Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
2.6 Women’s drinking behaviour, knowledge and attitudes regarding alcohol use in pregnancy
Australian surveys have found that between 50 percent and 59 percent of women consumed alcohol at some time during pregnancy, with only 41 percent of women having abstained in all three trimesters (O'Callaghan et al. 2003; Colvin et al. 2007)*†. Studies indicate that the majority of those who continue to drink alcohol during pregnancy typically do so at low or reduced levels. In the 2004 National Drug Strategy Household Survey (NDSHS), 38 percent of women reported that they abstained during pregnancy, 59 percent reported drinking less, while only three percent of women reported drinking ‘the same or more’ than when they were not pregnant (AIHW 2005). The proportion of pregnant women abstaining from alcohol during pregnancy increased in 2010 (from 40.0 percent in 2007 to 52.0 percent in 2010) (AIHW 2011).
With regard to the quantity of alcohol consumed, the study by O’Callaghan et al. found the average alcohol consumption was within the 2001 NHMRC guideline at two glasses per week in early pregnancy and approximately one glass per week in late pregnancy (O'Callaghan et al. 2003). Binge drinking in early pregnancy was reported by 20 percent of the women on at least one occasion.
Colvin and colleagues also noted an overall decrease in alcohol consumption over the course of the pregnancy. In their study of more than 4,000 women in Western Australia, 54 percent drank an average of less than one standard drink per day, four percent drank between one and less than five standard drinks per day and 0.1 percent averaged five or more standard drinks per day (Colvin et al. 2007). In this study, 15 percent of women drank outside the Australian guideline’s recommendation for alcohol consumption in pregnancy during the first trimester, a figure which decreased to 10 percent in the second and third trimesters. About 11 percent consumed more than two standard drinks and/or more than six drinks per week while around two percent binge drank during the second or third trimesters of pregnancy (Colvin et al. 2007). Timing of alcohol consumption in pregnancy has been identified as an important factor, both in relation to its potential impact on the fetus and for the design of targeted interventions for FASD prevention (Floyd et al. 1999; Maier and West 2001; Floyd et al. 2007; O'Leary et al. 2009).
Studies focusing on Indigenous Australians have typically reported lower rates of alcohol use in pregnancy than in non-Indigenous women. In the Western Australian Aboriginal Child Health Survey, 23 percent of women reported consuming alcohol during pregnancy (Zubrick et al. 2004). Measures of the frequency and quantity of alcohol intake were unavailable; however, the study authors point to research suggesting that Aboriginal women who do drink are more likely to do so at hazardous levels (Roche and Deehan 2002). The Bibbulung Gnarneep Study of Aboriginal women in Perth who had a baby in the mid 1990s, reported that 44 percent had consumed alcohol during their pregnancy and 23 percent had become intoxicated at least once during their pregnancy (Eades 2003). Recent data from the Fitzroy Valley in WA support these findings. In a cohort of 129 women, 51 percent drank alcohol during pregnancy, of whom 93 percent drank at high risk levels (Australian Human Rights Commission 2011; Elliott et al. 2012). Data from the Ord Valley in the East Kimberly reported 84.7 percent of 78 women during antenatal assessments reported alcohol use during pregnancy, often inadvertently before women were aware of being pregnant. Over half of these women reported to abstain from alcohol following initial FASD education, 14 percent cut down and 1 percent continued to drink alcohol. Ten percent were unable to be contacted for follow-up (Bridge 2011).
