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Effect of maternal alcohol consumption on gestational diabetes detection and mother-infant’s outcomes in Kinshasa, DR Congo

Open Journal of Obstetrics and Gynecology, 2011, 1, 208-212
doi:10.4236/ojog.2011.14040 Published Online December 2011 (
Published Online December 2011 in SciRes.
Effect of maternal alcohol consumption on gestational
diabetes detection and mother-infant’s outcomes in
Kinshasa, DR Congo
Tandu-Umba Barthélémy*, Mbangama Muela Andy, Mbungu Mwimba Roger
Department of OB-GYN, University Clinics, Kinshasa, Congo.
Email: *
Received 11 August 2011; revised 28 September 2011; accepted 16 October 2011.
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.
Keywords: Pregnancy; Alcohol Consumption; GDM;
Mother-Infant’s Outcomes
Alcohol is a potent teratogen in humans and both mode-
rate and high levels of alcohol intake during early preg-
nancy may result in alterations of growth and morpho-
genesis in the fetus, including the so called fetal alcohol
syndrome (FAS) [1-5]. In neonates this syndrome is known
as microcephaly associating characteristic face made of
short palpebral fissures, sunken nasal bridge, short nose,
flattening of the cheekbones and midface, smoothing and
elongation of the ridged area (the philtrum) between the
nose and lips, and smooth, thin upper lip.
Previously, it has been suggested that moderate drin-
king would increase insulin sensitivity [6], but no study
questioned it as protective or adverse factor on either de-
tection or survey of Gestational Diabetes Mellitus (GDM)
T.-U. Barthélémy et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 208-212 209
which is known as a situation of low insulin sensitivity.
This study aims at three issues: to evaluate the impor-
tance of alcohol consumption by pregnant women in our
milieu; to determine whether alcohol consumption dur-
ing pregnancy influences GDM detection; to determine
its influences on maternal and infant’s outcomes among
GDM women.
This observational study was approved by the institu-
tional review board of the faculty of medicine, Univer-
sity of Kinshasa. Women with already known diabetes
were excluded. Multiple pregnancies were also 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 to enroll in 50-gram glucose O’Sullivan testing at
24-week gestation (calculated from the last menstrual
period and early ultrasound examination data). Venous
blood glucose was assayed by use of One Touch Profile
Meters (Lifescan, Johnson & Johnson, High Wycombe,
U.K.). Based on this testing GDM was defined as blood
glucose 200 mg/dL. Women with values between 140
mg/dL and 199 mg/dL (n = 38) were encouraged to join
a 100-gram oral glucose tolerance test (OGTT).
Alcohol consumption was quoted as light (less than 1
litre but more than 30 cl/day) or heavy (more than 1
l/day) [3-5] and no counseling was initiated for drinkers.
Maternal characteristics included age, parity, gestity,
body mass index (BMI calculated as [weight (kg)/height
(m)2]), and fat mass according to impedancimetry (with
an OMRON BF 300 impedance meter). Risk factors for
GDM were also registered: obesity (BMI > 25), family-
history of diabetes (grandparents, parents, brothers, sis-
ters), or of arterial hypertension (HTA), previous history
of polyhydramnios, infant’s birth weight 3800 g (>
90th percentile in our milieu), stillbirth and congenital
malformation. Diagnosed GDM was first treated with
diet and exercise, aiming to achieve a fasting blood glu-
cose lower than 95 mg/dL, thereafter with MetforminR,
and if necessary with insulin. For other (normal) women
data remained blinded until confinement. Weight of the
newborn was measured immediately after birth. Infants
were examined, and judged clinically as having or not
signs of effect of alcohol on morphogenesis.
2.1. Maternal and Infant’s Adverse Outcomes
Such as maternal urinary infection, preeclampsia, cesar-
ean section, intrauterine growth retardation (IUGR), bir-
th weight 3800 g, Apgar score < 7 at the first minute,
shoulder dystocia or other birth injury, clinical neonatal
hypoglycemia and FAS were compared according to
both GDM and alcohol status.
