Year of Publication

2014

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Christina Studts, PhD

Committee Member

Pamela Teaster, PhD

Committee Member

Robin Vanderpool, DrPH, CHES

Abstract

Alcohol is reported to be one of the most used legal substances among women of reproductive age, and its use during pregnancy is one of the most preventable causes of birth defects and developmental disabilities.1 Due to its teratogenic nature, alcohol use during pregnancy has been associated with a condition referred to as Fetal Alcohol Spectrum Disorders (FASD).2 This comprises of a wide spectrum of disorders such as Fetal Alcohol Syndrome (FAS), alcohol-related birth defects, and alcohol-related neurodevelopmental disorders, which are estimated to affect 1% of all births in the United States and can be prevented through the modification of maternal behaviors.1 These adverse birth outcomes and defects are not only witnessed during infancy, but often translate into life-long impairments.3 Not only does this constitute a problem to the population living with it, but it also poses an enormous public health and economic burden, with an estimated annual health care cost of $74.6 million.4 To eliminate this issue, medical health care workers and public health officials have developed several policies, recommendations, guidelines, and interventions. Examples include recommendations by the Surgeon General and American Congress of Obstetricians and Gynecologists (ACOG) for pregnant women to abstain from any alcohol during pregnancy.1 This came about due to the lack of evidence for a safe consumption level of alcohol during pregnancy, as even low levels of in-utero alcohol exposure have been associated with subsequent persistent developmental, behavioral, and emotional problems.3 In line with efforts to address this issue is the Healthy People 2020 goal of attaining both an alcohol abstinence rate of 98.3%, and a binge drinking abstinence rate of 100% during pregnancy.5 Ilogu 4 Despite these recommendations and interventions, the rate of alcohol use during pregnancy remains alarming. Research estimates the rate of alcohol consumption during pregnancy to range from 13% to over 50%, with the Institute of Medicine (IOM) suggesting use of some form of alcohol by approximately 20% of pregnant women.6 Other studies have reported a prevalence of 10% in the United States for alcohol consumption during pregnancy.7 Several research studies addressing alcohol use during pregnancy have been conducted, and their findings have influenced the development of interventions. One recent study analyzed the Pregnancy Risk Assessment Monitoring Systems (PRAMS) data to explain the relationship between maternal socio-demographic characteristics and alcohol use during pregnancy. Associations were found between alcohol use during pregnancy and the following maternal socio-demographic characteristics: race/ethnicity (non-Hispanic white), age (≥ 35 years), education (more than high school), and income (higher incomes).8 However, these maternal socio-demographic characteristics differ from characteristics (lower income, less educated, younger black women) viewed as high risk for other maternal harmful health behaviors such as tobacco use during pregnancy, not breastfeeding, and not using the back to sleep position.8 Most research studies concerning alcohol use during pregnancy are focused mainly on intrapersonal factors, that is, factors solely within the individual and their control. However, Bronfenbrenner’s ecological theory provides another context through which this issue can be addressed, by postulating that human development and behaviors are shaped by several environmental systems.9 The microsystem, which refers to the individual’s immediate surroundings, is the system of interest for this study.10 Translating Ilogu 5 this theory to the issue of alcohol use during pregnancy, maternal characteristics within an individual’s microsystem that may be associated with this risk behavior include physical abuse, depression and stress. These maternal psychosocial characteristics are the focus of the current study. Psychosocial characteristics present in women before and during pregnancy could lead to alcohol use during pregnancy. 20.6% of teens and 14.2% of adult women report physical abuse during pregnancy.11 Conservative estimates of the prevalence of physical abuse during pregnancy range from 2.1% to 6.3%.12 Despite these varying prevalence estimates, adverse outcomes of physical abuse during pregnancy are known to include late or no access to prenatal care, spontaneous abortion, fetal injury, and low birth weight.13 Previous studies suggest that women may be at higher risk for depressive symptoms during pregnancy, with a period prevalence for major and minor depressive symptoms during pregnancy of 18.4%.14 Depression during pregnancy is also associated with adverse birth outcomes, such as preterm birth and low birth weight.14 These psychosocial factors are not only associated with negative birth and developmental outcomes, but physical violence and abuse, emotional abuse, mood, and chronic distress have also been tied to risk of substance abuse.15 The main objective of this study was to examine the associations between maternal psychosocial characteristics in the microsystem—specifically physical abuse, depression, and stress—and the health risk behavior of alcohol use during pregnancy, controlling for known socio-demographic correlates. The study hypothesized that the presence of these psychosocial characteristics before and during pregnancy would increase the likelihood of alcohol use during pregnancy, after accounting for previously Ilogu 6 demonstrated effects of socio-demographic factors. Having a clear understanding of the various risk factors for alcohol use during pregnancy will aid in the development of risk-specific interventions aimed at mitigating this public health issue.

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