You Didn’t Drink During Pregnancy, Did You?

Abstract

Background Accurate characterization of prenatal alcohol exposure (PAE) is challenging due to inconsistent use of screening questionnaires in routine prenatal care and substantial underreporting due to stigma associated with alcohol use in pregnancy. The aim of this study was to identify self‐report tools that are efficient in accurately characterizing PAE. Methods Participants meeting eligibility criteria for mild‐to‐moderate PAE were recruited into the University of New Mexico Ethanol, Neurodevelopment, Infant and Child Health cohort (N = 121) and followed prospectively. Timeline follow‐back (TLFB) interviews were administered at baseline to capture alcohol use in the periconceptional period and 30 days before enrollment; reported quantity was converted to oz absolute alcohol (AA), multiplied by frequency of use and averaged across 2 TLBF calendars. The interview also included questions about timing and number of drinks at the most recent drinking episode, maximum number of drinks in a 24‐hour period since the last menstrual period, and number of drinks on “special occasions” (irrespective of whether these occurred within the TLFB reported period). Continuous measures of alcohol use were analyzed to yield the number of binge episodes by participants who consumed ≥4 drinks/occasion. The proportion of women with ≥1 binge episode was also tabulated for each type of assessment. Results Average alcohol consumption was 0.6 ± 1.3 oz of AA/day (≈ 8.4 drinks/wk). Only 3.3% of participants reported ≥1 binge episode on the TLFB, 19.8% had ≥1 binge episode when asked about “special occasions,” and 52.1% when asked about the number of drinks the last time they drank alcohol. An even higher prevalence (89.3%) of bingeing was obtained based on the maximum number of drinks consumed in a 24‐hour period. Conclusions Self‐reported quantity of alcohol use varies greatly based on type of questions asked. Brief targeted questions about maximum number of drinks in 24 hours and total number of drinks during the most recent drinking episode provide much higher estimates of alcohol use and thus might be less affected by self‐reporting bias.

Independent and Combined Effects of Prenatal Alcohol Exposure and Prenatal Stress on Fetal HPA Axis Development

“…The mean number of binge episodes during the month around LMP was 3.71 ± 5.75. During pregnancy, the average AAD reported on the TLFB calendars was estimated at 0.001 ± 0.01 (<1 drink/month); however, 89.6% of participants reported at least one binge drinking episode (≥4 drinks/occasion) using a combination of TLFB and targeted questions about episodic binge drinking (e.g., maximum number of drinks consumed in a 24-h period since LMP) [ 51 ]. Cumulatively across the periconceptional period and pregnancy, mean AAD in the PAE group was 0.15 ± 0.28 (equivalent to approximately 2 drinks/week).…”

“…In fact, average estimates from the TLBF calendars were less than 1 drink per month, which has traditionally been considered negligible. However, we have previously demonstrated that pregnant persons might disclose alcohol use during pregnancy more openly if they are asked targeted questions, such as the maximum number of drinks consumed in a 24 h period since LMP and the number of drinks last time they consumed alcohol (with the date of last drink being compared to LMP) [ 51 ]. In fact, using such targeted questions and data from TLFB interviews, almost 90% of participants in the PAE group reported at least one binge drinking episode since LMP.…”

Potentially modifiable risk and protective factors affecting mental and emotional wellness in pregnancy

“…However, it should be noted that self-reported alcohol and substance use was validated by a panel of biomarkers. The combined use of repeated, prospective TLFB interviews, targeted questions about binge drinking episodes, and a broad panel of ethanol biomarkers is the most comprehensive approach to characterize PAE ( Bakhireva and Savage, 2011 ; Bakhireva et al, 2021 ). Further, we have previously reported high concordance between disclosure of less stigmatized substances, such as cannabis, and urine drug tests ( Garg et al, 2016 ; Page et al, 2022 ).…”

Using network analysis to illuminate the intergenerational transmission of adversity

“…This could be problematic because as evidenced in the analyses, individual ACEs have unequal weight of effect on later health outcomes and the trauma of losing a parent during childhood may not be the same as the impact of parental divorce or separation. Fourth, data on sensitive topics such as ACEs or prenatal substance use may be underreported due to associated stigma, fear of repercussions, and limited measures to elicit honest responses (Bakhireva, Leeman, Roberts, Rodriguez, & Jacobson, 2021 ). Fifth, although maternal sociodemographic characteristics during pregnancy were included as covariates in all the analyses, (epi)genetics, which may be important confounding factors in many of the relationships explored, were not accounted for.…”