Maternal alcohol use, adverse neonatal outcomes and pregnancy complications in British Columbia, Canada: a population-based study

Abstract

Background The current study aimed to estimate the prevalence of alcohol use identified as a risk factor during pregnancies by the antenatal care providers, resulting in live births in British Columbia (BC) and to examine associations between alcohol use, adverse neonatal outcomes, and pregnancy complications. Methods This population-based cross-sectional study utilized linked obstetrical and neonatal records within the BC Perinatal Data Registry (BCPDR), for deliveries that were discharged between January 1, 2015 and March 31, 2018. The main outcome measures were alcohol use identified as a risk factor during pregnancy, associated maternal characteristics, pregnancy complications, and adverse neonatal outcomes. Estimates for the period and fiscal year prevalence were calculated. Chi-square tests were used to compare adverse neonatal outcomes and pregnancy complications by alcohol use during pregnancy identified as a risk factor. Logistic regression was used to examine the association between alcohol use identified as a risk factor during pregnancy and adverse neonatal outcomes and pregnancy complications, after adjusting for identified risk factors. Results A total of 144,779 linked records within the BCPDR were examined. The period prevalence of alcohol use during pregnancy identified as a risk factor was estimated to be 1.1% and yearly prevalence was 1.1, 1.1, 1.3 and 0.9% from the 2014/2015 to 2017/2018 fiscal years, respectively. Alcohol use identified as a risk factor was associated with younger maternal age, fewer antenatal visits, being primiparous, a history of mental illness, substance use and smoking. Neonates with alcohol use during pregnancy identified as a risk factor had greater odds of being diagnosed with: “low birth weight (1000-2499g)” (ICD-10: P07.1; aOR = 1.25; 95% CI: 1.01, 1.53), “other respiration distress of newborn” (ICD-10: P22.8; aOR = 2.57; 95% CI: 1.52, 4.07), “neonatal difficulty in breastfeeding” (ICD-10: P92.5; aOR = 1.97; 95% CI: 1.27, 2.92) and “feeding problems, unspecified” (ICD-10: P92.9; aOR = 2.06; 95% CI: 1.31, 3.09). Conclusions The prevalence of alcohol use during pregnancy identified as a risk factor was comparable to previous estimates within the BCPDR. Identified prenatal alcohol exposure was associated with notable differences in maternal and neonatal characteristics and adverse neonatal outcomes. More consistent, thorough screening and prevention efforts targeting alcohol use in pregnancy are urgently needed in Canada.

Cigarette smoking during pregnancy and adverse perinatal outcomes: a cross-sectional study over 10 years

“…Second, we did not assess passive smoking or secondhand exposure, which may also affect the fetus [ 39 ]. Furthermore, we did not take into account certain factors that could be confounding, such as alcohol or cannabis use [ 40 , 41 ]. Information regarding other factors, such as comorbidities or concomitant medication use were not available and therefore were also not taken into account.…”

Why do women consume alcohol during pregnancy or while breastfeeding?

“…Congruent with the theme of drinking due to stress, women who drink in pregnancy report more mental health problems and a greater incidence of abuse/violence compared to women who do not drink [ 21 , 32 ]. Not surprisingly, this review found that pre‐existing substance abuse/dependence problems influenced alcohol consumption in pregnant women (as they do in other groups), again highlighting the importance of early screening and addiction treatment for women of childbearing age.…”

“…These risk and protective factors may be useful in identifying pregnant women who may need extra screening or access to brief interventions during pregnancy. For example, it has been shown that age cohorts and education levels affect alcohol use behaviour during pregnancy, though these effects vary based on country and subpopulation [ 23 , 32 ]. For example, one study from Australia reported that being older and more educated are associated with a greater likelihood of alcohol use during pregnancy in the general population [ 22 ].…”

“…For example, one study from Australia reported that being older and more educated are associated with a greater likelihood of alcohol use during pregnancy in the general population [ 22 ]. Another study from Canada found that being younger and having a history of mental illness are associated with alcohol use during pregnancy [ 32 ].…”

Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder

“…There are myriad factors that both directly and indirectly influence why a pregnant woman may consume alcohol, many of which parallel the social determinants of health (SDHs; Government of Canada, 2020 ). Experiences of trauma ( Bhengu et al, 2019 ); stressful life events ( Edwards et al, 2019 ); intimate partner violence ( Deutsch, 2019 ); having a partner who uses substances ( Ortega-García et al, 2020 ); lower levels of education ( May et al, 2020 ); less or later access of prenatal health care ( May et al, 2020 ; Popova et al, 2021 ); and mental health challenges ( Hyer et al, 2020 ; Popova et al, 2021 ) have all been associated with an increased risk of alcohol use during pregnancy. Many pregnancies are unplanned, and not all women recognize their pregnancy during the early stages.…”