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CORK Bibliography: Maternal Drinking

54 citations. January 2010 to present

Prepared: June 2011

Aliyu MH; Lynch O; Belogolovkin V; Zoorob R; Salihu HM. Maternal alcohol use and medically indicated vs. spontaneous preterm birth outcomes: A population-based study. European Journal of Public Health 20(5): 582-587, 2010. (36 refs.)

Background: The aetiology of preterm birth remains poorly understood. The purpose of this study is to investigate if an association exists between prenatal alcohol consumption and preterm birth and to determine if such an association differs by subcategories of preterm birth. Methods: We employed vital statistics data from the state of Missouri covering the period 1989-2005 (n = 1 221 677 singleton records). The outcome of interest was preterm birth, subclassified into medically indicated and spontaneous phenotypes. Multivariate logistic regression was used to generate adjusted odds ratios, with non-drinking mothers as the referent category. Results: Prenatal alcohol use was associated with elevated risk for preterm birth. The strength of association was more prominent for spontaneous preterm delivery {adjusted odds ratio (AOR) [95% confidence interval (CI)] = 1.34 (1.28-1.41)} than for medically indicated preterm birth [AOR (95% CI) = 1.16 (1.05-1.28)]. The overall risk for drinking-related spontaneous preterm birth increased with incremental rise in the number of drinks consumed per week (P for trend < 0.01). Conclusions: Prenatal alcohol use is a risk factor for preterm delivery, and especially for spontaneous preterm birth. These findings enhance our understanding of the aetiology of preterm birth and could be utilized in the development of appropriate prevention strategies that will assist in decreasing perinatal mortality and morbidity associated with preterm delivery.

Anderson K; Nisenblat V; Norman R. Lifestyle factors in people seeking infertility treatment - A review. (review). Australian & New Zealand Journal of Obstetrics & Gynaecology 50(1): 8-20, 2010. (159 refs.)

Background: Clinical infertility is a prevalent problem with significant financial and psychosocial costs. Modifiable lifestyle factors exist that may affect a person's time to conception and their chance of having a healthy, live birth. However, no guideline delineates what preconception advice should be offered to people presenting for infertility treatment. Aim: The aim of this article is to review the literature regarding modifiable lifestyle factors in people seeking infertility treatment. Results: A person's time to pregnancy and their chance of having a healthy, live birth may be affected by factors such as weight, vitamin and iodine intake, alcohol and caffeine consumption, smoking, substance abuse, stress, environmental pollutants, vaccinations and oxidative stress. Conclusions: Advice on modifiable lifestyle factors should be given to people presenting for infertility treatment to help them make positive changes that may improve their chances of pregnancy and delivering a healthy, live baby. Developing a guideline for this would be a prudent step towards helping clinicians to implement this aspect of preconception care.

Bakker R; Pluimgraaff LE; Steegers EAP; Raat H; Tiemeier H; Hofman A et al. Associations of light and moderate maternal alcohol consumption with fetal growth characteristics in different periods of pregnancy: The Generation R Study. International Journal of Epidemiology 39(3): 777-789, 2010. (41 refs.)

Methods This study was based on 7333 pregnant women participating in a population-based cohort study. Alcohol consumption habits and fetal growth were assessed in early (gestational age < 17.9 weeks), mid- (gestational age 18-24.9 weeks) and late pregnancy (gestational age >= 25 weeks). We assessed the effects of different categories of alcohol consumption (no; less than one drink per week; one to three drinks per week; four to six drinks per week; one drink per day and two to three drinks per day) on repeatedly measured fetal head circumference, abdominal circumference and femur length. Results In total, 37% of all mothers continued alcohol consumption during pregnancy, of whom the majority used less than three drinks per week. We observed no differences in growth rates of fetal head circumference, abdominal circumference or femur length between mothers with and without continued alcohol consumption during pregnancy. Compared with mothers without alcohol consumption, mothers with continued alcohol consumption during pregnancy had an increased fetal weight gain [difference 0.61 g (95% confidence interval: 0.18, 1.04) per week]. Cross-sectional analyses in mid- and late pregnancy showed no consistent associations between the number of alcoholic consumptions and fetal growth characteristics. All analyses were adjusted for potential confounders. Conclusions: Light-to-moderate maternal alcohol consumption during pregnancy does not adversely affect fetal growth characteristics. Further studies are needed to assess whether moderate alcohol consumption during pregnancy influences organ growth and function in postnatal life.

Boyles AL; DeRoo LA; Lie RT; Taylor JA; Jugessur A; Murray JC et al. Maternal alcohol consumption, alcohol metabolism genes, and the risk of oral clefts: A population-based case-control study in Norway, 1996-2001. American Journal of Epidemiology 172(8): 924-931, 2010. (36 refs.)

Heavy maternal alcohol consumption during early pregnancy increases the risk of oral clefts, but little is known about how genetic variation in alcohol metabolism affects this association. Variants in the alcohol dehydrogenase 1C (ADH1C) gene may modify the association between alcohol and clefts. In a population-based case-control study carried out in Norway (1996-2001), the authors examined the association between maternal alcohol consumption and risk of oral clefts according to mother and infant ADH1C haplotypes encoding fast or slow alcohol-metabolizing phenotypes. Subjects were 483 infants with oral cleft malformations and 503 control infants and their mothers, randomly selected from all other livebirths taking place during the same period. Mothers who consumed 5 or more alcoholic drinks per sitting during the first trimester of pregnancy had an elevated risk of oral cleft in their offspring (odds ratio (OR) = 2.6, 95% confidence interval (CI): 1.4, 4.7). This increased risk was evident only in mothers or children who carried the ADH1C haplotype associated with reduced alcohol metabolism (OR= 3.0, 95% CI: 1.4, 6.8). There was no evidence of alcohol-related risk when both mother and infant carried only the rapid-metabolism ADH1C variant (OR = 0.9, 95% CI: 0.2, 4.1). The teratogenic effect of alcohol may depend on the genetic capacity of the mother and fetus to metabolize alcohol.

Brigham G; Winhusen T; Lewis D; Kropp F. Incentives for retention of pregnant substance users: A secondary analysis. Journal of Substance Abuse Treatment 38(1): 90-95, 2010. (27 refs.)

Retention of pregnant substance users in treatment is challenging. In a multisite clinical trial, 200 pregnant substance users entering outpatient treatment at one of four programs were randomized to either three individual sessions of Motivational Enhancement Therapy for Pregnant Substance users or three individual sessions normally provided. Retail scrip from $25 to $30 was provided for attendance of research visits but not treatment visits. A post hoc analysis of the non-methadone-maintained participants (n = 175) evaluated the hypotheses that monetary reinforcement for attendance would result in more consecutive, and overall, weeks of attendance of research versus nonincentivized treatment visits. Findings indicate participants were nearly three times as likely to attend 4 consecutive weeks of research visits versus treatment sessions. There was no effect for income while fewer dependents were associated with more consecutive weeks of attendance. Incentives in the $25-to-$30 range may serve to significantly increase attendance and retention.

Brown CW; Olson HC; Croninger RG. Maternal alcohol consumption during pregnancy and infant social, mental, and motor development. Journal of Early Intervention 32(2): 110-126, 2010. (55 refs.)

Maternal alcohol consumption during pregnancy is a significant social problem associated with developmental difficulties in young children. Child developmental and behavioral characteristics were examined from the 9-month data point of the Early Childhood Longitudinal Studies-Birth Cohort, a prospective nationally representative study. Several findings indicate linear patterns between the amount of prenatal alcohol dosage and sensory regulation, mental, and motor development outcomes. Undesirable social engagement and child interaction were found to be statistically significant at the prenatal alcohol level of one to three drinks per week. Children exposed to four or more drinks per week showed statistically significant and clinically passive behavior on three sensory regulation variables.

Burden MJ; Westerlund A; Muckle G; Dodge N; Dewailly E; Nelson CA et al. The effects of maternal binge drinking during pregnancy on neural correlates of response inhibition and memory in childhood. Alcoholism: Clinical and Experimental Research 35(1): 69-82, 2011. (63 refs.)

Background: Although an extensive literature has documented a broad range of cognitive performance deficits in children with prenatal alcohol exposure, little is known about how the neurophysiological processes underlying these deficits may be affected. Event-related potentials (ERPs), which reflect task-specific changes in brain electrical activity, provide a method for examining multiple constituents of cognitive processing at the neural level. Methods: We recorded ERPs in 217 children from Inuit communities in Arctic Quebec (M age = 11.3 years) during 2 different tasks-Go/No-go response inhibition and continuous recognition memory. Children were classified as either alcohol-exposed (ALC) or controls (CON) depending on whether the mother reported binge drinking during pregnancy. Results: Both groups performed comparably in terms of accuracy and reaction time on the tasks, and both tasks elicited the expected effects on ERPs when responses were compared across conditions. However, the ALC group showed slower P2 latencies on Go/No-go, suggesting an altered neurophysiological response associated with initial visual processing of the stimuli. On the memory task, the ALC group showed reduced FN400 amplitude to New items, known as the familiarity effect, and reduced amplitude for the late positive component, possibly reflecting impairment in memory retrieval. Conclusions: These findings show that, even in tasks in which alcohol-exposed children exhibit behavioral performance that is comparable to controls, fetal alcohol exposure is associated with altered neurophysiological processing of response inhibition and recognition memory. The data suggest that fetal alcohol exposure is associated with reduced efficiency in the initial extracting of the meaning of a stimulus, reduced allocation of attention to the task, and poorer conscious, explicit recognition memory processing.

Burns E; Gray R; Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: A systematic review. (review). Addiction 105(4): 601-614, 2010. (80 refs.)

Aims: Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Methods: Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Results: Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71-91%) and AUDIT-C (95%), with high specificity (71-89%, 73-83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score >= 3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score >= 8 performed poorly. Conclusion: T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.

