Search

Abstinence from alcohol has been recommended for both pregnant and pre-conceptional women. The purpose of this study is to compare self and partner reports of abstinence from alcohol in a sample of 253 pregnant women who were T-ACE (Tolerance, Annoy, Cut-down, Eye-opener) alcohol screen positive. Dyads’ reports of the women’s abstinence from alcohol before, during, and after pregnancy were compared. Based on their own self-report, less than 20% of the pregnant women were abstinent in their first trimester and about half were abstinent for the rest of their pregnancy. Partners significantly over-estimated the women’s abstinence from alcohol at all points except in the post-partum period when the dyad had the highest rate of agreement (85.4%). Reasons for the discrepancies in the self and partner reports of prenatal abstinence, and how partners might influence such behavior remain speculative, but identify areas for future research and prevention.

Background: Identification of risk drinking in expectant fathers may be helpful as an important part of efforts to minimize maternal alcohol use, and as an opportunity to inform them about a problematic practice during a critical developmental stage for the couple. The purpose of this study was to evaluate the T-ACE screening questionnaire, which asks about tolerance to alcohol, being annoyed by other's comments about drinking, attempts to cut down, and having a drink first thing in the morning ("eye-opener"), in the male partners of pregnant women who themselves were T-ACE positive. Methods: Two hundred fifty-four male partners were asked to complete the T-ACE embedded in a health survey, the Alcohol Use Disorders Identification Test (AUDIT), and other questions about their alcohol use in the past 30 days when their pregnant partners had a median gestation of 11.5 weeks (T 1 ). After delivery, male partners again completed the T-ACE and quantity_frequency questions (T 2 ). The predictive ability of the T-ACE and AUDIT was compared, using risk drinking (> 4 drinks/day or > 14 drinks/week) as the criterion standard. Results: A substantial minority of male partners had risk drinking, 31 percent at T 1 and 25 percent at T 2 . Although the AUDIT was better than the T-ACE as an independent predictor of risk drinking, the latter was most accurate when the tolerance threshold exceeded 2 drinks, the same established for pregnant women. The sensitivity (T 1 = 84.6%, T 2 = 82.8%) and specificity (T 1 = 43.8%, T 2 = 51.1%) of the T-ACE at this threshold compared favorably with those of the A UDIT at the standard cut point of 8. Conclusions: The T-ACE may be a practical way for clinicians to identify risk drinking in both pregnant women and expectant fathers.

Objective The impact of a couple's knowledge about healthy pregnancy habits involving alcohol and substance use was assessed in the context of other factors previously identified to predict prenatal alcohol consumption in a sample of 254 pregnant women and their male partners. Method Couples were asked to assess independently a series of statements (true or false) describing the consequences of prenatal substance exposure, while also providing information about their own drinking. Results Although the couples demonstrated good knowledge of healthy habits during pregnancy, they did not agree when the element of chance was considered. Median household income was more highly predictive of a pregnant woman's knowledge score than her partner's score. In turn, the subject's knowledge of healthy pregnancy habits as manifested in the assessment score had only a weak relationship with prenatal alcohol consumption. Previous alcohol use by the pregnant woman was the strongest predictor of prenatal alcohol use. Conclusions Because previous alcohol consumption use by the pregnant woman was the strongest predictor of prenatal alcohol use, the importance of its accurate identification is emphasized. Although pending further investigation, knowledge about healthy pregnancy behaviors may exert greater impact if it is shared by a pregnant woman and her partner.

This study evaluated stage of change as a predictor of alcohol use in a sample of 301 pregnant women who were either in the precontemplation (62%) or in the action (38%) stage of change in their first trimester. Stage of change distinguished between different patterns of alcohol consumption before and after pregnancy. Those in the precontemplation stage drank more per episode and more often before pregnancy than those in the action stage. The precontemplation group also had a significantly greater quantity of alcohol after pregnancy. However, stage of change did not directly predict subsequent prenatal alcohol use. Previous alcohol use, age, and education were the most significant predictors of prenatal drinks per drinking day. Temptation to drink alcohol was the best predictor of prenatal drinking frequency after study enrollment. Women in both stages of change reduced the quantity and the frequency of their alcohol consumption while pregnant and achieved comparable rates of abstinence.