2.2. Statistical Analysis (p < 0.05 Significant)
Differences between means were calculated using Stu-
dent’s t test (for normally distributed results) or other-
wise according to Mann-Whitney test. Differences be-
tween proportions were calculated according to chi-
square or Fischer’s exact test where appropriate. Multi-
variate adjusted odds ratios (95% confidence interval)
were used to eliminate influence of variables that could
modify effect of alcohol consumption on GDM diagno-
sis as well as on maternal and infant’s adverse outcomes.
Up to 240 pregnant women accepted to enroll into the
study. Their gestational age at delivery ranged from 37
to 41 weeks. Gestational age at recruitment was 30.78 ±
4.6 weeks. The birth weight at term was 3132.97 ± 470.1
g. Other characteristics means at recruitment are pre-
sented in Tab l e 1.
Table 1. Maternal characteristics according to alcohol status (Mean ± Standard deviation).
(n =
240) A
(n =
162) A
(n =
p values
Age (yrs) 31.25 ± 4.9 30.94 ± 5.03 31.88 ± 4.6 0.1699
Parity 1.99 ± 1.84 1.93 ± 1.89 2.1 ± 1.7 0.5041
Gestity 3.0 ± 2.08 2.85 ± 2.17 3.29 ± 1.8 0.1244
BMI (kg/m2) 24.73 ± 4.4 24.65 ± 4.3 24.88 ± 4.6 0.7051
Fat mass (kg) 19.88 ± 7.7 19.6 ± 7.6 20.45 ± 7.8 0.4326
Fat mass (%) 27.5 ± 6.5 27.5 ± 6.2 27.8 ± 7 0.7190
Plasma glucose during O’Sullivan (mg/dL) 121.10 ± 30.7 122.2 ± 31.2 121.9 ± 30.8 0.4071
GDM after O’Sullivan 6 5 (3.1%) 1 (1.3%) 0.7190
GDM after OGTT 15 10 (6.2%) 5 (6.4%) 0.4071
GDM 21 13 (8%) 8 (10.2%) 0.6071
opyright © 2011 SciRes. OJOG
T.-U. Barthélémy et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 208-212
Alcohol consumption concerned 78 (32.5%) of the
women attending our antenatal care unit, most of them
(61 = 25.42% of the overall series) being heavy con-
sumers. Beer was the only type of beverage reported.
The most invoked reason for alcohol consumption was
the prevention of discomforting nausea and vomiting.
No significant difference was found between alcohol
consumers and abstainers. Out of 240 women registered
for O’Sullivan testing 6 were recognized GDM (200
mg/dL of blood glucose value) and 188 were O’Sullivan
negative (glucose values less than 140 mg/dL). Among
46 women who had glucose values ranging from 140
mg/dL and 199 mg/dL 11 failed to join OGTT and were
excluded for the calculation of GDM’s prevalence which
thus concerned 6 women diagnosed after O’Sullivan
testing and 15 after OGTT (21/229 = 9%).
Risk factors for GDM were alike (p not significant) in
both alcohol consumers and non consumers, except for
familial history of HTA that was more frequent (p = 0.02)
among drinkers (Tab l e 2 ).
Eight women who delivered before term or at another
maternity were excluded for mother/infant’s outcomes
assessment, which thus restricted further calculations to
221 mother/infant couples (Tab l e s 3 - 4 ).
No adverse outcome was more prominent in any sub-
group, 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 (Tabl e 4 ), birth weight 3800 g was found
more frequent in alcohol consumers than in abstainers (p
= 0.0284). Since maternal history of HTA in the family
was the only risk factor for GDM more frequent (p =
0.02) among drinkers, its influence on prominent APO
(Preeclampsia, Apgar at the first minute < 7, birth weight
3800 g) according to alcohol consumption was as-
sessed using multivariate adjusted odds ratios (95% con-
fidence interval): odds ratio of 1.067 (CI: 0.129 - 8.813),
0.975 (CI: 0.057 - 3.061) and 2.694 (CI: 0.536 - 13.544)
for Preeclampsia, Apgar 1’ < 7, and birth weight 3800
g respectively. This means that a history of hypertension
in the family multiplies by three the risk of having an
infant 3800 g in alcohol drinkers.
Table 2 . Risk factors for GDM according to alcohol status.