Burstyn I; Kapur N; Cherry NM. Substance use of pregnant women and early neonatal morbidity: Where to focus intervention? Canadian Journal of Public Health 101(2): 149-153, 2010. (31 refs.)

Background: Few studies, and none in Canada, have examined the relation between maternal smoking, alcohol consumption and drug dependence during pregnancy and early neonatal morbidity. Methods: We analyzed records of singleton live births in Alberta, Canada. Markers of neonatal morbidity were Apgar scores (<7 at 5 minutes postpartum) and resuscitation measures (2001-2005, N=191,686), and neonatal intensive care unit (NICU) admissions (2002-2005, N=154,924). Logistic regression was used to estimate odds ratios (ORs) for self-reported substance use and maternal health before conception, adjusting for maternal age, parity, year and fetal gender. Univariate ORs and population-attributable fractions were computed with and without correction for under-reporting of substance use. Results: Maternal smoking during pregnancy was the most prevalent risk factor, affecting 20% of mothers by self-report, with the figure being possibly twice as high once corrected for under-reporting. Smoking (ORs 1.2), alcohol consumption (ORs 1.2-1.5) and drug dependence (ORs 1.7-2) by the mother during pregnancy were associated with increased risk for each of the markers of early neonatal morbidity (p<0.05, after correcting for covariates). Eliminating the most common among these risk factors, maternal smoking, would prevent 10-15% of each of the three neonatal morbidity markers. Other recorded factors related to mother's pre-conception health, despite some strong associations, were responsible for only a small proportion of cases. Discussion: We conclude that in preventing early neonatal morbidity among singleton births in Alberta, control of maternal smoking, the most common of the potentially modifiable risk factors, remains an important goal.

Cheng DA; Kettinger L; Uduhiri K; Hurt L. Alcohol consumption during pregnancy: Prevalence and provider assessment. Obstetrics and Gynecology 117(2, Part 1): 212-217, 2011. (19 refs.)

OBJECTIVE: To estimate the prevalence of prenatal alcohol consumption and the extent of provider screening and discussion about alcohol use during pregnancy. METHODS: Data were obtained from a stratified random sample of 12,611 mothers from Maryland who delivered live infants during the years 2001-2008 and completed the Maryland Pregnancy Risk Assessment Monitoring System survey. Analyses were conducted using Proc Surveyfreq in SAS 9.2. RESULTS: Nearly 8% (95% confidence interval 7.1-8.4) of mothers from Maryland reported alcohol consumption during the last 3 months of pregnancy. The highest prevalence of late-pregnancy alcohol consumption was reported by mothers who were non-Hispanic white, (10.9%, confidence interval 9.8-11.9), aged 35 years or older (13.4%, confidence interval 12.4-14.4), and college graduates (11.4%, confidence interval 10.2-12.6) (P<.001). Nineteen percent (confidence interval 17.6-21.0) of mothers reported that their prenatal care provider did not ask whether they were drinking alcoholic beverages, and 30% (confidence interval 28.3-30.8) reported that a healthcare provider did not counsel them about the consequences of alcohol use on the child. Reported screening and counseling were least prevalent among mothers who were non-Hispanic white, aged 35 years or older, and college graduates (P<.01). CONCLUSION: Despite the substantial number of women who continue to drink alcohol during pregnancy, healthcare providers do not routinely assess alcohol consumption or counsel all women about its harmful effects. Counseling was least prevalent among the same groups of women with the highest rates for drinking. Provider alcohol assessment, as recommended by the U. S. Surgeon General to prevent alcohol misuse, needs further promotion as a routine part of prenatal care.

Chung EK; Nurmohamed L; Mathew L; Elo IT; Coyne JC; Culhane JE. Risky health behaviors among mothers-to-be: The impact of adverse childhood experiences. Academic Pediatrics 10(4): 245-251, 2010. (46 refs.)

Objectives.-Adverse childhood experiences (ACEs) are risk factors for health problems later in life. This study aims to assess the influence of ACEs on risky health behaviors among mothers-to-be and determine whether a dose response occurs between ACEs and risky behaviors. Methods.-A prospective survey of women attending health centers was conducted at the first prenatal care visit, and at 3 and 11 months postpartum. Surveys obtained information on maternal sociodemographic and health characteristics, and 7 ACEs prior to age 16. Risky behaviors included smoking, alcohol use, marijuana use, and other illicit drug use during pregnancy. Results.-Our sample (N = 1476) consisted of low-income (mean annual personal income, $8272), young (mean age, 24 years), African American (71%), single (75%) women. Twenty-three percent of women reported smoking even after finding out they were pregnant, 7% reported alcohol use, and 7% reported illicit drug use during pregnancy. Nearly three fourths (72%) had one or more ACEs. There was a higher prevalence of each risky behavior among those exposed to each ACE than among those unexposed. The exception was alcohol use during pregnancy, where there was not an increased risk among those exposed when compared with those unexposed to witnessing a shooting or having a guardian in trouble with the law or in jail. The adjusted odds ratio for each risky behavior was >2.5 for those with >3 ACEs when compared with those without. Conclusions.-ACEs were associated with risky health behaviors reported by mothers-to-be. Greater efforts should target the prevention of ACEs to lower the risk for adverse health behaviors that have serious consequences for adults and their children.

De La Rosa M; Dillon FR; Rojas P; Schwartz SJ; Duan R. Latina mother-daughter dyads: Relations between attachment and sexual behavior under the influence of alcohol or drugs. Archives of Sexual Behavior 39(6): 1305-1319, 2010. (61 refs.)

Associations among mother-daughter attachment, mother and daughter substance abuse, and daughter's sexual behavior under the influence of drugs and alcohol were investigated among 158 adult U.S. Latina daughters. Latina daughters were sampled from four mother-daughter dyad types: substance abusing mother and daughter, substance abusing mother only, substance abusing daughter only, and non-substance-abusing mother and daughter. Substance abusing daughters with substance abusing mothers, and daughters who were less strongly attached to their mothers, reported more sex under the influence of drugs. Age, marital status, substance abuse, and mother's substance abuse all influenced the daughter's sex under the influence of alcohol. An unexpected positive association between attachment and sex under the influence of alcohol was found for daughters who were more closely attached to a substance abusing mother. Implications for future research, and HIV/AIDS and drug prevention and treatment programs for Latinas are discussed.

Della Grotta S; LaGasse LL; Arria AM; Derauf C; Grant P; Smith LM et al. Patterns of methamphetamine use during pregnancy: Results from the Infant Development, Environment, and Lifestyle (IDEAL) Study. Maternal and Child Health Journal 14(4): 519-527, 2010. (28 refs.)

The objectives of this study are to characterize methamphetamine (MA) usage patterns during pregnancy, examine whether patterns of MA use are associated with sociodemographic characteristics and prenatal care, and test the hypothesis that persistent or increasing MA use during pregnancy is associated with greater use of other illicit drugs. The sample consisted of 191 MA-using mothers who participated in a large-scale multi-site study of prenatal MA exposure. Patterns of substance use were assessed by maternal self-report via the Substance Use Inventory (SUI), which included detailed information about MA use, including frequency, quantity, and maximum use during each trimester of pregnancy. The study demonstrated that on average, the prevalence of MA use decreased over the three trimesters of pregnancy (84.3% vs. 56.0% vs. 42.4%), and decreased frequency was observed among users from the first trimester to the third (3.1 vs. 2.4 vs. 1.5 days/week). Closer examination of the individual patterns revealed that 29.3% of women maintained consistently high frequency, 9.4% increased frequency, 25.7% had a stable low/moderate pattern, and 35.6% decreased their frequency of MA over the course of pregnancy. These four groups did not differ in sociodemographic characteristics; women who decreased their use of MA had significantly more prenatal visits compared to the consistently high-use group, but were the most likely to use alcohol during their pregnancy. In conclusion, this article elucidated the different patterns of MA use in this community sample. Approximately, one third of MA-using mothers could be classified as consistently high users with a profile of use with the greatest risk to themselves and potentially to their infants including high levels of MA use throughout pregnancy and fewer prenatal care visits. Overall, we found that MA use declined across pregnancy; however, a substantial proportion of users had consistently high or increasing MA use, while those who decreased their MA frequency had a higher prevalence of polydrug use. Future research will investigate the association of these patterns with neonatal outcomes.

du Toit MM; Smith M; Odendaal HJ. The role of prenatal alcohol exposure in abruptio placentae. South African Medical Journal 100(12): 832-835, 2010. (25 refs.)

Objective. To investigate the association between preconception and prenatal alcohol use and abruptio placentae. Methods. A case-control study of women with the clinical diagnosis of abruptio placentae, 65 cases and 66 controls, at Tygerberg Academic Hospital, Western Cape, South Africa. Women in whom a retroplacental blood clot, covering at least 15% of the placental surface, was found at delivery at 24 weeks' gestation or later were asked to complete a timeline follow-back questionnaire to determine their alcohol intake 12 and 3 months before and during pregnancy. The same questionnaire was administered to a control group of high-risk women who had no antepartum haemorrhage. Outcome. Women who drank alcohol 12 months before conception were more than 4 times more likely to develop abruptio placentae than the control group (odds ratio (OR) 4.49, p=0.00009). Women who drank alcohol 3 months prior to conception were 3 times more likely to develop abruptio placentae than the control group (OR 3.06, p=0.003). Drinking alcoholic beverages during pregnancy carried a more than 3 times greater risk of developing abruptio placentae (OR 3.52, p=0.0006). In the study group, women consumed a mean of 13.6, 12.0 and 11.2 standard drinks in a typical week at 12 and 3 months before and during pregnancy, respectively. The study group demonstrated a binge-drinking pattern, with two to four sessions per month. Conclusion. An association was found between preconception and prenatal consumption of alcohol and abruptio placentae.

