after which it begins to implant itself into the uterine wall. By the 12th day, it is completely embedded. Prior to implantation, the embryo draws on its own reserves and those present in the fluids of the fallopian tube and uterus for sustenance. Other substances, like alcohol, may be present in these fluids, but there is little evidence these foreign substances adversely influence embryonic development.
The authors evaluated the association between alcohol intake during pregnancy and risk of stillbirth and infant death in a cohort of pregnant women receiving routine antenatal care at Aarhus University Hospital (Aarhus, Denmark) between 1989 and 1996. Prospective information on alcohol intake, other lifestyle factors, maternal characteristics, and obstetric risk factors was obtained from self-administered questionnaires and hospital files, and 24,768 singleton pregnancies were included in the analyses (116 stillbirths, 119 infant deaths). The risk ratio for stillbirth among women who consumed ≥5 drinks/week during pregnancy was 2.96 (95% confidence interval: 1.37, 6.41) as compared with women who consumed <1 drink/week. Adjustment for smoking habits, caffeine intake, age, prepregnancy body mass index, marital status, occupational status, education, parity, and sex of the child did not change the conclusions, nor did restriction of the highest intake group to women who consumed 5–14 drinks/week (risk ratio = 3.13, 95% confidence interval: 1.45, 6.77). The rate of stillbirth due to fetoplacental dysfunction increased across alcohol categories, from 1.37 per 1,000 births for women consuming <1 drink/week to 8.83 per 1,000 births for women consuming ≥5 drinks/week. The increased risk could not be attributed to the effect of alcohol on the risk of low birth weight, preterm delivery, or malformations. There was little if any association between alcohol intake and infant death.
Objectives: Since it has been suggested that moderate alcohol drinking would increase insulin sensitivity, which could benefit Gestational Diabetes Mellitus (GDM), the study aimed at evaluating alcohol con-sumption during pregnancy, and seeing whether this consumption influences GDM detection and mater-nal/perinatal outcomes. Study design: Women with already known diabetes and those with multiple pre-gnancy were excluded. All other pregnant women attending antenatal care unit of the university clinics, Kinshasa, DR Congo during the period from 1 March throughout 31 October 2010, were invited at 24-week gestation to enroll in O'Sullivan blood glucose testing and if eligible in 100-gram oral glucose tolerance test. Alcohol consumption, risk factors for GDM, and ge-neral characteristics such as age, parity, gestity, BMI, fat mass were registered. Diagnosed GDM was first treated with diet and exercise, thereafter with Met-formin, and if necessary with insulin. For other (nor-mal) women data remained blinded until confinement. Maternal and infant's adverse outcomes such as ma-ternal urinary infection, preeclampsia, cesarean sec-tion, intrauterine growth retardation, birth weight < 2500 g, birth weight ≥ 3800 g (as stated > percentile 90 in our milieu), Apgar score at the first minute < 7, shoulder dystocia or other birth injury, neonatal hy-poglycemia and fetal alcohol syndrome (FAS) were compared and analyzed according to GDM diagnosis as well to alcohol status. Results: Up to 240 pregnant women accepted to enroll into the study. Alcohol con-sumption concerned 78 (32.5%) of the women, most of them (61 = 25.42%) being heavy consumers. Risk factors for GDM and Physical and blood glucose characteristics were alike (p not significant) in both consumers and non consumers, except for history of HTA in the family that was significantly more fre-quent (p = 0.02) among drinkers. GDM's prevalence was 9%. No adverse outcome was more prominent in any subgroup, except Apgar score < 7 at the first minute that was more frequent (p = 0.038) among neonates of GDM mothers. No FAS, neither shoulder dystocia nor neonatal hypoglycemia were diagnosed. When alcohol status was considered, Birthweight ≥ 3800 g was found more frequent (p = 0.0284) in alco-hol consumers than in abstainers. Risk of this out-come was three times higher when history of family hypertension was present (odds ratio 2.694; CI: 0.536 -13.544). Conclusions: The prevalence of alcohol con-sumption by pregnant women of our series (32.5%) seems not to impact the detection of GDM (9%). FAS was not diagnosed. Lack of significant differences in adverse outcomes between GDM and non GDM could be attributed to huge follow-up of GDM women. In-fluence of alcohol consumption on birth weight mo-stly in setting of familial history of hypertension re-mains to be addressed.