(n =
Abstainers (n = 162) Drinkers (n = 78) p values
Maternal age 35 years 64 (26.7%) 42 (25.9%) 22 (34.4%) 0.139
History of diabetes in the family 79 (32.9%) 51 (31.5%) 28 (35.9%) 0.594
History of HTA in the family 19 (7.9%) 8 (4.9%) 11 (14%) 0.026
History of Macrosomia 31 (12.9%) 22 (13.6%) 9 (12%) 0.803
History of stillbirth 15 (6.3%) 13 (8%) 2 (3%) 0.182
History of polyhydramnios 4 (1.7%) 3 (1.9%) 1 (1.5%)
History of congenital malformation 0 0 0
BMI > 25 kg/m2 91 (37.9%) 58 (35.8%) 5 (6%) 0.406
Table 3 . Mother/infant’s adverse outcomes according to GDM status (N = 221).
Preeclampsia GDM (n = 20) 2 (10%) Non GDM (n = 201) 17 (8.5%) p values 0.814
Cesarean section 9 (45%) 55 (27.4%) 0.097
Apgar score 1’ < 7 3 (15%) 6 (3%) 0.038
Birthweight < 2500 gr 1 (5%) 10 (4.9%) 0.657
Birthweight 3800 gr 2 (10%) 16 (7.9%) 0.502
Shoulder dystocia or 0 0 -
other birth injury
Neonatal hypoglycemia 0 0 -
FAS 0 0 -
opyright © 2011 SciRes. OJOG
T.-U. Barthélémy et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 208-212 211
Table 4 . GDM diagnosis and mother/infant’s adverse outcomes according to alcohol status (N = 221).
Alcohol drinkers (n = 71) Alcohol abstainers (n = 150) p values
GDM 7 (9.9%) 13 (8.7%) 0.773
Preeclampsia 6 (8.5%) 13 (8.7%) 0.957
Cesarean section 23 (32.4%) 41 (27.3%) 0.439
Apgar score 1’ < 7 4 (5.6%) 5 (3.3%) 0.419
Birthweight < 2500 g 2 (2.8%) 9 (6%) 0.310
Birthweight 3800 g 10 (14.1%) 8 (5.3%) 0.0284
When compared to the prevalence found five years ago
(5.2%) in a multicentre study in Kinshasa [7] the rate of
this one-hospital-based study (9%) is much higher,
probably due to differences in study population sampling,
but a real rise should be questioned. Nevertheless, it is
expected to rise with use of lower blood glucose stan-
dards recently recommended by the 6th Symposium on
Pregnancy & Diabetes held in Salzburg, Austria, in
March 2011, which emphasized the HAPO study [8] and
seems to have got global agreement on the “one-step
diagnosis” of gestational diabetes mellitus (GDM). This
makes GDM range among epidemic problems to be fa-
ced in our milieu, not only for pregnancy outcomes but
mostly for prevention strategies, since GDM is likely to
announce type 2 diabetes.
In respect of alcohol consumption during pregnancy, it
is known that South Africa has the highest rate of FAS in
the world [9], but data from other African countries are
scarce to find. The rate of drinkers among pregnant wo-
men of our series (32.5%) is much higher than that of
4.4% reported in an Indian series [10]) and in North
America (10% in USA and 17% - 25% in Canada [11]).
Rates reported in Europe vary considerably from 34% in
France [12] to 81% in Ireland [13]. Due to feeling of
guilt or shame likely to accompany self-reporting of al-
cohol consumption by pregnant women [14], the actual
rate of our study might have to be higher.
Side effects related to alcohol consumption have been
reportedly noticeable even with light drinking, which led
to the “no alcohol at all during pregnancy” recommen-
dation [15,16]. Since most consumers of our series were
heavy ones, many fetuses were expected to be at risk.
Literature related to influences of alcohol consumption
on pregnancy generally refers to evaluation of consump-
tion during the first half of pregnancy [1-5]. Our study
deals with the second half but we have supposed that
drinking habits might be similar months before. This
supposition is supported by the fact that the most in-
voked reason for alcohol consumption was the preven-
tion of discomforting nausea and vomiting.
