Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences

Abstract

BackgroundSouth Africa has one of the world’s highest rates of fetal alcohol spectrum disorder (FASD) and interpersonal trauma. These co-occurring public health problems raise the need to understand alcohol consumption among trauma-exposed pregnant women in this setting. Since a known predictor of drinking during pregnancy is drinking behavior before pregnancy, this study explored the relationship between women’s drinking levels before and after pregnancy recognition, and whether traumatic experiences – childhood abuse or recent intimate partner violence (IPV) – moderated this relationship.MethodsWomen with incident pregnancies (N = 66) were identified from a longitudinal cohort of 560 female drinkers in a township of Cape Town, South Africa. Participants were included if they reported no pregnancy at one assessment and then reported pregnancy four months later at the next assessment. Alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT), and traumatic experiences of childhood abuse and recent IPV were also assessed. Hierarchical linear regressions controlling for race and age examined childhood abuse and recent IPV as moderators of the effect of pre-pregnancy recognition drinking on post-pregnancy recognition AUDIT scores.ResultsFollowing pregnancy recognition, 73% of women reported drinking at hazardous levels (AUDIT ≥ 8). Sixty-four percent reported early and/or recent exposure to trauma. While drinking levels before pregnancy significantly predicted drinking levels after pregnancy recognition, t(64) = 3.50, p < .01, this relationship was moderated by experiences of childhood abuse, B = -.577, t(60) = -2.58, p = .01, and recent IPV, B = -.477, t(60) = -2.16, p = .04. Pregnant women without traumatic experiences reported drinking at levels consistent with levels before pregnancy recognition. However, women with traumatic experiences tended to report elevated AUDIT scores following pregnancy recognition, even if low-risk drinkers previously.ConclusionThis study explored how female drinkers in South Africa may differentially modulate their drinking patterns upon pregnancy recognition, depending on trauma history. Our results suggest that women with traumatic experiences are more likely to exhibit risky alcohol consumption when they become pregnant, regardless of prior risk. These findings illuminate the relevance of trauma-informed efforts to reduce FASD in South Africa.

The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women

“…The influence of ACEs on perceived stress (Nelson et al, 2010) and anxiety (Agrati et al, 2015; Buist, Gotman & Yonders, 2011) during pregnancy may contribute to use of alcohol as a coping mechanism (Choi et al, 2014). …”

“…While we were interested in controlling for prenatal alcohol use to better understand the independent relationship between ACEs and alcohol use during pregnancy, it is important to note that pre-pregnancy alcohol use may actually moderate the relationship between ACEs and alcohol use during pregnancy. A recent longitudinal study in South Africa found that women with a history of childhood trauma (physical abuse, sexual abuse, emotional abuse, and neglect) increased their risky alcohol consumption after becoming pregnant regardless of their pre-pregnancy alcohol use levels (Choi et al, 2014). The cultural context of using alcohol during pregnancy in South Africa is likely different from that in the U.S., but this study highlights the need for prospective studies with adequate power to explore the complex relationships between ACEs, prenatal alcohol consumption, and alcohol use during pregnancy.…”

“…Research has consistently demonstrated that women who use alcohol during pregnancy are older (Alvik, Heyerdahl, Haldersen, & Lindeman, 2006b; Harrison & Sidebottom, 2009; Meschke, Holl & Messelt, 2013; Palma et al, 2007), have higher income (Alvik et al, 2006a; McLeod, Pullon, Cookson, & Cornford, 2002; Palma et al, 2007; Zammit, Skouteris, Wertheim, Paxton, & Milgrom, 2008), and report higher rates of depression (Harrison & Sidebottom, 2009; Meschke, Holl & Messelt, 2013), intimate partner violence (Choi et al, 2014; Denton, Adinoff, Lewis, Walker, & Winhusen, 2014; Harrison & Sidebottom, 2009; Leonardson, Loudenburg, & Struck, 2007; Meschke, Hellerstedt, Holl, & Messlet, 2008), smoking (Alvik et al, 2006b; Harrison & Sidebottom, 2009; Meschke, Holl & Messelt, 2013; Ethen et al, 2009) and pre-pregnancy alcohol use (Alvik et al, 2006; Ethen at al., 2009; Harrison & Sidebottom, 2009; Palma et al, 2007; Zammit et al, 2008). An emerging area of research also suggests that a history of childhood stressors, such as physical, sexual, and emotional abuse may influence alcohol use among pregnant women.…”

Maladaptive coping mediates the influence of childhood trauma on depression and PTSD among pregnant women in South Africa

“…Women who were more advanced in their pregnancy tended to have lower levels of depression. Recent research in this setting has revealed that pregnancy recognition can be a stressful and often undesirable experience (Choi et al, 2014; Watt et al, 2014), so it is possible that women who are further along in their pregnancy may have more time to reconcile with their pregnancy status and adjust to the stressors brought on by pregnancy. Notably, however, one in four women in the sample did present with comorbid antenatal depression and PTSD.…”

Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study

“…The Revised Conflict Tactics Scales (CTS-2) was used to assess IPV in the current relationship. The CTS-2 has good cross-cultural reliability and has been used in low-resource settings (Nayak et al 2010; Shamu et al 2011; Kastello et al 2015) and in South Africa (Dawes et al 2006; Choi et al 2014). A short form of the U.S. Household Food Security Survey Module (HFSSM) measured inadequacy of food each month, frequency of going hungry, and not having money to buy enough food for the individual or their household in the preceding 6 months (Blumberg et al 1999).…”