France K; Henley N; Payne J; D'Antoine H; Bartu A; O'Leary C et al. Health professionals addressing alcohol use with pregnant women in Western Australia: Barriers and strategies for communication. Substance Use & Misuse 45(10): 1474-1490, 2010. (32 refs.)

Health professionals have an important role to play in preventing prenatal alcohol exposure. In 2006 qualitative data were collected from 53 health professionals working in primary care in metropolitan and regional Western Australia. Thematic analysis was used to elucidate barriers in addressing prenatal alcohol use and the strategies used to overcome them. Health professionals identified strategies for obtaining alcohol use information from pregnant women but they are not recognizing moderate alcohol intake in pregnant women. Study limitations are noted and the implications of the results are discussed. This research was funded by the Health Promotion Foundation of Western Australia.

Fraser JG; Harris-Britt A; Thakkallapalli EL; Kurtz-Costes B; Martin S. Emotional availability and psychosocial correlates among mothers in substance-abuse treatment and their young infants. Infant Mental Health Journal 31(1): 1-15, 2010. (49 refs.)

Emotional availability (EA) was investigated among low-income mothers enrolled in substance-abuse treatment and their young infants (n = 21) compared with a demographically matched group of mother-infant pairs who, by self-report, were not at risk for substance abuse (n = 27). The mother-infant dyads in the treatment group generally demonstrated poorer EA functioning than those in the comparison group, but few differences between the groups on individual dimensions of EA were significant. This finding was notable considering that mothers in treatment reported significantly higher levels of depressive symptoms and psychological stress. Treatment effects may have buffered the negative impact of depression and psychological stress on mothers' EA scores. The clinical implications of the findings are discussed as they relate to substance-abuse-treatment services for pregnant and parenting women.

Gauthier TW; Kable JA; Burwell L; Coles CD; Brown LAS. Maternal alcohol use during pregnancy causes systemic oxidation of the glutathione redox system. Alcoholism: Clinical and Experimental Research 34(1): 123-130, 2010. (39 refs.)

Background: Increased systemic oxidant stress contributes to a variety of maternal complications of pregnancy. Although the antioxidant glutathione (GSH) and its oxidized component glutathione disulfide (GSSG) have been demonstrated to be significantly altered in the adult alcoholic, the effects of maternal alcohol use during pregnancy on oxidant stress in the postpartum female remain under investigation. We hypothesized that maternal alcohol use would increase systemic oxidant stress in the pregnant female, evidenced by an oxidized systemic GSH redox potential. Methods: As a subset analysis of a larger maternal language study, we evaluated the effects of alcohol consumption during pregnancy on the systemic GSH redox staus of the postpartum female, using an extensive maternal questionnaire. Postpartum women were queried regarding their alcohol consumption during pregnancy. Any drinking, the occurrence of drinking > 3 drinks/occasion, and heavy drinking of > 5 drinks/occasion during pregnancy were noted. Using HPLC, maternal plasma samples were analyzed for GSH, oxidized GSSG and the redox potential of the GSH/GSSG antioxidant pair calculated. Results: Maternal alcohol use occured in 25% (83/321) of our study sample. Two in ten women reported consuming > 3 drinks/occasion during pregnancy, while 1 in 10 women reported consuming alcohol at > 5 drinks/occasion. Any alcohol use during pregnancy significantly decreased plasma GSH (p < 0.05), while alcohol at > 3 drinks/occasion or > 5 dinks/occasion signifcantly decreased plasm a GSH concetration (p < 0.005), increased the percent of oxidized GSSG (p < 0.05), and substantially oxidized the plasma GSH redox potential (p < 0.05). Conclusions: Alcohol use during pregnancy, particulary at levels > 3 drinks/occasion, caused significant oxidation of the systemic GSH system in the postpartum wome. The clinical ramifications of the observed alcohol-induced oxidation of the GSH redox system on high risk pregnancies or on the exposed offspring require more accurate identification and further investigation.

Gifford AE; Farkas KJ; Jackson LW; Molteno CD; Jacobson JL; Jacobson SW et al. Assessment of benefits of a universal screen for maternal alcohol use during pregnancy. Birth Defects Research. Part A: Clinical and Molecular Teratology 88(10, special issue): 838-846, 2010. (40 refs.)

INTRODUCTION: The objective of this report is to estimate the benefits of universal meconium screening for maternal drinking during pregnancy. Fetal alcohol spectrum disorder (FASD), including its most severe manifestation fetal alcohol syndrome (FAS), is preventable and remains a public health tragedy. The incidences of FAS and FASD have been conservatively estimated to be 0.97 and 10 per 1000 births, respectively. Meconium testing has been demonstrated to be a promising at-birth method for detection of drinking during pregnancy. METHODS: The current costs of FAS and FASD, alcohol treatment programs, and meconium screening were estimated by literature review. Monetary values were converted roughly to equal dollars in 2006. RESULTS: Costs of adding meconium analysis to the current newborn screening program and of treatment for the identified mothers were estimated and compared to potential averted costs that may result from identification and intervention for mothers and affected infants. Three potential maternal treatment strategies are analyzed. Depending on the treatment type, the savings may range from $6 to $97 for every $1 spent on screening and treatment. DISCUSSION: It needs to be emphasized, however, that such screening is premature and that to be effective this screening can be implemented only if there is a societal willingness to institute prevention and intervention programs to improve both women's and children's health. Future research should be directed at improving detection and developing in-depth prevention and remedial intervention programs. A thorough consideration of the ethical issues involved in such a screening program is also needed.

Goldman GD; Ryan SD. Direct and modifying influences of selected risk factors on children's pre-adoption functioning and post-adoption adjustment. Children and Youth Services Review 33(2): 291-300, 2011. (83 refs.)

Child adoption outcomes are influenced by child's behavior and parents' expectations (Haugaard & Hazan, 2003). Pre-adoption risk factors, such as prenatal alcohol, tobacco and/or other drug (ATOD) exposure, male sex, sexual abuse, and multiple out-of-home placements have been linked to increased externalizing (acting out) behaviors that are difficult to manage and are most closely associated with adoption disruption (Barth, 1991, 2001 Rosenthal & Groze, 1991; Smith & Howard, 1999). However, adoption researchers have found that positive outcomes (fewer externalizing behaviors) are possible for children who have been exposed to pre-adoption risk factors, suggesting that adoptive families provide protective environments that allow healing (Barth, 1991, 1993; Barth & Brooks, 2000). The current study sought to increase understanding of the influence of these pre-adoption risk factors on adoption outcome with attention to the influence of prenatal alcohol, tobacco, and/or other drug (ATOD) exposure. Results indicated that pre-adoption functioning was significantly influenced by prenatal ATOD exposure, but post-adoption adjustment was not. Structural equation modeling then was used to analyze both the direct and moderating influences of the identified risk factors on the relationship between the child's pre-adoption functioning and post-adoption adjustment. Negative influences of the risk factors on the child's externalizing behavior, individually and additively, in both direct effects and moderation analyses, were not found, with one exception. The only model to have a statistically significant effect was the moderation analysis containing the interaction of all four risk factors. Child development, child welfare, addiction professionals, and adoptive families will find this information to be of value in their quest to facilitate successful adoptions and growth of healthy children and families.

Gyllstrom ME; Hellerstedt WL; McGovern PM. Independent and interactive associations of prenatal mood and substance use with infant birth outcomes. Maternal and Child Health Journal 15(2): 198-204, 2011. (34 refs.)

The main objective of this work is to examine low prenatal mood, alcohol and tobacco use and rates of preterm (PTB) and low birth weight (LBW) births among women in Minnesota between 2002 and 2006. We examined the Minnesota version of the national, cross-sectional survey of postpartum women, the Pregnancy Risk Assessment Monitoring System (MN PRAMS). Of the 11,891 women sampled in 2002-2006, 7,457 had complete data for analysis; the weighted response rates averaged 76%. The major variables of interest were: LBW, PTB, maternal mood during pregnancy, prenatal alcohol use, prenatal tobacco use and interaction terms created from the mood and substance use variables. Women with low mood who used tobacco during pregnancy were twice as likely to have a LBW infant as women who did not smoke and reported high mood (AOR = 2.12, 95% CI: 1.35, 3.33, P = 0.001). Among women who abstained from alcohol during pregnancy, those with low mood were at an increased risk for PTB (AOR = 1.95, 95% CI: 1.54-2.45, P < 0.0001) compared to women with high mood. Low maternal mood was associated with increased risks for PTB, and LBW births among MN PRAMS respondents. Substance use and low prenatal mood co-occur and the combined effect on PTB and LBW birth outcomes warrants further investigation.

Hannigan JH; Chiodo LM; Sokol RJ; Janisse J; Ager JW; Greenwald MK et al. A 14-year retrospective maternal report of alcohol consumption in pregnancy predicts pregnancy and teen outcomes. Alcohol 44(7/8, special issue): 583-594, 2010. (77 refs.)