Lack of FAS in our series could thus be linked to fail-
ure to diagnose this condition in newborns, or to a lesser
sensibility of fetuses of our milieu, which remains to be
addressed. Mullally et al. [13] also observed only 3
cases (0.005%) of FAS among women whose up to 81%
were alcohol consumers.
As of GDM related mother/infant’s adverse outcomes
lack of significant differences between GDM and non
GDM women (except for Apgar score < 7 at the first
minute) could be attributed to huge follow-up of GDM
women while results remained blinded for others. This
finding is consistent with the need to actively treat GDM
in order to improve mother-infant’s outcomes. Increased
risk of Birth weight 3800 g by alcohol consumption
mostly among women having familial history of HTA is
difficult to interpret. Previously, protective effects of
moderate drinking on the development of type 2 diabetes
in elders has been evidenced mostly when compared
with heavy drinkers but not with abstainers [17]. No
favorable alcohol effect however has been claimed either
on GDM detection or survey or on APO in diabetic pa-
tients although it has been suggested that moderate
drinking would be associated with increased insulin sen-
sitivity [6].
The prevalence of alcohol consumption by pregnant
women in our milieu is as high as 32.5%, most of them
being heavy drinkers. The prevalence of GDM (9%)
seems not to be impacted by alcohol consumption. As of
mother/infant’s adverse outcomes (including FAS) lack
of significant differences between GDM and non GDM
(except for Apgar score < 7 at the first minute) is con-
sistent with the need to actively treat GDM. Influence of
alcohol consumption on Birth weight 3800 g mostly in
setting of familial history of HTA remains to be ad-
opyright © 2011 SciRes. OJOG
T.-U. Barthélémy et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 208-212
We are grateful to colleagues and collaborators from the department of
OB-GYN, University Clinics, Kinshasa, DR Congo for invaluable assi-
stance in collecting data and caring for pregnant women.
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opyright © 2011 SciRes. OJOG
... A study has shown that 2.4% of the pregnant women reported drinking six or more units on one occasion at least weekly or monthly and 5.4% of the women reported hazardous drinking with an Alcohol Use Disorders Identification Test-Consumption(AUIDT-C)score of three or more, and 2.2% of them reported risky drinking with Tolerance, Annoyance, Cut Down and Eye-Opener (T-ACE) score of two or more [21]. Only a few studies have been conducted in Sub-Sahara Africa on alcohol exposure during pregnancy, for instance, the prevalence of binge drinking during pregnancy among the general population in South Africa (3.8%) [22], the Democratic Republic of the Congo (24.5%) [23] and Uganda (9%) [24]. According to the studies conducted in Ethiopia, 7.7%of the respondents consumed four to five standard drinks and 2% of the respondents had eight or more drinks on a single occasion [25] and 16.1% had risky alcohol use behavior [26]. ...
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Background Alcohol use during pregnancy has a potential negative impact on the health of women and children. Binge or hazardous drinking may do greater alcohol-related damage to the developing fetus than drinking a comparable amount spread over several days or weeks. This study aimed to identify determinants of hazardous alcohol use among pregnant women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia. Methods An unmatched facility-based nested case-control study was carried out to identify the determinants of hazardous alcohol use among pregnant women within a prospective cohort study from 29 October 2019 to 7 May 2020. A two-stage random sampling technique was used to select 455 (113 cases and 342 controls) pregnant women. Data collection was performed using the AUDIT-C standardized and pretested questionnaire. Bivariable and multivariable logistic regression analyses were computed to identify the predictors of alcohol consumption using the odds ratio, 95% CI, and p-value < 0.05. Results Multivariable logistic regression model revealed that no formal education of the husbands [AOR = 2.79; 95%CI: 1.24, 6.29], being housewife[AOR = 2.43; 95%CI: 1.12, 5.26], poor household wealth index[AOR = 2.65; 95%CI: 1.07, 6.54], unplanned pregnancy [AOR = 4.36;95%CI: 2.44, 7.79], poor social support [AOR = 4.9;95%CI: 2.4, 10.04], depression[AOR = 3.84;95%CI: 2.16, 6.82], and not ever heard the risk of alcohol drinking during pregnancy [AOR = 1.97; 95%CI: 1.08, 3.58] were significantly associated with hazardous alcohol use. Conclusions Routine alcohol screening during ANC visits creates an appropriate referral system for clinical management and provides an opportunity for healthcare workers to offer information on the potential risks associated with alcohol use in pregnancy. Antenatal care providers have a special role to play in assuring that women receive adequate advice about alcohol use and care to manage the problems especially for pregnant women with depression, poor social support, unplanned pregnancy, low socioeconomic status, and for housewives during the antenatal visits. The warning marks on alcoholic beverages including an ongoing message about the risks of alcohol use during pregnancy could be public health good strategies to minimize preventable harms attributed to alcohol consumption during pregnancy.