We prospectively identified 96 women consuming at least 4 drinks/day during pregnancy by screening 9628 pregnant women. In these women with heavy prenatal alcohol use, there were three stillbirths and one preterm delivery; 98 matched nondrinking women had no stillbirths and two preterm births. Preterm rates did not differ significantly. The stillbirth rate was higher in the exposed group (p = 0.06). Additional investigation showed the stillbirth rate in the exposed population (3.1%) was significantly higher (p = 0.019) than the reported Chilean population rate (0.45%). Our data suggest that heavy alcohol consumption may increase the risk for stillbirth but not preterm delivery.
To evaluate the adequacy of recorded prenatal care provided to adolescents in Bulawayo, Zimbabwe.
A quantitative descriptive design, using checklists to audit 80 prenatal records, based on the assumption that care recorded reflects care rendered.
Four clinics and two hospitals providing public prenatal and birth services in Bulawayo, Zimbabwe.
80 Adolescents' prenatal records were audited.
Recorded prenatal care was checked according to the expected prenatal activities: history taking, health education and counselling, physical examinations, routine laboratory tests, client evaluations and planning for birth.
documentation in the prenatal records was incomplete, especially on aspects of health promotion and social history.
Inadequacies in prenatal records could denote poor prenatal care rendered to adolescents, limiting the potential benefits pregnant adolescents and their infants could derive from these services in Bulawayo. In-service education should be offered to the midwives to enhance their knowledge and skills on health assessment, history taking, physical examinations and accurate documentation of all aspects of prenatal care.
Preventing fetal alcohol spectrum disorders (FASDs) requires detection of in-pregnancy maternal risk drinking. The widely used T-ACE screen has been applied in various ways, although the impact of those different uses on effectiveness is uncertain. We examined relations among different T-ACE scoring criteria, maternal drinking, and child outcome. Self-reported across-pregnancy maternal drinking was assessed in 75 African-American women. The different T-ACE criteria used varied the level of drinking that defined tolerance (two or three drinks) and the total T-ACE score cut-points (two or three). Receiver operator curves and regression analysis assessed the significance of relations. Increasing the total T-ACE score cut-point to 3 almost doubled specificity in detecting risk drinking whereas maintaining adequate sensitivity, equivalent to that in the original report, and identified substantially more neurobehavioral deficits in children. Redefining tolerance at three drinks did not improve T-ACE effectiveness in predicting outcomes. This study is among the first to show the ability of an in-pregnancy T-ACE assessment to predict child neurodevelopmental outcome. In addition, increasing the total T-ACE score criterion (from 2 to 3) improved identification of non-drinking mothers and unaffected children with little loss in detection of drinkers and affected children. Efficient in-pregnancy screens for risk drinking afford greater opportunities for intervention that could prevent/limit FASDs.
Researching the epidemiology and estimating the prevalence of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) for mainstream populations anywhere in the world has presented a challenge to researchers. Three major approaches have been used in the past: surveillance and record review systems, clinic-based studies, and active case ascertainment methods. The literature on each of these methods is reviewed citing the strengths, weaknesses, prevalence results, and other practical considerations for each method. Previous conclusions about the prevalence of FAS and total FASD in the United States (US) population are summarized. Active approaches which provide clinical outreach, recruitment, and diagnostic services in specific populations have been demonstrated to produce the highest prevalence estimates. We then describe and review studies utilizing in-school screening and diagnosis, a special type of active case ascertainment. Selected results from a number of in-school studies in South Africa, Italy, and the US are highlighted. The particular focus of the review is on the nature of the data produced from in-school methods and the specific prevalence rates of FAS and total FASD which have emanated from them. We conclude that FAS and other FASD are more prevalent in school populations, and therefore the general population, than previously estimated. We believe that the prevalence of FAS in typical, mixed-racial, and mixed-socioeconomic populations of the US is at least 2 to 7 per 1,000. Regarding all levels of FASD, we estimate that the current prevalence of FASD in populations of younger school children may be as high as 2-5% in the US and some Western European countries.