Studies of women’s practice, knowledge and attitudesAn Australian study by Peadon et al. investigated the knowledge, attitudes and practice in relation to alcohol use in pregnancy of more than 1000 Australian women aged 18-45 years (Peadon et al. 2010; Peadon et al. 2011). These women were not pregnant at the time of the telephone interview. With regard to drinking practice, the majority of these women (89 percent) had consumed alcohol in the last 12 months; 15 percent usually consumed alcohol at risky or harmful levels (five or more standard drinks per sitting) and 54 percent had consumed at risky or harmful levels at least once in the last twelve months. During their last pregnancy, 34 percent consumed alcohol (quantity not recorded) and 16 percent smoked tobacco. About one-third (32 percent) of women said they would continue to drink alcohol if they were planning a pregnancy and five percent would continue to smoke cigarettes. Thirty one percent reported they would be less likely to consume alcohol in a future pregnancy if their partner stopped drinking and 38 percent would be less likely to drink if their partner encouraged them to stop or cut back. Intention to consume alcohol if planning a pregnancy was strongly associated with: alcohol use in the last pregnancy; agreeing that pregnant women should be able to drink alcohol; intention to smoke in a future pregnancy and; feeling neutral or positive towards alcohol use during pregnancy.
With regard to knowledge about the effects of alcohol use in pregnancy, 62 percent had heard about adverse effects that alcohol could have on the fetus, including one third who nominated FASD as a possible outcome. Other identified problems included neurobehavioural issues, impaired growth and birth defects. Women with higher education levels or general knowledge about alcohol were more likely to have heard of the risk to the fetus from alcohol use in pregnancy.
Although 34 percent of women had consumed alcohol on one or more occasions during pregnancy, 81 percent believed that pregnant women should not drink alcohol. Most (93 percent) reported that alcohol could affect the unborn child but 84 percent did not know that alcohol exposure in utero could lead to lifelong disabilities. With regard to attitudes, 79 percent of women reported negative attitudes (such as concern, disappointment, disgust, annoyance or anger) when they were given a scenario of seeing a pregnant woman drinking alcohol. Negative feelings were associated with women knowing that alcohol use in pregnancy can affect the unborn child; awareness that alcohol can cause birth defects or neurobehavioral problems; and the belief that the disabilities are lifelong. In this survey a tolerant attitude to alcohol use (i.e. women did not report concern in response to the scenario above) during pregnancy strongly predicted intention to drink alcohol in a future pregnancy, even in women with knowledge of the adverse effects of alcohol on the fetus.
Another recent study conducted by D’Antoine and colleagues investigated the knowledge, attitudes and practice of Aboriginal women living in the Kimberley and Goldfield regions in Western Australia through focus groups (D’Antoine et al. 2008). The specific study aims were to describe the knowledge and attitudes of Indigenous women in relation to alcohol use in pregnancy and the unborn child; to gain insight into the current practice of alcohol consumption during pregnancy for Aboriginal women; to ascertain support for initiatives to provide women of childbearing age with information about the risks of alcohol consumption in pregnancy; and to identify the preferred mode/s of delivery of educational messages.
Thematic analysis of the data transcriptions from the focus groups show that many Aboriginal women are aware of a wide range of effects of alcohol consumption in pregnancy on the unborn child. Women provided a range of strategies that they felt would support Aboriginal women to abstain from alcohol use in pregnancy and the study findings have potential to inform future interventions to favourably influence women’s decisions regarding alcohol use in pregnancy. The women highlighted the importance of strategies being inclusive of the Aboriginal community but not targeting them. These findings have been disseminated widely to all key stakeholders and will further contribute to the process of developing prevention programs of particular relevance to alcohol use in pregnancy by Aboriginal women (D’Antoine et al. 2008).
The findings of Peadon et al. have implications for public health interventions and because they identify groups of women who are at higher risk of using alcohol in pregnancy and who might be targeted through education (Peadon et al. 2007). The findings also illustrate that knowledge about the adverse effects of alcohol in pregnancy will not change behaviour and that societal attitudes about alcohol use in the community and in pregnancy in particular, need to be addressed if we are to reduce alcohol consumption. Partners should also be included in such interventions, because maternal drinking is strongly correlated with partner alcohol use (Passaro et al. 1998).
* Included only non-Indigenous women.
† Proportions of Indigenous and non-Indigenous participants not specified.
Chapter 2: Prevalence and correlates of alcohol use in pregnancy.