... 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]. However, this finding is lower than the finding from Bahir Dar, Ethiopia [21], and Nigeria [54]. ...
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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
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Introduction Gestational diabetes mellitus (GDM) is rapidly increasing worldwide. Globally, 18.4 million pregnancies are complicated by GDM. Despite its known effect, GDM screening is not part of routine antenatal services in Tanzania. There is paucity of data on the magnitude and risk factors for GDM. Therefore, this study sought to determine prevalence and predictors of GDM among pregnant women in Dodoma region, Tanzania from March to August 2018. Research design and methods A cross-sectional study was carried out in Dodoma region, Tanzania between April and August of 2018. A total of 582 pregnant women were recruited from four local health facilities, where purposive sampling procedure was used to select the region, districts and health facilities. Simple random sampling was used to select study participants. Screening and diagnosis of GDM were performed using the 2013 WHO criteria. Descriptive and inferential analyses were performed using SPSS V.23 to determine prevalence and independent predictors of GDM. Results Among 582 participants, 160 (27.5%) participants were diagnosed with GDM. GDM was more prevalent in urban areas than rural areas, among overweight participants, among participants with a history of a large for gestational age baby, among participants with a history of caesarean section, and among participants with college or university education. Multiple logistic regression analysis showed that maternal age above 35 years (adjusted OR (AOR) 3.115 (95% CI: 1.165 to 8.359)), pre-eclampsia (AOR 3.684 (95% CI: 1.202 to 5.293)), low physical activity level (AOR 4.758 (95% CI: 2.232 to 10.143)), lack of awareness of GDM (AOR 6.371 (95% CI: 1.944 to 13.919)), alcohol use (AOR 4.477 (95% CI: 1.642 to 12.202)) and family history of diabetes (AOR 2.344 (95% CI: 1.239 to 4.434)) were significantly associated with GDM. Conclusions Prevalence of GDM is relatively high in Dodoma region. Most pregnant women are unaware of the condition such that it leads to a high-risk lifestyle. Besides, GDM significantly contributes to the number of high-risk pregnancies that go undetected and suboptimally managed. The antenatal care centres offer an optimum platform for screening, preventing and treating GDM by prioritising high-risk women.
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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.
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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.
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Background Human papillomavirus (HPV) infection plays key role in the development of cervical cancer. The purpose of this study was to investigate socioeconomic and lifestyle factors associated with HPV infection in pregnant women in Beijing, China. Methods An age matched case-control study designed with 66 women as the case group (HPV positive) and 132 women as the control group (HPV negative) was carried out in two hospitals in Beijing. Socioeconomic and lifestyle factors were obtained using a standard questionnaire. Cervical cells from study subjects were collected for HPV detection. An unconditional logistic regression model with backward stepwise selection was performed to predict the odds ratio (OR) and 95% confidence interval (CI) for the significant factors associated with HPV infection. Results The analyses of present data show that alcohol consumption during pregnancy was the strongest significant factor (OR = 3.35, 95% CI = 1.40–8.03, p = 0.007) when comparing the case (HPV positive) group with the control (HPV negative) group. There were no statistical differences observed in any of the socioeconomic factors when comparing the case and control groups. Conclusion The results of this study may help to prevent HPV infection in China by providing evidence to support improving the national policy on alcohol restriction and introducing public health interventions, especially for pregnant women in Beijing.
