alcohol use during pregnancy data from maryland prams, 2001-2005 diana cheng, m.d. medical director,...

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Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental Hygiene

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Page 1: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005

Diana Cheng, M.D.Medical Director, Women’s Health

Maryland Department of Health and Mental Hygiene

Page 2: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

2005 Maryland Births (74, 880 Births)• Race/Ethnicity

– 49% White Non-Hispanic – 33% Black Non-Hispanic– 6% Asian Non-Hispanic – 12% Hispanic

• Age– 19% age 35+– 9% age <20

• Other– 37% unmarried– 42% first birth, 10% 4th+ birth– 32% Medicaid

Page 3: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

• Collaborative agreement between CDC and state health departments

• Ongoing mail/phone survey of Maryland women each year, 2 to 6 months after delivery– Random sample– Stratified for birth weight and maternal age– Data collected for 2001-2005 births so far

• Over 7,500 completed surveys

• Response rate over 70% each year

OK

AK

GA

FL

SCAL

NCCO

NM AR

IL

NY

ME

WV

WA

LA

UT OHNE

HI

VT

MDNYC

MS

OR MN

MI

TX

RINJ

Page 4: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Maryland Topics• assisted reproduction • reproductive health• vaccination• automobile safety• depression• oral health• bed-rest during pregnancy• circumcision• infections• neighborhood safety

PRAMS Core Topics• alcohol and tobacco use• feelings about pregnancy• quality of prenatal care• physical abuse • infant health• stressors• medical disorders • living conditions• breastfeeding• folic acid use

Page 5: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

PRAMS Survey Question, 2001-2005

“During the last 3 months of your pregnancy, how many alcoholic drinks did you have in

an average week?

14 drinks or more a week 7-13 drinks a week 4 to 6 drinks a week 1-3 drinks a week Less than 1 drink a week I don’t know I didn’t drink then”

(“A drink is 1 glass of wine, wine cooler, can or bottle of beer, shot of liquor,

or mixed drink” was added as an explanation to a previous question.)

Page 6: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

1

Drink=

12 oz. can or bottle of beer (4.5% alcohol)

4-5 oz. wine (12% alcohol)

1.25 oz. liquor (80 proof/

40% alcohol)

Page 7: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

4 - 6 drinks/wk0.2%

1 - 3 drinks/wk1.2%

7 - 13 drinks/wk

0.1%

< 1 drink/wk6.2%

Nondrinkers92.3%

Drinkers 7.7%

Number of Alcoholic Drinks Consumed During the Last 3 Months of Pregnancy, 2001-2005 PRAMS

Page 8: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

1.9

1.1

1.0 1.1 1.7

1.1

1.1

1.1

8.3

3.3

3.1

6.5

10.7

7.7

3.7 3.9

9.8

3.8

7.5

2.1

1.63

.3

0

2

4

6

8

10

12

14W

hite

Non-H

isp

Bla

ck N

on-H

isp

<25

25-3

4

+35

Marr

ied

Unm

arr

ied

<16

+16

<$20,0

00

+$20,0

00

Per

cent

Light drinker, <1 drink/wkRegular drinker, 1-14 drinks/wk

Percent Mothers Who Reported Alcohol Use During the Last 3 Months of Pregnancy, 2001-2005 PRAMS

Page 9: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

10.77.2

25.4

19.8

13.8

32.4

0

10

20

30

40

NondrinkerLight drinker

Regular Drinker

Prenatal Cigarette Use Postpartum Depression

Percent Prenatal Smoking and Postpartum Depression by Alcohol Use, 2001-2005 PRAMS

Page 10: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

7.9

12.5

6.5

0

5

10

15

Nondrinker Light Drinker RegularDrinker

Perc

ent

Percentage of Low Birth Weight Infants by Alcohol Use, 2001-2005 PRAMS

Page 11: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

PRAMS Survey Question, 2001-2003

Yes 81%

No 19%

“At any time during your prenatal care, did a doctor, nurse, or other health care worker ask if you were drinking alcoholic beverages (beer, wine, wine cooler, or liquor)?”