Alcohol consumption has been identified as an important risk factor for chronic disease and injury. In the first paper in this Series, we quantify the burden of mortality and disease attributable to alcohol, both globally and for ten large countries. We assess alcohol exposure and prevalence of alcohol-use disorders on the basis of reviews of published work. After identification of other major disease categories causally linked to alcohol, we estimate attributable fractions by sex, age, and WHO region. Additionally, we compare social costs of alcohol in selected countries. The net effect of alcohol consumption on health is detrimental, with an estimated 3.8% of all global deaths and 4.6% of global disability-adjusted life-years attributable to alcohol. Disease burden is closely related to average volume of alcohol consumption, and, for every unit of exposure, is strongest in poor people and in those who are marginalised from society. The costs associated with alcohol amount to more than 1% of the gross national product in high-income and middle-income countries, with the costs of social harm constituting a major proportion in addition to health costs. Overall, we conclude that alcohol consumption is one of the major avoidable risk factors, and actions to reduce burden and costs associated with alcohol should be urgently increased.
To assess alcohol use by pregnant women in three underprivileged areas of the Western Cape.
Data were collected from subjects, selected in a randomised manner, during a single, structured interview.
Interviews were conducted among pregnant women voluntarily attending selected antenatal clinics in the George/Oudtshoorn, Vredenburg/Saldanha, and Cape Metropole areas of the Western Cape.
On completion of the interview, women at risk were counselled with regard to the dangers of prenatal alcohol exposure to the fetus.
42.8% of the women in the sample admitted to varying degrees of alcohol ingestion during the current pregnancy. The reported alcohol intake of over 55% of these women, i.e. 23.7% of the sample, was sufficient to place their unborn children at high risk for the fetal alcohol syndrome (FAS). These heavy drinkers followed a pattern of binge drinking over weekends and showed a marked preference for beer. Combined alcohol and tobacco use occurred in 29.6% of the sample. Only one subject admitted to using marijuana.
The data in this study confirm that a high rate of alcohol and tobacco use prevails among pregnant women in poorer communities of the Western Cape. Extrapolating from experience, as many as 9.5% of the sample may produce children with FAS.
Fetal alcohol syndrome (FAS) is a common cause of developmental disability, neuropsychiatric impairment and birth defects. The disorder is identified by the presence of growth impairment, central nervous system dysfunction, and a characteristic pattern of craniofacial features. The reported prevalence of the disorder varies widely and recent estimates approach 1% of live births. Expression of these features varies by age. People with FAS have high rates of comorbid conditions: attention deficit hyperactivity disorder (40%), mental retardation (15-20%), learning disorders (25%), speech and language disorders (30%), sensory impairment (30%), cerebral palsy (4%), epilepsy (8-10%). Birth defects are common. In the United States, the annual birth cohort of persons with FAS could be as high as 39,000 cases annually. Cause-specific mortality is 6% for patients with FAS. The disorder is expensive to treat and most patients have lifelong impairment. The annual cost of care in the United States would approach US$5.0 billion. Early recognition and entry into appropriate treatment programs appear to improve outcome. Prevention efforts should involve screening for alcohol use prior to pregnancy and at the first prenatal care visit.
Alcohol is an important element in the causal chain of risk for fetal, infant, and childhood mortality. Mortality risk is influenced by interactions of alcohol with other environmental and genetic factors and temporal periods of susceptibility. In this paper we discuss four time periods (preconceptual, gestational, infancy, and childhood) where alcohol use may create a context of risk. Alcohol use in one period increases the risk of alcohol use in subsequent periods. Gestational alcohol use can influence risk of mortality from abuse of mother/fetus, can cause other adverse outcomes, and can result in fetal alcohol spectrum disorders (FASDs). In infancy alcohol use can increase risk from impairment of arousal in adults who use alcohol. Infants with gestational exposure can be behaviorally difficult with sleep disturbance, irritability, and colic. This can increase the risk of harm or death, especially during periods of caretakers' alcohol use. Caretakers' alcohol use and smoking are strongly correlated. The all-cause mortality rate in people diagnosed with fetal alcohol syndrome (FAS) is over 5%. All-cause mortality in siblings of diagnosed cases of FAS is increased 530% compared to siblings of matched controls. We recommend that a context of alcohol use be considered as a marker for multifactorial risk in all fetal, infant, and child deaths. A schema to collect data on alcohol use is provided to increase awareness of alcohol use as an environmental risk marker for mortality.