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Gestational diabetes mellitus (GDM) is a common health problem during pregnancy and its prevalence is increasing globally, especially in China. The aim of this study was to investigate socioeconomic, environmental and lifestyle factors associated with GDM in Chinese women. A matched pair case-control study was conducted with 276 GDM women and 276 non-GDM women in two hospitals in Beijing, China. Matched factors include age and pre-pregnancy body mass index (BMI). GDM subjects were defined based on the International Association of Diabetes Study Group criteria for GDM. A conditional logistic regression model with backward stepwise selection was performed to predict the odds ratio (OR) for associated factors of GDM. The analyses of data show that passive smoking at home (OR = 1.52, p = 0.027), passive smoking in the workplace (OR = 1.71, p = 0.01), and family history of diabetes in first degree relatives (OR = 3.07, p = 0.004), were significant factors associated with GDM in Chinese women. These findings may be utilized as suggestions to decrease the incidence of GDM in Chinese women by improving the national tobacco control policy and introducing public health interventions to focus on the social environment of pregnant women in China.
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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.
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Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and it affects 18% of pregnant women worldwide. GDM is considered a high-risk state which may lead to type II diabetes which is associated with an increase in a number of interrelated adverse perinatal outcomes. Given the fact that the progress of a successful pregnancy is dependent on the intricate communication between several biological molecules, identification of the proteomic profile perturbations in women with GDM is expected to help in understanding the disease pathogenesis and also discovery of clinical biomarker(s). In recent years, both gel-free and gel-based proteomics have been extensively investigated for improving maternal and child health. Although there are several reports integrating various aspects of proteomics in pregnancy related diseases such as preeclampsia, extensive Pubmed search shows no review so far on the application of proteomics in gestational diabetes. In this review, we focus on various high-throughput proteomic technologies for the identification of unique biosignatures and biomarkers responsible for the early prediction of GDM. Further, different analytical strategies and biological samples involved in proteomic analysis of this pregnancy-related disease are discussed.
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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.
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Evidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptional alcohol consumption. A cohort study of 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007. Self-reported alcohol consumption at the booking visit was categorised as low (0-5 units per week), moderate (6-20 units per week) and high (>20 units per week). Of the 81% of women who reported alcohol consumption during the peri-conceptional period, 71% reported low intake, 9.9% moderate intake and 0.2% high intake. Factors associated with moderate alcohol consumption included being in employment OR 4.47 (95% CI 4.17 to 4.80), Irish nationality OR 16.5 (95% CI 14.9 to 18.3), private health care OR 5.83 (95% CI 5.38 to 6.31) and smoking OR 1.86 (95% CI 1.73 to 2.01). Factors associated with high consumption included maternal age less than 25 years OR 2.70 (95% CI 1.86 to 3.91) and illicit drug use OR 6.46 (95% CI 3.32 to 12.60). High consumption was associated with very preterm birth (<32 weeks gestation) even after controlling for socio-demographic factors, adjusted OR 3.15 (95% CI 1.26-7.88). Only three cases of Fetal Alcohol Syndrome were recorded (0.05 per 1000 total births), one each in the low, moderate and high consumption groups. Public Health campaigns need to emphasise the importance of peri-conceptional health and pre-pregnancy planning. Fetal Alcohol Syndrome is likely to be under-reported despite the high prevalence of alcohol consumption in this population.
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This is the first ever study conducted to assess the prevalence of problem alcohol use in the rural women of Telangana region of Andhra Pradesh. To evaluate the prevalence of dependence and problem drinking, observe the factors that led to it and to monitor the effect of intervention in the form of psycho-education on their treatment seeking attitude. Cases were referred by the registrar from the Medicine Out-Patient Department using a three-item questionnaire for history of alcohol intake. Consecutive consenting female patients fulfilling the inclusion-exclusion criteria formed the sample. ICD-10 criteria and CAGE Questionnaire were used to assess dependence, problem drinking and co-morbid psychiatric illnesses. The socio-demographic data and the details regarding the nature and pattern of drinking and its complications were recorded using a semi-structured proforma. All patients were instructed to report at the end of 1 and 3 weeks for follow-up after a brief psycho-education regarding the problems of alcohol use. Dependence was seen in 4.1% and problem drinking in 1%. Physical complications possibly due to alcohol were seen in 4.1% and psychiatric co-morbidity in 1%. Pregnancy drinking was recorded in 4.4%. Only 0.2% came for follow-up. To conclude, there is a perceptible degree of problematic use of alcohol in the rural women of this region. Yet, none of them were seeking psychiatric help. The soaring number of pregnancy drinking needs further exploration. The poor psychiatric follow-up leads us to conclude that in this sample the perception of alcohol problem is very low.
