Padrão do consumo de álcool em gestantes atendidas em um hospital público universitário e fatores de risco associados

Abstract

PURPOSE: To determine the pattern of alcohol use before and during pregnancy and associated risk factors in puerperal women hospitalized in a public university hospital in Southeastern Brazil. METHODS: Between June and September 2009, 493 puerperae were consecutively evaluated. Those with cognitive impairment were excluded from the study. The AUDIT and CAGE questionnaires were used to diagnose alcohol use/abuse before pregnancy, in addition to the T-ACE during pregnancy. Another questionnaire was applied to collect sociodemographic data, such as age, educational level, marital status, and household income. The χ 2 test was used in the statistical analysis and the Odds Ratio (OR) and 95% confidence interval (95%CI) were calculated. A p-value <0.05 was considered to be significant. RESULTS: Before pregnancy, the CAGE was positive in 50/405 (12.3%) women and the AUDIT identified alcohol use in 331 (67.1%), which was of low risk in 233 (47.3%), risky in 73 (14.8%), and harmful or indicating possible alcohol dependence in 25 (5%). During pregnancy, the CAGE was positive in 53/405 (13.1%) women and the T-ACE in 84 (17%); the AUDIT identified alcohol use in 114 women, which was of low risk in 73 (14.8%), risky in 27 (5.5%), and harmful or indicating possible alcohol dependence in 14 (2.8%). During pregnancy, alcohol use was more frequent (OR=2.8; 95%CI 1.2-6.2) among women with a lower educational level (8.8 versus 3.3%) and more frequent (OR=3.8; 95%CI 1.3-11.1) among those who did not cohabit with a partner (6 versus 1.7%). Among pregnant women who drank alcohol, 49/114 (43%) were advised to stop drinking. CONCLUSIONS: Alarming alcohol use was observed during pregnancy, especially among pregnant women with a lower educational level and those who did not cohabit with a partner. There was a low frequency of counseling aimed at abstinence and the AUDIT was the instrument that most frequently diagnosed alcohol consumption.

Prevalence and factors associated with alcohol consumption during pregnancy

“…10,[15][16][17][18][19]23 The Brazilian Ministry of Health recommends that during prenatal sessions a good bond between the mother and team of primary health care professionals is established. This helps to identify women with a propensity for alcohol abuse and guide them on the consequences of alcohol consumption during pregnancy.…”

“…11,13 In Brazil, studies carried out using different methodologies estimate the frequency of alcohol consumption around to be approximately 10 to 40% of pregnant women. [14][15][16][17][18][19] T-ACE (Tolerance, Annoyed, Cut Down, and Eye-opener) was the first validated alcohol consumption screening questionnaire for use in obstetrical and gynecological practices, 20 and is routinely used in various services proving to be efficient in detecting pregnant women who consume alcohol. 1,21,22 A Brazilian Portuguese version of T-ACE, translated and adapted from the original questionnaire of Sokol et al, 20 was validated by Fabbri et al 22 in 2001. .…”

Associação Entre Características Sociodemográficas E Frequência De Uso De Álcool Por Gestantes

“…Esse dado aponta para a possibilidade do aumento do consumo dessa substância também durante a gravidez (3) . Além dos efeitos biológicos na mãe e no feto, o consumo de bebidas alcoólicas na gestação influencia de forma direta na experiência da maternidade, podendo interferir na interação mãe e filho e potencializar dificuldades econô-micas, sociais, psicológicas e de saúde já vivenciadas pela mulher (4) . Os fatores determinantes dessas consequências estão relacionados à frequência do uso, à quantidade utilizada, bem como ao contexto social, econômico e de saúde no qual a gestante está inserida (5) .…”

“…Esta análise subsidia uma intervenção precoce e eficaz no enfrentamento de problemas relacionados ao uso do álcool no período gestacional, que variam desde o desenvolvimento de anomalias congênitas às dificuldades de vinculação da mãe com o bebê (4) .…”

“…No entanto, estudo aponta resultados com associações expressivas para o uso de álcool, abandono escolar e/ou repetências (19) . O uso de álcool, assim como de outras drogas, pode estar asso- (4) . Segundo o Ministério da Saúde, a situação conjugal influencia nos fatores de risco gestacionais, e a instabilidade do estado civil é classificada como característica individual desfavorável à gestação (13) .…”