Detecting patterns of maternal drinking that place fetuses at risk for fetal alcohol spectrum disorders (FASDs) is critical to diagnosis, treatment, and prevention but is challenging because information on antenatal drinking collected during pregnancy is often insufficient or lacking. Although retrospective assessments have been considered less favored by many researchers due to presumed poor reliability, this perception may be inaccurate because of reduced maternal denial and/or distortion. The present study hypothesized that fetal alcohol exposure, as assessed retrospectively during child adolescence, would be related significantly to prior measures of maternal drinking and would predict alcohol-related behavioral problems in teens better than antenatal measures of maternal alcohol consumption. Drinking was assessed during pregnancy, and retrospectively about the same pregnancy, at a 14-year follow-up in 288 African-American women using well-validated semistructured interviews. Regression analysis examined the predictive validity of both drinking assessments on pregnancy outcomes and on teacher-reported teen behavior outcomes. Retrospective maternal self-reported drinking assessed 14 years postpartum was significantly higher than antenatal reports of consumption. Retrospective report identified 10.8 times more women as risk drinkers one drink per day) than the antenatal report. Antenatal and retrospective reports were moderately correlated and both were correlated with the Michigan Alcoholism Screening Test. Self-reported alcohol consumption during pregnancy based on retrospective report identified significantly more teens exposed prenatally to at-risk alcohol levels than antenatal, in-pregnancy reports. Retrospective report predicted more teen behavior problems (e.g., attention problems and externalizing behaviors) than the antenatal report. Antenatal report predicted younger gestational age at birth and retrospective report predicted smaller birth size; neither predicted teen IQ. These results suggest that if only antenatal, in-pregnancy maternal report is used, then a substantial proportion of children exposed prenatally to risk levels of alcohol might be misclassified. The validity of retrospective assessment of prior drinking during pregnancy as a more effective indicator of prenatal exposure was established by predicting more behavioral problems in teens than antenatal report. Retrospective report can provide valid information about drinking during a prior pregnancy and may facilitate diagnosis and subsequent interventions by educators, social service personnel, and health-care providers, thereby reducing the life-long impact of FASDs.

Hien D; Cohen LR; Caldeira NA; Flom P; Wasserman G. Depression and anger as risk factors underlying the relationship between maternal substance involvement and child abuse potential. Child Abuse & Neglect 34(2): 105-113, 2010. (46 refs.)

Objective: This study examines how emotion regulation deficits in the area of anger arousal and reactivity are associated with child abuse potential in mothers with substance use and depressive disorders in order to identify targeted areas for prevention and treatment. Methods: A sample of 152 urban mothers was interviewed on measures of substance use, diagnosis of depression, anger arousal and reactivity, and child abuse potential. Results: Linear hierarchical regressions revealed that anger arousal and reactivity exceeded diagnostic and demographic variables in predicting maternal child abuse potential. Additionally, anger arousal and reactivity was found to be a partial mediator of the relationship between diagnostic category and child abuse potential. Conclusions: Findings are discussed in relation to a multifaceted model of child abuse potential which broadens the existing literature to include an examination of depression and emotion regulation in order to more fully understand how substance use and child abuse potential are linked. Practice implications: Models and approaches which help clients to manage and regulate difficult feeling states, specifically anger, could be helpful, and may be most readily applied in such Populations.

Holmqvist M; Nilsen P. Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care: A national-based investigation into midwives' alcohol-related education, knowledge and practice. Midwifery 26(4): 430-434, 2010. (19 refs.)

Objective: to evaluate how much education midwives in Sweden have undertaken to help them assess alcohol intake during pregnancy, and what tools they use to identify women who may be at risk of drinking during pregnancy. Design: a national survey was conducted in March 2006, using a questionnaire constructed by a Swedish team of researchers and clinicians. Setting: maternity health-care centres in Sweden. Participant: 2106 midwives. Findings: nearly all midwives stated that they had excellent or good knowledge concerning the risks associated with drinking during pregnancy. They considered themselves less knowledgeable about detecting pregnant women with risky alcohol consumption before pregnancy. The majority of the midwives had participated in some education in handling risky drinking. Almost half of the midwives assessed women's alcohol intake before pregnancy. Important facilitators for increased activity concerned recommendations and decisions at different levels(national, local and management) on how to address alcohol with expectant parents and work with risky drinkers. Key conclusions: more education was associated with more common use of a questionnaire for assessment of women's alcohol intake before pregnancy, and more frequent counselling when identifying a pregnant woman whose pre-pregnancy consumption was risky.

Holtrop JS; Meghea C; Raffo JE; Biery L; Chartkoff SB; Roman L. Smoking among pregnant women with Medicaid insurance: Are mental health factors related? Maternal and Child Health Journal 14(6): 971-977, 2010. (33 refs.)

Smoking during pregnancy is the single most modifiable risk factor for poor birth outcomes, yet it remains prevalent among low-income women. This study examined factors associated with continued smoking and quitting among pregnant women. A total of 2,203 Medicaid-eligible pregnant women were screened at their first enhanced prenatal services visit for risk factors including demographics, health behaviors (smoking, alcohol and drug use), mental health (history of mental health disorders, current depressive symptoms), and stress. Smoking status was divided into non-smokers, quitters (quit smoking since learning of pregnancy), and continuing smokers. Descriptive statistics and logistic regression models were used to describe the sample and analyze relationships between smoking status and other characteristics. Overall, 57% were non-smokers, 17% quitters, and 26% continuing smokers. Approximately 18% had severe depressive symptoms, 53% had a high stress score, and 33% had a history of mental health problems. Younger women had lower odds of continued smoking as compared to both non-smokers (OR = 0.48, p < 0.01) and quitters (OR = 0.56, p < 0.05). Older women with less than a 12th grade education had higher odds of continued smoking (OR = 2.17, p < 0.01) and quitting (OR = 1.62, p < 0.05) as compared to non-smokers. Alcohol use (OR = 2.81, p < 0.05) and drug use before pregnancy (OR = 5.32, p < 0.01) predicted continued smoking compared to non-smoking. Women with a mental health history (OR = 1.81, p < 0.01) and high stress scores (OR = 1.39, p < 0.05) had higher odds of continued smoking compared to non-smokers. Mental health history, stress, demographics, current alcohol and past drug use are strongly related to continued smoking in this population.

Kahila H; Gissler M; Sarkola T; Autti-Ramo I; Halmesmaki E. Maternal welfare, morbidity and mortality 6-15 years after a pregnancy complicated by alcohol and substance abuse A register-based case-control follow-up study of 524 women. Drug and Alcohol Dependence 111(3): 215-221, 2010. (31 refs.)

Background: A register-based retrospective case-control study to investigate the long-term morbidity mortality and welfare among women with alcohol and/or substance misuse identified during pregnancy Methods: Cohort of 524 women followed-up ante- and perinatally 1992-2001 at special out-patient clinics of maternity hospitals in the capital area of Finland The control group of 1792 women with no evidence of alcohol or substance misuse was matched for maternal age parity date of birth and hospital of index delivery Both groups were followed-up until end of 2007 Results: 79% (42/524) of the cases and 0 2% (4/1792) of the controls had died by the end of the median follow-up of 9 years (OR 38 95% CI 14-108) The cases displayed significant morbidity requiring inpatient care in the areas of mental disorders (AOR 8 8 95% CI 6 5-11 9) viral (AOR 23 5 95% CI 8 8-62 7) and bacterial (AOR 6 1 95% CI 3 5-10 4) infections skin diseases (AOR 3 9 95% CI 2 0-7 8) and injury and poisoning (AOR 4 2 95% CI 3 1-5 6) The cases displayed more out-patient visits (OR 2 7 95% CI 2 7-2 8) Their mean length of hospital stay was longer compared to controls (10 3 vs 44 days p < 0 001) The risk of pension granted due to a disorder disease or disability (OR 8 8 95% CI 6 0-13 0) and the risk for minimum unemployment benefit were higher compared to controls (OR 2 1 95% CI 1 8-2 5) Conclusions: These women display significant long-term morbidity mortality and loss of productivity after delivery. The results emphasize the importance of adequate postnatal follow-up and treatment for misuse

Kelley ML; Braitman A; Henson JM; Schroeder V; Ladage J; Gumienny L. Relationships among depressive mood symptoms and parent and peer relations in collegiate children of alcoholics. American Journal of Orthopsychiatry 80(2): 204-212, 2010. (57 refs.)

Relationships among adult children of alcoholics (ACOAs) and parent and peer relations and depressive mood were examined among 136 ACOAs and 436 non-ACOAs. As compared to non-ACOAs, ACOAs reported less positive relationships to mothers, fathers, and peers, and more depressive mood; however, more positive relationships to parents and peers significantly reduced the strength of the association between ACOA categorization and depressive mood. Examination of data from ACOAs alone revealed that maternal alcoholism was related to less positive relationships to their mothers and to their peers; however, paternal alcoholism did not predict the quality of the relationship to fathers, mothers, or peers. Attachment to parents and peers and the gender of the alcohol-abusing parent were associated with depressive symptoms among ACOAs.

Kothari CL; Wendt A; Liggins O; Overton J; Sweezy LD. Assessing maternal risk for fetal-infant mortality: A population-based study to prioritize risk reduction in a healthy start community. Maternal and Child Health Journal 15(1): 68-76, 2011. (42 refs.)

Study goals were to distinguish between maternal risk factors for fetal versus infant mortality, and to identify which maternal characteristics contributed the greatest risk of mortality overall. This case-control retrospective study abstracted data on more than forty maternal characteristics from 261 prenatal and delivery records: all 26 fetal deaths, all 40 infant deaths and 195 randomly selected surviving births in a high-mortality Healthy Start community. Bivariate and multivariate analyses were conducted. The fetal-mortality population was significantly more likely than the infant-mortality population to have no insurance (P = .047), inadequate prenatal care (P = .039) and previous fetal death (P = .021). Comparing the combined mortality population with the surviving sample, two tiers of risk emerged: Rare-but-lethal risks, including no prenatal care (P < .001) and Child-Protective-Service involvement (P = .001), and common-and-dangerous risks, including inadequate maternal weight gain (OR = 13.55), drug or alcohol abuse (OR = 8.67), obesity (OR = 2.77) and anemia (OR = 3.61). Both fetal and infant mortality groups must be considered when identifying maternal risks. Inadequate prenatal weight gain, obesity and anemia contribute as much to feto-infant mortality as substance abuse. Public health efforts to improve maternal nutrition and healthy weight should be redoubled.

Latino-Martel P; Chan DSM; Druesne-Pecollo N; Barrandon E; Hercberg S; Norat T. Maternal alcohol consumption during pregnancy and risk of childhood leukemia: Systematic review and meta-analysis. (review). Cancer Epidemiology, Biomarkers & Prevention 19(5): 1238-1260, 2010. (59 refs.)