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The U-shaped relationship between alcohol consumption and diabetes mellitus was observed among western populations. However, few studies have systematically evaluated the association in Chinese. We aimed to investigate the associations of alcohol consumption with diabetes mellitus and impaired fasting glycemia (IFG) among middle-aged and elderly Chinese. We examined 1,458 men and 1,831 women aged 50 to 70 from Beijing and Shanghai China in a cross-sectional survey. Fasting glucose, adipokines and markers of inflammation were measured. Macronutrients and alcohol consumption were assessed with standardized questionnaires. Compared with abstainers, alcohol consumption was associated with a decreased risk of having diabetes mellitus in women (OR: 0.41, 95%CI: 0.22-0.78) after controlling for socio-demographic factors, physical activity, smoking, family income, family history of cardiovascular disease or diabetes, macronutrients intake, body mass index, and markers of inflammation and adipokines. In men, both low and high alcohol consumptions were associated with increased risks of having combined diabetes and IFG (ORs 1.36 [95%CI: 1.02-1.82] and 1.50 [95%CI: 1.04-2.15], respectively]. In the multivariable stratified analyses among men, moderate drinkers who had drinking days of ≥ 5 days/week had a deceased likelihood (OR: 0.61, 95%CI: 0.37-0.98) and liquor drinkers had an increased likelihood (OR: 1.47, 95%CI: 1.09-1.98) of having combined diabetes and IFG respectively, compared with the abstainers. An approximately J-shaped association was observed between alcohol consumption and combined diabetes and IFG among men compared with abstainers in Chinese. Whether moderate alcohol intake could help decrease diabetic risk among Chinese people warrants further investigation.
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The objective of this study was to investigate the association of 4-year changes in alcohol consumption with a subsequent risk of type 2 diabetes. We prospectively examined 38,031 men from the Health Professionals Follow-Up Study who were free of diagnosed diabetes or cancer in 1990. Alcohol consumption was reported on food frequency questionnaires and updated every 4 years. A total of 1,905 cases of type 2 diabetes occurred during 428,497 person-years of follow-up. A 7.5 g/day (approximately half a glass) increase in alcohol consumption over 4 years was associated with lower diabetes risk among initial nondrinkers (multivariable hazard ratio [HR] 0.78; 95% CI: 0.60-1.00) and drinkers initially consuming <15 g/day (HR 0.89; 95% CI: 0.83-0.96), but not among men initially drinking ≥15 g/day (HR 0.99; 95% CI: 0.95-1.02; P(interaction) < 0.01). A similar pattern was observed for levels of total adiponectin and hemoglobin A(1c), with a better metabolic profile among abstainers and light drinkers who modestly increased their alcohol intake, compared with men who either drank less or among men who were already moderate drinkers and increased their intake. Likewise, compared with stable light drinkers (0-4.9 g/day), light drinkers who increased their intake to moderate levels (5.0-29.9 g/day) had a significantly lower risk of type 2 diabetes (HR 0.75; 95% CI: 0.62-0.90). Increases in alcohol consumption over time were associated with lower risk of type 2 diabetes among initially rare and light drinkers. This lower risk was evident within a 4-year period following increased alcohol intake.
