Background: The purpose of this study was to demonstrate feasibility of screening and to identify rates and correlates of alcohol use in a large, demographically representative sample of pregnant women across a number of obstetrics clinics, extending previous studies of single or high-risk settings. Identification of harmful alcohol use during pregnancy and of associated factors is critical for the design and implementation of secondary prevention strategies.
Methods: A total of 1131 pregnant women age 18 and older were screened in the waiting areas of eight obstetrics clinics in Southeastern Michigan using a brief (10 min) screening questionnaire. This survey consisted of direct and indirect (TWEAK) measures of alcohol use, as well items assessing demographic characteristics, use of tobacco, and whether participants' physicians discussed alcohol use behavior with them. Women ranged in age from 18 to 46, with a mean age of 28.7 (SD = 5.3). The racial/ethnic distribution of our sample suitably reflects the various racial segments of the Michigan population.
Results: We found that 15.1% of the total sample (n = 169) reported any alcohol use during pregnancy, with the majority of those women reporting relatively low levels of alcohol use. One hundred and forty-seven women (13%) scored above the cutoff on the TWEAK (i.e., above a score of 2). Based on multivariate analyses, higher risk alcohol use (defined as binge drinking or greater than one standard drink per week) during pregnancy was predicted by smoking and earlier stage of pregnancy. Caucasian race, smoking, psychological distress, and greater number of drinks during pregnancy predicted scores above a cutoff of 2 on the TWEAK.
Conclusion: This study demonstrated that screening in busy obstetrics clinics is feasible and acceptable to women and that it may be optimal to use both indirect and direct measures of alcohol use. In addition, brief assessments should be conducted throughout pregnancy and may be targeted or intensified for smokers and for women earlier in their pregnancy.