Background: Leukemia is the most frequently occurring cancer in children. Although its etiology is largely unknown, leukemia is believed to result from an interaction between genetic and environmental factors. Among different potential risk factors, the possible role of maternal alcohol consumption during pregnancy has been questioned. Methods: To assess the association between maternal alcohol consumption during pregnancy and childhood leukemia, a systematic review and meta-analysis of published studies was done. Results: Twenty-one case-control studies were included in categorical and dose-response meta-analyses. No cohort study was identified. Analyses were conducted by type of leukemia, children's age at diagnosis, and type of alcoholic beverage and trimester of pregnancy at alcohol use. Alcohol intake during pregnancy (yes versus no) was statistically significantly associated with childhood acute myeloid leukemia (AML) [odds ratio (OR), 1.56; 95% confidence interval (CI), 1.13-2.15] but not with acute lymphoblastic leukemia (OR, 1.10; 95% CI, 0.93-1.29). Heterogeneity between studies was observed. The OR of AML for an increase of a drink per week was 1.24 (95% CI, 0.94-1.64). The association of alcohol intake during pregnancy with AML was observed for cancers diagnosed at age 0 to 4 years (OR, 2.68; 95% CI, 1.85-3.89) in five studies without heterogeneity (I-2 <= 0.1%). Conclusions: The results of case-control studies indicate that maternal alcohol consumption during pregnancy is associated with a significantly increased risk of AML in young children. Impact: Avoidance of maternal alcohol drinking during pregnancy might contribute to a decrease in the risk of childhood AML.

Lee SH; Shin SJ; Won SD; Kim EJ; Oh DY. Alcohol use during pregnancy and related risk factors in Korea. Psychiatry Investigation 7(2): 86-92, 2010. (22 refs.)

Objective: The number of Korean women of childbearing age who drink alcohol and binge drink has increased remarkably in recent years. En the present study, we examined self-reported rates of alcohol use before and during pregnancy and identified maternal characteristics associated with drinking in pregnancy. Methods: One thousand pregnant Korean women who visited the Department of Obstetrics and Gynecology (OB/GYN) completed a self-administered questionnaire that sought information on their demographic characteristics and incorporated features of the Alcohol Use Disorder Identification Test (AUDIT)-C to investigate their use of alcohol, including binge drinking, during three time periods ("in the year before this pregnancy," "during this pregnancy," and "in the previous 30 days"). Results: Of these participants, 16.4% reported using alcohol during their pregnancy, 12.2% had used alcohol in the previous 30 days, and 1.7% reported binge drinking during their pregnancy. In the year before pregnancy, 77.1% had used alcohol, and 22.3% had binge drunk. The group using any amount of any alcohol during pregnancy showed a lower educational level, a lower rate of planned pregnancy, a lower level of knowledge relating to the risks of drinking alcohol during pregnancy, and a higher frequency of alcohol drinking in the year before pregnancy when compared with the abstinent group. Low educational level and unplanned pregnancy were revealed to be significant risk factors for alcohol consumption in pregnant women. Conclusion: This is the first study to examine any alcohol and binge alcohol drinking during pregnancy in Korea. Clinical attention and monitoring system on alcohol use during pregnancy are necessary in Korea.

Lowe JB; Baxter L; Hirokawa R; Pearce E; Peterson JJ. Description of a media campaign about alcohol use during pregnancy. Journal of Studies on Alcohol and Drugs 71(5): 739-741, 2010. (6 refs.)

Objective: This study describes the development and testing of a multicomponent media campaign aimed at increasing discussions of alcohol use during pregnancy. Method: Women, Infants, and Children (WIC) programs in Iowa were paired and, within each pair, were randomly assigned to a usual-care group (advice not to consume alcohol while pregnant and the opportunity to watch a 30-second television commercial about the effects of drinking during pregnancy) or intervention group (usual care plus a 10-minute videotape/DVD and a printed pamphlet. Among the 700 research participants in those out-reach programs, interpersonal communication about alcohol use during pregnancy was assessed both before and after intervention, and participants were surveyed for knowledge of the effects of alcohol use during pregnancy. Results: More women in the intervention group than in the usual-care group talked to friends about alcohol use during pregnancy. Also, only women in the intervention group demonstrated an increase in relative knowledge about the effects of drinking during pregnancy. Conclusions: A multimedia campaign may be an effective way to increase interpersonal discussions and awareness of the dangers of alcohol use during pregnancy.

Lowe PK; Lee EJ. Advocating alcohol abstinence to pregnant women: Some observations about British policy. Health Risk & Society 12(4): 301-311, 2010. (37 refs.)

In 2007, the English Department of Health (DH) issued advice stating 'pregnant woman' and 'those trying to conceive' should abstain from drinking alcohol. As others have noted, this advice was issued despite their being no new evidence about the deleterious effects of low levels of alcohol consumption. In this paper, we argue this development is significant for the social construction of 'risk', since in advocating abstinence without an evidence base for this advice, policy makers formalise a connection between uncertainty and danger. We suggest this development has important implications, most obviously for pregnant women, certainly impacting on the nature of the advice they will now receive and likely more generally on their experience of the transition to motherhood. We suggest it has wider implications for individuals' experience also, as policy makers appear to be advocating the same approach to risk to non-pregnant people. Further, it suggests a noteworthy formalisation of a new definition of risk, which should be debated far more extensively, as it matters for the future development of health policy.

Malone SM; McGue M; Iacono WG. Mothers' maximum drinks ever consumed in 24 hours predicts mental health problems in adolescent offspring. Journal of Child Psychology and Psychiatry 51(9): 1067-1075, 2010. (32 refs.)

Background: The maximum number of alcoholic drinks consumed in a single 24-hr period is an alcoholism-related phenotype with both face and empirical validity. It has been associated with severity of withdrawal symptoms and sensitivity to alcohol, genes implicated in alcohol metabolism, and amplitude of a measure of brain activity associated with externalizing disorders in general. In a previous study we found that the maximum number of drinks fathers had ever consumed in 24 hrs was associated with externalizing behaviors and disorders in preadolescent and adolescent children. The purpose of the present study was to determine whether maternal maximum consumption has similar correlates. Method: We examined associations between maternal maximum consumption and alcohol dependence, respectively, and disruptive disorders and substance-related problems in two large independent population-based cohorts of 17-year-old adolescents. Results: Maximum consumption was associated with conduct disorder, disruptive disorders in general, early substance use and misuse, and substance disorders in adolescent children regardless of sex. Associations were consistent across cohorts, providing internal replication. They also paralleled our previous findings regarding paternal status. They could not be explained by maternal alcohol dependence, effects of drinking during pregnancy, or paternal maximum consumption. They were not simple artifacts of the fact that maximum consumption is a continuous measure while alcohol dependence is dichotomous. Conclusions: Despite deriving from a single question about lifetime behavior, parental maximum consumption appears to reflect vulnerability for mental health problems, especially substance-related ones, more directly than a diagnosis of alcohol dependence.

Moore DG; Turner JD; Parrott AC; Goodwin JE; Fulton SE; Min MO et al. During pregnancy, recreational drug-using women stop taking ecstasy (3,4-methylenedioxy-N-methylamphetamine) and reduce alcohol consumption, but continue to smoke tobacco and cannabis: Initial findings from the Development and Infancy Study. Journal of Psychopharmacology 24(9): 1403-1410, 2010. (35 refs.)

While recreational drug use in UK women is prevalent, to date there is little prospective data on patterns of drug use in recreational drug-using women immediately before and during pregnancy. A total of 121 participants from a wide range of backgrounds were recruited to take part in the longitudinal Development and Infancy Study (DAISY) study of prenatal drug use and outcomes. Eighty-six of the women were interviewed prospectively while pregnant and/or soon after their infant was born. Participants reported on use immediately before and during pregnancy and on use over their lifetime. Levels of lifetime drug use of the women recruited were high, with women reporting having used at least four different illegal drugs over their lifetime. Most users of cocaine, 3,4-methylenedioxy-N-methylamphetamine (MDMA) and other stimulants stopped using these by the second trimester and levels of use were low. However, in pregnancy, 64% of the sample continued to use alcohol, 46% tobacco and 48% cannabis. While the level of alcohol use reduced substantially, average tobacco and cannabis levels tended to be sustained at pre-pregnancy levels even into the third trimester (50 cigarettes and/or 11 joints per week). In sum, while the use of 'party drugs' and alcohol seems to reduce, levels of tobacco and cannabis use are likely to be sustained throughout pregnancy. The data provide polydrug profiles that can form the basis for the development of more realistic animal models.

Morojele NK; London L; Olorunju SA; Matjila MJ; Davids AS; Rendall-Mkosi KM. Predictors of risk of alcohol-exposed pregnancies among women in an urban and a rural area of South Africa. Social Science & Medicine 70(4): 534-542, 2010. (43 refs.)

The study sought to determine the prevalence and predictors of being at risk of an alcohol-exposed pregnancy (AEP) among women of child-bearing age in an urban and rural location in South Africa. We conducted a cross-sectional household survey of 1018 women aged 18-44 years in one urban (n = 606) and one rural (n = 412) site. The women were interviewed using a structured questionnaire. We defined the primary dependent variable, being at risk of having an AEP, as current alcohol use, not being pregnant, being fertile, and no effective use of contraceptives. The independent variables included demographic, substance use, health perceptions, psycho-social, and partner characteristics. The rural women (21.84%) were more likely than their urban counterparts (11.22%) to be at risk of an AEP. In multiple logistic regression analyses, significant predictors of being in the "at risk" group for the urban women were (a) being 'white' as opposed to 'black/African', and being 'coloured' as opposed to 'black/African'; and (b) current smoking. For the rural women, significant risk factors were (a) current smoking and (b) early onset of alcohol use. The significant protective factors were (a) education: (b) knowledge about Fetal Alcohol Syndrome; (c) parity. Use of stricter alcohol use criteria (i.e., three or more drinks and five or more drinks per sitting) in the definition of risk of an AEP yielded slightly different patterns of significant predictors. The results revealed high levels of risk of an alcohol-exposed pregnancy, especially amongst the rural women, and a need for location-specific prevention programmes. The high burden of AEP in South Africa calls for the establishment of national AEP prevention strategies and programmes as a matter of urgency.