Because of alcohol's effects on maternal, fetal and child health, the public health implications of alcohol abuse by women are potentially greater than those of alcohol abuse by men. This report provides a summary of developments in the field of alcohol use and women's health in the 1990s. During the 1990s, the prevalence of alcohol consumption, including binge drinking, appears to have increased among pregnant women, whereas there was little change among non-pregnant women of childbearing age. The prevalence of alcohol use among women under 21 years of age, for whom alcohol should be inaccessible, is equal to or greater than that in older age groups. Adverse effects have been detected among pregnant women who consume more than three drinks per week on average. Alcohol may impair fertility and increase the risk for breast cancer. The national burden from all effects of alcohol on women's health has not been assessed. The available brief screening instruments to detect alcohol use do not detect moderate alcohol consumption or binge drinking by pregnant women. Brief primary care clinic-based behavioral interventions and some medications have been shown to decrease alcohol use and subsequent problems among women who are problem drinkers. To prevent alcohol-exposed pregnancies, researchers need to study the feasibility of these interventions for pregnant women including moderate drinkers, as well as interventions that enhance the use of contraception among women who misuse alcohol and are at risk for pregnancy. Attempts to reduce alcohol-exposed pregnancies should begin prior to conception. Primary care providers for women, including obstetricians, general practitioners, family planning advisers and school health-care providers can play an important role in the prevention of all adverse effects of alcohol consumption by women.
Object Epidemiological study on addictive disorders during pregnancy. Methods An epidemiological study about addictive disorders has been led in the maternity of the University Hospital of Nantes in 2008 on a sample of 300 women, just after childbirth. The prevalence of consumption of drugs was assessed on declared consumption of legal and illegal substances and on the Fagerström questionnaire, the AUDIT questionnaire and the CAST questionnaire. Diagnostic of eating disorders was based on DSM IV criteria of mental anorexia and bulimia nervosa. Results At the beginning of pregnancy, 34% of women used tobacco, 63% alcohol and 8% cannabis. Among the women of the study 0.7% had criteria for mental anorexia, 2.3% for bulimia nervosa and 9% for sub clinic forms. After the first trimester, 22% of women declared using tobacco, 20% alcohol and 3% cannabis. The use of various drugs during pregnancy concerned 6.3% of women, and 38% used at least one drug after the first trimester. Conclusion The high prevalence of addictive disorders during pregnancy should incite professional of prenatal care to improve their screening methodology and not only when tobacco or alcohol is suspected.
South Africa has the highest prevalence of Fetal Alcohol Spectrum Disorders (FASDs) in the world. The purpose of this study was to identify high risk factors associated with drinking alcohol prior to pregnancy recognition in 24 neighborhoods in the Cape Flats outside Cape Town, South Africa. An interviewer assessed risk among 619 pregnant Black/African women between the ages of 18 and 41 years. Logistic regression analyses explored factors associated with drinking alcohol post conception but prior to pregnancy recognition. Forced multiple logistic regression analysis revealed that drinking prior to pregnancy recognition was associated with being younger, single, having better living conditions, smoking, having a longer gestation prior to pregnancy recognition, having a greater number of sexual partners, and a higher incidence of intimate partner violence. Depressive symptoms tended to be higher among alcohol users. These risk factors were consistent with other research on the characteristics of South African women having children with a diagnosis of Fetal Alcohol Spectrum Disorders and/or of non pregnant women at high risk for an alcohol-exposed pregnancy. These findings highlight the need for women of child-bearing age to be routinely screened for alcohol use and its associated risk factors. Intervention efforts could be integrated into health initiatives already present in South Africa including the prevention and treatment of HIV/AIDS, tuberculosis, and malnutrition. Preconception care is particularly important since pregnancy recognition often occurs several weeks to months following conception and could be implemented by South African community health workers. These endeavors should facilitate national goals of healthier pregnancies and the elimination of FASDs in South Africa.
Information on fetal hazards arising from moderate or low levels of maternal alcohol consumption is unavailable in man. In order to study this question an unselected group of pregnant women was interviewed during pregnancy regarding their alcohol intake. At the time of delivery pairs of high-risk and control infants were examined without knowledge of maternal drinking history. Of 163 infants examined, 11 were judged clinically to show signs compatible with a prenatal effect of alcohol on growth and morphogenesis. Nine of these 11 came from the high-risk drinking group. Only two of these infants were classified as having the fetal alcohol syndrome, and each of the mothers was a very heavy drinker. The other seven infants, who showed lesser alterations of growth and morphogenesis suggestive of fetal alcohol syndrome, were born to women who reported drinking an average of one ounce or more of absolute alcohol per day in the month prior to recognition of pregnancy. These results indicate that both moderate and high levels of alcohol intake during early pregnancy may result in alterations of growth and morphogenesis in the fetus.