Page 12: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

PRAMS Survey Question, 2001-2005

“ During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? Please count only discussions, not reading materials or videos.

How smoking during pregnancy could affect my babyBreastfeeding my babyHow drinking alcohol during pregnancy could affect my babyUsing a seat belt during my pregnancyBirth control methods to use after my pregnancyMedicines that are safe to take during my pregnancyHow using illegal drugs could affect my babyDoing tests to screen for birth defects or diseases that run in my

familyWhat to do if my labor starts earlyGetting tested for HIVPhysical abuse to women by their husbands or partners”

Page 13: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Prenatal Counseling Reported 2001-2005 PRAMS

42.5

48.1

61.9

69.1

70.5

78.4

79.9

83.4

84.8

87.8

88

0 20 40 60 80 100

Violence

Seatbelt

Illegal drugs

Smoking

Alcohol

Birth control

Breastfeed

HIV test

Preterm labor

Meds

Birth defects

percentage

Page 14: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Percentage of Women Not Receiving Counseling About Alcohol

34

23

38

19

13

28

39

12

24

35

18

34

0

20

40W

hit

e

Bla

ck

Asia

n

His

pan

ic

Ag

e <

20

20-3

5

35+

Ed

u <

12

12

>12

Med

icaid

No

Med

icaid

pe

rce

nt

Page 15: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

“… I drank 7 times a week, I was instructed by my doc to drink one wine cooler at night to relax my cervix and to

stop me from going into labor.”

PRAMS mother

Page 16: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

PRAMS Survey Question, 2001-2005

“During the last 3 months of your pregnancy, how many times did you drink 5 alcoholic drinks or more in one sitting?

14 drinks or more a week 7-13 drinks a week 4 to 6 drinks a week 1-3 drinks a week Less than 1 drink a week I don’t know I didn’t drink then”

(“A drink is 1 glass of wine, wine cooler, can or bottle of beer, shot of liquor, or mixed drink” was added as an explanation to a previous question.)

Page 17: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

No binges99.5% >=1 binge

0.5%

Number of Binge Episodes During the Last 3 Months of Pregnancy, 2001-2005 PRAMS

Page 18: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Alcohol Use* Among Women Ages 18-44, Maryland

1.1

4.95.9

7.2

10.7

14

0

4

8

12

16

'95,'97,'99 '01-'04 '06

pe

rce

nta

ge

chronicbinge

*preliminary Maryland BRFSS ’95-’06 data, binge definition change in 2006

Page 19: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Chronic Drinking Trends, MarylandMale and Female

4.6

5.6

1.1

5.9

0

2

4

6

'95,'97,'99 '06

per

cen

t

malefemale

*preliminary Maryland BRFSS ’95-’06 data

Page 20: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Binge* Drinking Trends, MarylandMale and Female

22

25.8

7.2

14

0

10

20

30

'95,'97,'99 '06

per

cen

t

malefemale

*preliminary Maryland BRFSS ’95-’06 data, binge definition change in 2006

Page 21: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Alcohol Use 3 Months Before Pregnancy 2001 and 2005 PRAMS

Chronic Drinking, 7+ Drinks/week

1.8

3

0

2

4

2001 2005

per

cen

t

Binge Drinking, 5+ Drinks/time

13.214

0

5

10

15

2001 2005

perc

ent

Page 22: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Limitations of PRAMS

• Self-report• Recall bias• Responder bias• Social desirability bias• Definition of drink • 3-month prenatal period• Quality of counseling • Sample size small for

many indices

Page 23: Alcohol Use During Pregnancy Data from Maryland PRAMS, 2001-2005 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental

Alcohol Use During PregnancyMaryland, 2001-2005 PRAMS

• During the last 3 months of pregnancy– 8% of mothers reported alcohol consumption– <1% reported binge drinking

• *Consumption of 1+ drink per week was associated with– prenatal smoking– postpartum depression– infant low birth weight

• During prenatal visits– 30% were not counseled about alcohol effects– 19% were not asked about alcohol consumption

• Preconceptional alcohol use increasing– Family planning important

• Need for more research, education, advocacy, support

*restricted results due to small PRAMS data sample