Namagembe I; Jackson LW; Zullo MD; Frank SH; Byamugisha JK; Sethi AK. Consumption of alcoholic beverages among pregnant urban Ugandan women. Maternal and Child Health Journal 14(4): 492-500, 2010. (30 refs.)

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.

Nettleman MD; Brewer J; Stafford M. Scheduling the first prenatal visit: office-based delays. American Journal of Obstetrics and Gynecology 203(3): article 207.e1, 2010. (15 refs.)

OBJECTIVE: The purpose of this study was to evaluate the office-based component of delayed entry into prenatal care. STUDY DESIGN: Phone numbers for all obstetrics offices in a single state were obtained from a commercial list. A research assistant who posed as a newly pregnant, fully insured woman asked each clinic when she should come in for her first prenatal visit. RESULTS: Information was provided by 239 of the 279 (86%) offices. The recommended appointment times ranged from immediately (4 weeks of gestation) to 10.6 weeks, which averaged 6.37 weeks. Twenty-five percent of clinics recommended a first appointment at >= 8 weeks. Scheduling calls were not a source of prenatal advice: <5% of clinics asked about smoking, alcohol, or medical condition; 88% of clinics did not mention vitamins. CONCLUSION: Office-based delays in scheduling the first prenatal visit occur in a substantial proportion of clinics, even for fully insured women. There is a need for a standard source of advice in early pregnancy.

Niccols A; Milligan K; Sword W; Thabane L; Henderson J; Smith A et al. Maternal mental health and integrated programs for mothers with substance abuse issues. (review). Psychology of Addictive Behaviors 24(3): 466-474, 2010. (59 refs.)

To examine the impact of integrated treatment programs (those with substance use treatment and pregnancy-, parenting-, or child-related services) on maternal mental health, we compiled a database of studies of integrated programs published between 1990 and 2007 with outcome data on maternal mental health. There were 18 cohort studies, 3 randomized trials, and 2 quasi-experimental studies. Of the five studies comparing integrated to nonintegrated programs, three studies provided enough information to allow for them to be combined in a meta-analysis. The average effect size was 0.23 (95% CI = 0.15 to 0.31, SE = 0.04), p < .001. There was no statistically significant heterogeneity among the studies, Q = 5.66, p = .059. This meta-analysis is the first systematic quantitative review of studies evaluating the impact of integrated programs on maternal mental health. Findings suggest that integrated programs may be associated with a small advantage over nonintegrated programs in improving maternal mental health. This review highlights the need for further research with improved methodology, study quality, and reporting to improve our understanding of how best to meet the mental health needs of mothers with substance abuse issues.

Nilsen P; Holmqvist M; Bendtsen P; Hultgren E; Cedergren M. Is questionnaire-based alcohol counseling more effective for pregnant women than standard maternity care? Journal of Women's Health 19(1): 161-167, 2010. (25 refs.)

Objective: To compare current standard maternity care in Sweden concerning provision of alcohol advice with a more comprehensive questionnaire-based counseling model. Methods: The study population included pregnant women in Linkoping who were registered at a maternity care center during a 2-year period and whose pregnancies resulted in liveborn infants without birth defects, representing 93% of all pregnant women. Anonymous questionnaires were mailed to the women. The first cohort (registered April 2005 1, to March 31, 2006) received standard care according to a procedure that is common practice in Sweden. The second cohort (April 1, 2006 to March 31, 2007) received alcohol advice based on a comprehensive counseling model, incorporating the use of the three-item Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire and tailored counseling based on the AUDIT-C score. Results: The response rate was 61% in the first cohort (standard care) and 70% in the second cohort (questionnaire-based counseling). The cohorts were similar in sociodemographic variables and prepregnancy drinking characteristics. The proportion of women who continued drinking alcohol during the pregnancy was 6.0% in cohort 1 and 5.8% in cohort 2. Women in cohort 2 were more favorable to the advice and, to a larger extent, perceived the main message to be abstinence from drinking during pregnancy. Conclusions: The questionnaire-based counseling model was more favorably perceived than the standard care model, but the new model was not more effective in terms of its impact on the proportion of women who abstained from drinking during pregnancy.

Oberlander TF; Jacobson SW; Weinberg J; Grunau RE; Molteno CD; Jacobson JL. Prenatal alcohol exposure alters biobehavioral reactivity to pain in newborns. (review). Alcoholism: Clinical and Experimental Research 34(4): 681-692, 2010. (109 refs.)

Objectives: To examine biobehavioral responses to an acute pain event in a Cape Town, South Africa, cohort consisting of 28 Cape Colored (mixed ancestry) newborns (n = 14) heavily exposed to alcohol during pregnancy (exposed), and born to abstainers (n = 14) or light (< 0.5 oz absolute alcohol/d) drinkers (controls). Methods: Mothers were recruited during the third trimester of pregnancy. Newborn data were collected on postpartum day 3 in the maternity obstetrical unit where the infant had been delivered. Heavy prenatal alcohol exposure was defined as maternal consumption of at least 14 drinks/wk or at least 1 incident of binge drinking/mo. Acute stress-related biobehavioral markers [salivary cortisol, heart rate (HR), respiratory sinus arrhythmia (RSA), spectral measures of heart rate variability (HRV), and videotaped facial actions] were collected thrice during a heel lance blood collection (baseline, lance, and recovery). After a feeding and nap, newborns were administered an abbreviated Brazelton Neonatal Behavioral Assessment Scale. Results: There were no between-group differences in maternal age, marital status, parity, gravidity, depression, anxiety, pregnancy smoking, maternal education, or infant gestational age at birth (all ps > 0.15). In both groups, HR increased with the heel lance and decreased during the postlance period. The alcohol-exposed group had lower mean HR than controls throughout, and showed no change in RSA over time. Cortisol levels showed no change over time in controls but decreased over time in exposed infants. Although facial action analyses revealed no group differences in response to the heel lance, behavioral responses assessed on the Brazelton Neonatal Scale showed less arousal in the exposed group. Conclusions: Both cardiac autonomic and hypothalamic-pituitary-adrenal stress reactivity measures suggest a blunted response to an acute noxious event in alcohol-exposed newborns. This is supported by results on the Brazelton Neonatal Scale indicating reduced behavioral arousal in the exposed group. To our knowledge, these data provide the first biobehavioral examination of early pain reactivity in alcohol-exposed newborns and have important implications for understanding neuro-/biobehavioral effects of prenatal alcohol exposure in the newborn period.

O'Leary CM; Bower C; Zubrick SR; Geelhoed E; Kurinczuk JJ; Nassar N. A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: Improving our ability to examine fetal effects from low to moderate alcohol. Journal of Epidemiology and Community Health 64(e-11), 2010. (36 refs.)

Background: When examining the association between prenatal alcohol exposure and fetal effects, the timing and intensity of exposure have been ignored in epidemiological studies. The effect of using dose, pattern and timing of consumption ("composite" method) was investigated in this study, to examine the association between prenatal alcohol exposure and fetal effects. Methods The composite method resulted in six categories of exposure (abstinent, low, moderate, binge Copyright 2010, BMJ Publishing Group

Parackal SM; Parackal MK; Harraway JA. Warning labels on alcohol containers as a source of information on alcohol consumption in pregnancy among New Zealand women. International Journal of Drug Policy 21(4): 302-305, 2010. (20 refs.)

Background: The addition of a warning label on alcohol containers is a policy measure yet to be adopted in New Zealand. The current study aims to report the rating of a national sample of 16-40-year-old nonpregnant New Zealand women on a warning label on alcohol containers as a source of information on risks associated with alcohol consumption in pregnancy. Methods: A nationwide, cross-sectional survey was conducted in 2005 on a random sample of 1129 nonpregnant women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a Web-assisted telephone interviewing system. Results: Overall, the survey achieved a response rate of 65%. Just over half of the women surveyed (53%; 95% Cl 50.2-56.0) gave a high rating for a warning label as a source of information on alcohol consumption in pregnancy. Women below 30 years of age and who were of non-European ethnicity were more likely to give a high rating compared with older women and European women, respectively (p<0.05). Conclusions: Introduction of a warning label on alcohol containers in New Zealand may be effective in increasing awareness of the risks associated with alcohol consumption in pregnancy among at-risk drinkers, namely, younger women and New Zealand women of Maori and Pacific ethnicities. However, to accentuate behavioural change, other prevention approaches within a health promotion framework may be needed to complement this approach.

Peadon E; Payne J; Henley N; D'Antoine H; Bartu A; O'Leary C et al. Women's knowledge and attitudes regarding alcohol consumption in pregnancy: A national survey. BMC Public Health 10: 510, 2010. (22 refs.)