Lack of social support during pregnancy may be associated with the prenatal use of alcohol. The purpose of this study is to evaluate the degree, predictors, and consequences of social support in a cohort of 200 pregnant women who scored 2 or more on the T-ACE, a 4-item screening questionnaire for prenatal drinking.The pregnant women completed the Maternal Social Support Index (MSSI). Their partners completed the same measure, which was modified to reflect their status as the biological fathers.Despite having similar overall MSSI scores, there was only slight to fair agreement on the level of support received by the pregnant women for most daily tasks when their responses were compared with their partners. Predictors of increased maternal social support included the woman's being married and having more education and a more prestigious job than her partner. Social support was not predictive of either subsequent prenatal alcohol use or newborn birth weight.Regardless of social support, previous, prepregnancy, and early pregnancy drinking were the most predictive factors for subsequent prenatal alcohol consumption in this sample, underscoring the importance of screening pregnant women for drinking.

The behavioral problems and cognitive deficits resulting from even small amounts of prenatal alcohol exposure can be significant and enduring but completely preventable. The purpose of this study was to examine the impact of a prenatal drinking goal selected during a brief intervention for 115 pregnant women and their partners on subsequent consumption. Higher proportions of women having their first pregnancy chose abstinence as a goal over drinking reduction. Goal selection was highly predictive of subsequent drinking behavior. Interestingly, the participants who were abstinent at enrollment and who chose to remain abstinent had the highest rates of abstinence. In contrast, the women who chose cutting down on drinking were the least likely to drink less subsequently, despite recognizing more situations putting them at risk for drinking and identifying more alternatives to consumption. We conclude that goal choice in behavioral self-management of alcohol use by pregnant women is critical.

Objective This study was undertaken to compare the frequencies with which physicians and patients report medical and behavioral risk factors during pregnancy, with particular attention to identification of women at risk for prenatal alcohol use. Study design The sample included 278 women, drawn from a randomized trial of T-ACE (alcohol screening questionnaire) positive pregnant women receiving obstetric care. Medical records and participants' self-reports were available for comparison. Results Physicians identified only 10.8% of women recognized as at risk for alcohol consumption by the T-ACE screening measure. In contrast, the physicians' records were more inclusive for medical risk factors than the participant's self-reports. Physicians were significantly more likely to correctly identify nonwhite participants as being at risk for prenatal alcohol use (odds ratio=3.59, P = .026), compared with their white counterparts. Conclusion Self-report on the T-ACE questionnaire is more effective than medical records in identifying women at risk for prenatal alcohol use.

Maternal prenatal alcohol use is one of the leading preventable causes of birth defects, mental retardation, and neurodevelopmental disorders in the United States.1 Despite accumulating evidence that prenatal alcohol consumption at levels less than one drink per day can adversely affect fetal growth and development, pregnant women continue to drink.2,3 The prevalence of any alcohol use among pregnant women was 12.8% in 1999, with 6% of women reporting frequent (defined as more than 7 drinks per week) and binge (defined as 5 or more drinks per episode) drinking.4 Although this is an improvement over the 1988 baseline rate of 21% of pregnant women consuming alcohol, neither the Healthy People 2000 nor the Healthy People 2010 goal of 94% abstinence from alcohol during pregnancy would be satisfied.5,6 Abstinence during pregnancy is the recommendation of both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists to pregnant and preconceptional women.7 Thus, early identification and modification of prenatal alcohol use are highly desirable, particularly because past drinking predicts drinking levels during pregnancy.8 The T-ACE (Tolerance, Annoyed, Cut down, Eye-opener) is a validated screening instrument for prenatal alcohol use that may facilitate early recognition.9,10 Although initial treatment research focused on the pregnant drinker with severe alcohol problems, modification of low-to-moderate (one drink a day or less) prenatal consumption may provide the most benefit since these levels of consumption are more commonly reported.11,12 For example, a study of 361 highly disadvantaged gravidas who acknowledged having 1.3 drinks per week antenatally were actually drinking at rather higher levels.13 In fact, there is no universally safe level of prenatal alcohol use, which has led to the recommendations of abstinence.14 In general, expectant fathers or partners are not routinely screened for health problems or behaviors that could impact the pregnant woman’s health habits. Yet, several studies support the expectant father or partner as an influential modifier of prenatal behaviors. A convenience sample of 153 pregnant women in their third trimester found that social support was significantly related to reduction of alcohol use in pregnancy.15 Two European studies of prenatal cigarette smoking identified the partner’s smoking habits as being one of the most powerful predictors of smoking cessation by the pregnant woman.16,17 The purpose of this randomized trial was to test the effectiveness of a brief intervention enhanced by including a partner chosen by a pregnant woman. The partner could be her spouse, father of the child, or any other supportive adult who would be knowledgeable about her health habits. We hypothesized that, although both groups of pregnant women would demonstrate reductions in prenatal alcohol use, those randomized to the brief intervention with a partner would have greater declines in antenatal alcohol consumption.