Data were obtained from three samples of women of childbearing age. One sample of women is from prenatal clinics serving Plains Indian women. The second sample is of women from the Plains whose children were referred to special diagnostic developmental clinics, as their children were believed to have developmental issues consistent with prenatal alcohol consumption. The third sample is of women from South Africa, each of whom has given birth to a child diagnosed with full fetal alcohol syndrome (FAS). Data across samples conform to expected trends on many variables. For example, the maternal age at time of pregnancy, a major risk factor for FAS, ranged from a mean of 23.5 years for the prenatal clinic sample, to 23.8 years for the developmental clinic sample, to 27.6 for the sample of women who have delivered children with FAS. Other variables of maternal risk for FAS expected from the extant literature, such as high gravidity and parity, binge drinking, heavy intergenerational drinking in the mother's extended family and immediate social network, and length of drinking career, were compared across the three samples with variable results. However, normative measures of drinking problems are unreliable when reported across cultures. An unexpected finding from this three-sample comparison was the differential risk found when comparing U.S. women to South African women. Women in the U.S. Plains Indian samples report a high consumption of alcohol in a binge pattern of drinking, yet there is less detectable damage to the fetus than among the South African women. Body mass index (BMI) and lifelong and current nutrition may have a substantial impact, along with the above factors, in relative risk for an FAS birth. The level of risk for producing a child with FAS is influenced by environmental and behavioral conditions that vary between populations and among individual women. Also, because many syndromes are genetically based, there is a need for full behavioral and genetic histories of the mother, family, and child being studied. Collecting extensive behavioral information as well as genetic histories will provide the requisite information for making an accurate diagnosis of FAS.
To present an incremental process for a staged screening strategy to identify women at increased risk of having a child with fetal alcohol spectrum disorder (FASD) and to enhance the management of women using alcohol during pregnancy. We include an illustrative example of the development of a screening component using an existing data set.
We describe a seven-step protocol to screen for alcohol use during pregnancy. The screening process begins with a one-question initial screen, followed by exposure assessment, maternal risk stratification to estimate risk for FASD, and concludes with recommendations for intervention and monitoring of exposure for women drinking during pregnancy.
This screening process has very modest time commitments in the early stages. Time commitments increase for women drinking during pregnancy and the process focuses on the population at highest risk of having a child with FASD. The process has the benefit of risk specificity, since the process refines risk estimates for an adverse outcome specific for FASD. The process concludes with a programme to facilitate intervention and to monitor changes in prenatal alcohol exposure during pregnancy. Prevention of FASD is an important public health priority. In addition to the ongoing study of clinical strategies to improve detection rates of alcohol exposure at all stages of pregnancy, additional research on the tools and the process used in screening efforts is urgently needed. The efforts should also include research on both the screening tools and the outcome of the screening process in routine prenatal care settings.
Our objective was to estimate the mortality rate in subjects with fetal alcohol spectrum disorders (FASD) and their siblings whose FASD status was unknown.
We used the state FASD Registry to link subjects with FASD to a North Dakota birth certificate. We were able to link 304 of 486 cases (63%). We used the birth certificates to identify the mother and children born to the mother (siblings). We then searched for death certificates for both the FASD cases and their siblings. We then calculated the annual and age-adjusted mortality rates for the siblings of the Registry cases and compared them with mortality rates from North Dakota.
The FASD case mortality rate was 2.4%, with a 4.5% mortality rate for their sibings, accounting for 14% of all deaths when compared to the North Dakota residents matched by age and year of death. The sibling deaths accounted for 21.5% of all cause mortality matched by age and year of death. The age-standardized mortality ratios were 4.9 for the FASD cases and 2.6 for their siblings whose FASD status was unknown.
Mortality rates for FASD cases and their siblings were increased and represent a substantial proportion of all cause mortality in North Dakota. Prevention of FASD may be a useful strategy to decrease mortality.
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