Background: Alcohol exposure in pregnancy is a common and modifiable risk factor for poor pregnancy and child outcomes. Alcohol exposure in pregnancy can cause a range of physical and neurodevelopmental problems in the child including the Fetal Alcohol Spectrum Disorders (FASD). In order to improve prevention strategies, we sought to describe the knowledge and attitudes of women of childbearing age regarding alcohol consumption during pregnancy and its effects on the fetus. Methods: We conducted a national cross-sectional survey via computer assisted telephone interview of 1103 Australian women aged 18 to 45 years. Participants were randomly selected from the Electronic White Pages. Pregnant women were not eligible to participate. Quotas were set for age groups and a minimum of 100 participants per state to ensure a national sample reflecting the population. The questionnaire was based on a Health Canada survey with additional questions constructed by the investigators. Descriptive statistics were calculated and logistic regression analyses were used to assess associations with participants' knowledge and attitudes. Results: Of women surveyed, 61.5% had heard about effects of alcohol on the fetus and 55.3% had heard of Fetal Alcohol Syndrome. Although 92.7% agreed alcohol can affect the unborn child, 16.2% did not agree that the disabilities could be lifelong. Most women agreed that pregnant women should not drink alcohol (80.2%) and 79.2% reported having negative feelings towards pregnant women drinking alcohol. Women with higher education levels were more likely to know the effects of alcohol consumption in pregnancy (adjusted OR 5.62; 95% CI 3.20 to 9.87) but education level and knowledge were not associated with attitude. Conclusions: There was a disjunction between knowledge and attitudes towards alcohol consumption in pregnancy. These findings will assist in developing effective health promotion campaigns to reduce fetal alcohol exposure and subsequent fetal damage.

Powers JR; Loxton DJ; Burns LA; Shakeshaft A; Elliott EJ; Dunlop AJ. Assessing pregnant women's compliance with different alcohol guidelines: An 11-year prospective study. Medical Journal of Australia 192(12): 690-693, 2010. (26 refs.)

Objective: To assess women's compliance with different Australian guidelines on alcohol intake during pregnancy and examine factors that might influence compliance Design, setting and participants: We analysed prospective, population-based data on women aged 22-33 years who were pregnant before October 2001, when guidelines recommended zero alcohol (n = 419), or were first pregnant after October 2001, when guidelines recommended low alcohol intake (n = 829) Data were obtained from surveys conducted in 1996, 2000, 2003 and 2006 as part of the Australian Longitudinal Study on Women's Health. Main outcome measures: Relative risks (RRs) for zero alcohol intake, low alcohol intake and compliance with alcohol guidelines, estimated by a modified Poisson regression model with robust error variance. Results: About 80% of women consumed alcohol during pregnancy under zero and low alcohol guidelines Compliance with zero alcohol guidelines or low alcohol guidelines (up to two drinks per day and less than seven drinks per week) was the same for women who were pregnant before October 2001 and women who were first pregnant after October 2001 (20% v 17% for compliance with zero alcohol guidelines, P>0 01, 75% v 80% for compliance with low alcohol guidelines, P>0 01) Over 90% of women drank alcohol before pregnancy and prior alcohol intake had a strong effect on alcohol intake during pregnancy, even at low( levels (RR for zero alcohol, 0 21 [95% CI, 0 16-0 28], RR for low alcohol, 091 [95% Cl, 086096]) 96]) RR for compliance with guidelines was 3 54 (95% CI, 2 85-4 40) for women who were pregnant while low alcohol intake was recommended, compared with those who were pregnant while zero alcohol guidelines were in place. Conclusion: The October 2001 change in alcohol guidelines does not appear to have changed behaviour risks associated with different levels of alcohol intake during pregnancy need to be clearly established and communicated

Roberts SCM; Nuru-Jeter A. Women's perspectives on screening for alcohol and drug use in prenatal care. Women's Health Issues 20(3): 193-200, 2010. (39 refs.)

Background. Screening for alcohol and drug use in prenatal care is widely promoted in the United States as a public health strategy for reducing alcohol and drug use during pregnancy. However, the published literature does not consider women's perspectives or the potential negative ramifications of screening. Methods. Twenty semistructured interviews and two focus groups (n = 38) were conducted with a racially/ethnically diverse sample of low-income pregnant and parenting women using alcohol and/or drugs in a northern California county. Results. Most women were averse to having drug but not alcohol use identified and were mistrustful of providers' often inconspicuous efforts to discover drug use. Women expected psychological, social, and legal consequences from being identified, including feelings of maternal failure, judgment by providers, and reports to Child Protective Services. Women did not trust providers to protect them from these consequences. Rather, they took steps to protect themselves. They avoided and emotionally disengaged from prenatal care, attempted to stop using substances that could be detected by urine tests before prenatal care visits, and shared strategies within social networks for gaining the benefits of prenatal care while avoiding its negative consequences. Conclusion. Considerations of the public health impact of screening for drug use in prenatal care should account for the implications of women's physical avoidance of and emotional disengagement from prenatal care, specifically the direct effects of late, limited, and no prenatal care on pregnancy outcomes and missed opportunities for health promoting interventions.

Rossi BV; Berry KF; Hornstein MD; Cramer DW; Ehrlich S; Missmer SA. Effect of alcohol consumption on in vitro fertilization. Obstetrics and Gynecology 117(1): 136-142, 2011. (21 refs.)

OBJECTIVE: To estimate whether alcohol use at the initiation of an in vitro fertilization (IVF) cycle is associated with IVF outcomes. METHODS: In this prospective cohort study, men and women completed a self-administered questionnaire before their first IVF cycle. Participants reported alcohol type, amount, and frequency consumed. Discrete survival analysis was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) for live birth-the primary outcome. Secondary outcomes were cycle characteristics and points of failure in the IVF process (cycle cancellation, failed fertilization, implantation failure, and spontaneous abortion). We conducted multicycle analyses with final models adjusted for potential confounders that included cycle number, cigarette use, body mass index, and age. RESULTS: A total of 2,545 couples contributed 4,729 cycles. Forty-one percent of women and 58% of men drank one to six drinks per week. Women drinking at least four drinks per week had 16% less odds of a live birth rate compared with those who drank fewer than four drinks per week (OR 0.84, CI 0.71-0.99). For couples in which both partners drank at least four drinks per week, the odds of live birth were 21% lower compared with couples in which both drank fewer than four drinks per week (OR 0.79; CI 0.66-0.96). CONCLUSION: Consumption of as few as four alcoholic drinks per week is associated with a decrease in IVF live birth rate.

Sayers S; Boyle J. Indigenous perinatal and neonatal outcomes: A time for preventive strategies. (review). Journal of Paediatrics and Child Health 46(9): 475-478, 2010. (28 refs.)

Pregnancy outcomes for Indigenous mothers and babies have improved, but marked disparities remain between Indigenous and non-Indigenous women. Many contributors to these disparities such as smoking, alcohol use, poor nutrition, infection, teenage pregnancy and stress are preventable or modifiable particularly if addressed prior to pregnancy. It is suggested that we expand our reproductive health research, education and care to a life course approach beginning in early adolescence.

Shor S; Nulman I; Kulaga V; Koren G. Heavy in utero ethanol exposure is associated with the use of other drugs of abuse in a high-risk population. Alcohol 44(7/8, special issue): 623-627, 2010. (38 refs.)

Many ethanol dependent women also use other drugs of abuse that may affect pregnancy outcome and long-term child neurodevelopment. This study investigated the association between drugs of abuse and concurrent use of ethanol in pregnancy. A study cohort of neonates with FAEE levels above 2 nmol per gram meconium, indicative of heavy in utero ethanol exposure, was identified (n = 114). Meconium and hair analyses for the presence of other drugs of abuse were obtained for some of these neonates and the rates of drug exposure were compared with the rates in a cohort of neonates who were tested negative (FAEE below 2 nmol per gram meconium) for ethanol exposure (n = 622). Odds ratios (ORs) for various drugs were calculated with ethanol exposure. A 15.5% positive rate for intrauterine ethanol exposure was detected. A high rate of in utero drug exposure was detected in neonates with and without in utero ethanol exposure, 60.5% versus 62.7% respectively. Neonates with heavy in utero ethanol exposure were almost twice as likely to be exposed to narcotic opiates (OR = 1.90; 95% confidence interval [CI]: 1.13-3.20) and 3.3 times as likely to be exposed to amphetamine (OR = 3.30; 95% CI 1.06-10.27) when compared to neonates with no ethanol exposure. Exposure to cannabinoids predicted less likely exposure to ethanol (OR = 0.61; 95% CI: 0.38-0.98) and no significant difference was noted in the exposure to cocaine (OR = 1.24, 95% Cl: 0.81-1.91). Neonates suspected of heavy in utero ethanol exposure should be tested for other drugs of abuse and vice versa. Early detection of drug exposures can facilitate early intervention to both the neonate and the mother, thus decreasing the risk of long-term neurodevelopmental outcomes for the child, including secondary disabilities associated with fetal alcohol spectrum disorder.

Shrestha A; Nohr EA; Bech BH; Ramlau-Hansen CH; Olsen J. Smoking and alcohol use during pregnancy and age of menarche in daughters. Human Reproduction 26(1): 259-265, 2011. (44 refs.)

BACKGROUND: We assessed whether exposure to prenatal smoking or alcohol accelerates age of menarche (AOM) in offspring. METHODS: We studied a Danish cohort of 3169 singleton females born in April 1984-April 1987. Linear regressions were conducted to examine associations between prenatal smoking or alcohol exposure and offspring's AOM on: (i) the daughters who provided data on both month and the year of menarche (n = 1634) and (ii) the entire sample that provided at least the year of menarche (n = 3169). We also examined associations between only pre-pregnancy smoking or childhood exposure to smoking and AOM. The full model was adjusted for maternal pre-pregnancy body mass index, maternal age at childbirth, parental socio-economic status, parity, consumption of milk products during pregnancy and marital status. RESULTS: Among those who provided both year and month, AOM was accelerated by 2.8 months (95% CI in months: -5.3, -0.4) among those exposed to 10+ cigarettes/day throughout pregnancy and by 4.1 months (95% CI in months: -7.7, -0.5) among those with mothers who quit smoking sometime during pregnancy, compared with the unexposed group after adjustment for covariates. Similar, but much weaker, associations were observed among girls whose mothers smoked 1-9 cigarettes/day throughout pregnancy or whose fathers smoked compared with their unexposed counterparts after adjustment for covariates [-0.8 months (95% CI: -2.6, 1.0)]. No associations were observed between AOM and only pre-pregnancy smoking or only childhood exposure or prenatal alcohol exposure. CONCLUSIONS: Our study indicates that heavy smoking throughout the pregnancy may be important in prenatal programming of AOM.

Terplan M; Smith EJ; Kozloski MJ; Pollack HA. "Compassionate coercion": Factors associated with court-mandated drug and alcohol treatment in pregnancy 1994-2005. Journal of Addiction Medicine 4(3): 147-152, 2010. (17 refs.)

Objectives: To describe trends in court-mandated treatment in pregnancy. In particular, to determine whether pregnant women who enter treatment via the criminal justice system differ from women who enter voluntarily. Methods: Data were obtained from the Treatment Episode Data Set, an administrative data set that captures admissions to federally funded treatment centers in the United States. Demographic and treatment-related measures were examined among pregnant women comparing referral source and stratified by year of admission to assess trends over time. Results: Throughout the study period, the proportion of pregnant women entering substance abuse treatment via the criminal justice system increased more rapidly than the increase observed among men or nonpregnant women reaching 30.9% by 2005. Compared with voluntary admissions, admissions originating in the criminal justice system were more likely to be white, young, and employed. The primary substances compelling court-mandated treatment for pregnant women were alcohol and cocaine in 1994, and by 2005 it had shifted to amphetamine and marijuana. Conclusion: The increase in criminal justice referrals parallels the growth of drug courts. The demographic characteristics of the pregnant referrals, however, suggest the presence of gaps in both screening and treatment in pregnancy.

Tinker SC; Reefhuis J; Dellinger AM; Jamieson DJ. Epidemiology of maternal injuries during pregnancy in a population-based study, 1997-2005. Journal of Women's Health 19(12): 2211-2218, 2010. (34 refs.)

Background: Maternal injuries during pregnancy are common and can cause adverse pregnancy outcomes. We sought to describe factors related to injury during pregnancy. Methods: We analyzed data from the National Birth Defects Prevention Study (NBDPS), a population-based, case-control study of birth defects in 10 U. S. states. We estimated the proportion of control mothers, a random sample of mothers delivering infants without major birth defects in the study regions, who reported an injury during pregnancy. We assessed associations with maternal and paternal characteristics using logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: Between October 1997 and December 2005, 490 (7.4%) of 6609 mothers reported 527 injuries during pregnancy. Falls caused over half of reported injuries during pregnancy (51.6%), and 9.5% of reported injuries were intentionally inflicted. Mothers who reported an injury during pregnancy were more likely to be aged <18 years vs. 18-29 years (aOR 2.84, 95% CI 1.54-5.23) and less likely to be aged >= 30 years (aOR 0.67, 95% CI 0.51-0.89). They were more likely to use alcohol during pregnancy (aOR for nonbinge drinking 1.38, 95% CI 1.05-1.81), to smoke during pregnancy (aOR 1.37, 95% CI 1.02-1.85), to have epilepsy (aOR 3.31, 95% CI 1.48-7.38), and to be employed (aOR 1.44, 95% CI 1.08-1.93) than mothers who did not report an injury. Conclusions: We identified several factors associated with maternal injury during pregnancy, an important step in identifying women who may be at higher risk and in designing interventions to prevent injuries during pregnancy.

Toutain S. What women in France say about alcohol abstinence during pregnancy. Drug and Alcohol Review 29(2): 184-188, 2010. (15 refs.)

Introduction and Aims. In spite of the implemented policies warning of the dangers of alcohol consumption for pregnant women, many women still continue drinking during pregnancy. This article focuses on the question of the representations of alcohol consumption during pregnancy in France. Design and Methods. A qualitative approach based on discussions with 42 pregnant women in three Internet chat groups in 2007 was used for our study. Results. The recommendation for total abstinence is often misunderstood by women, as are the consequences of drinking for the unborn babies. Besides, these Internet users do not seem to know much about the consequences of alcohol consumption for unborn babies. Finally, their sources of information are varied (written, oral, television, Internet, professionals of health, family networks and friends); however, their mothers remain the most credible source for them. Discussion and Conclusion. Alcohol consumption during pregnancy already constitutes a real taboo for the heath care professionals in France. It is extremely urgent and imperative that they recommend total abstinence during pregnancy, in order to avoid any irreversible consequences for the unborn babies.

van Gelder MMHJ; Reefhuis J; Caton AR; Werler MM; Druschel CM; Roeleveld N. Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study. Drug and Alcohol Dependence 109(1-3): 243-247, 2010. (23 refs.)

Background: According to the 2004 National Survey on Drug Use and Health, 4.6% of American women reported use of an illicit drug during pregnancy. Previous studies on illicit drug use during pregnancy and perinatal outcomes allowed inconsistent results. Methods: This population-based study included mothers who delivered live-born infants without birth defects between 1997 and 2004 and completed interviews for the National Birth Defects Prevention Study (response rate 69%; n=5871). Prevalence of self-reported illicit drug use (specifically cannabis, cocaine, and stimulants) during pregnancy and its associations with demographic and social factors were assessed. We used multivariable linear and logistic regression analyses to study the associations of cannabis use with birth weight and gestational age. Results: The prevalence of reported illicit drug use during pregnancy was 3.6% (standard error 0.24). Pregnant users of cannabis, cocaine, and stimulants were younger, had a lower level of education and lower household income, and were less likely to have used folic acid in the periconceptional period than nonusers. Illicit drug users were also more likely to have used alcohol and tobacco. After adjustment for confounding, cannabis use was not associated with mean birth weight or gestational age or with low birth weight or preterm delivery. Conclusion: Women who report use of illicit drugs during pregnancy differ in demographic and socioeconomic background from nonusers. Reported cannabis use does not seem to be associated with low birth weight or preterm birth.

Webb RT; Wicks S; Dalman C; Pickles AR; Appleby L; Mortensen PB et al. Influence of environmental factors in higher risk of sudden infant death syndrome linked with parental mental illness. Archives of General Psychiatry 67(1): 69-77, 2010. (42 refs.)

Context: Since national risk reduction campaigns have been conducted, sudden infant death syndrome (SIDS) has become increasingly concentrated among disadvantaged families, including those affected by mental illness. However, causal mechanisms specific to this group are poorly understood. Objectives: To estimate relative risk and compare risk factor prevalence in infants with and without parental psychiatric inpatient history, and to explore effect modification after the 1992 Swedish risk reduction campaign. Design: National birth cohort. Parental psychiatric admissions, maternal prenatal smoking, obstetric and social risk factors, and cause-specific infant death were ascertained via linkage between national registers. Setting: The Swedish population, 1978 through 2004. Participants: All singleton live births (N = 2.5 million). Main Outcome Measure: Incidence of SIDS. Results: Risk of SIDS was higher with a history of parental inpatient care, especially if both parents were admitted with any mental illness (odds ratio, 6.8; 95% confidence interval, 4.7-10.0), or if the mother (6.5; 4.9-8.7) or both parents (9.5; 5.5-16.4) had an alcohol/drug disorder. A 2-fold higher risk was also seen if the mother or father was admitted with any psychiatric illness other than alcohol or other drug disorders. Elevated risk persisted even if the last maternal inpatient episode had occurred 5 or more years before the infant's birth. After the national campaign, risk factor prevalence (especially maternal antenatal smoking) remained high in this population, and relative risks therefore increased. During 1992 through 2004, smoking and individual social adversity measures jointly accounted for approximately half the excess risk linked with maternal psychiatric inpatient history, whereas the confounding effects of obstetric factors were minimal. Conclusions: Tailored approaches are needed to ensure that standard safety advice is effectively communicated to these vulnerable families. In particular, mentally ill pregnant women should be encouraged and better supported to stop smoking. Families with 2 affected parents require particularly strong support. A clearer understanding is needed as to why high risk factor prevalence persists among these parents.

Yonkers KA; Gotman N; Kershaw T; Forray A; Howell HB; Rounsaville BJ. Screening for prenatal substance use development of the Substance Use Risk Profile-Pregnancy Scale. Obstetrics and Gynecology 116(4): 827-833, 2010. (25 refs.)

OBJECTIVE: To report on the development of a questionnaire to screen for hazardous substance use in pregnant women and to compare the performance of the questionnaire with other drug and alcohol measures. METHODS: Pregnant women were administered a modified TWEAK (Tolerance, Worried, Eye-openers, Amnesia, K[C] Cut Down) questionnaire, the 4Ps Plus questionnaire, items from the Addiction Severity Index, and two questions about domestic violence (N=2,684). The sample was divided into "training" (n=1,610) and "validation" (n=1,074) subsamples. We applied recursive partitioning class analysis to the responses from individuals in the training subsample that resulted in a three-item Substance Use Risk Profile-Pregnancy scale. We examined sensitivity, specificity, and the fit of logistic regression models in the validation subsample to compare the performance of the Substance Use Risk Profile-Pregnancy scale with the modified TWEAK and various scoring algorithms of the 4Ps. RESULTS: The Substance Use Risk Profile-Pregnancy scale is comprised of three informative questions that can be scored for high-or low-risk populations. The Substance Use Risk Profile-Pregnancy scale algorithm for low-risk populations was mostly highly predictive of substance use in the validation subsample (Akaike's Information Criterion=579.75, Nagelkerke R-2=0.27) with high sensitivity (91%) and adequate specificity (67%). The high-risk algorithm had lower sensitivity (57%) but higher specificity (88%). CONCLUSION: The Substance Use Risk Profile-Pregnancy scale is simple and flexible with good sensitivity and specificity. The Substance Use Risk Profile-Pregnancy scale can potentially detect a range of substances that may be abused. Clinicians need to further assess women with a positive screen to identify those who require treatment for alcohol or illicit substance use in pregnancy.