Frequent Alcohol Consumption Among Women of Childbearing Age -- Behavioral Risk Factor Surveillance System

Alcohol use during pregnancy can cause fetal alcohol syndrome and other congenital anomalies (1,2). Substantial prenatal alcohol use can occur before a woman knows she is pregnant, and teratogenic risk increases if she continues to drink during pregnancy. Characterization of alcoholconsumption patterns among women of childbearing age (i.e., age 18-44 years) can help identify the magnitude of this problem, the subpopulations at greatest risk, and the geographic areas in which increased prevention efforts are needed. This report presents state specific data on the prevalence of frequent alcohol consumption among women of childbearing age.

Data were analyzed from 26,829 women aged 18-44 years who resided in 47 states and the District of Columbia and participated in the 1991Behavioral Risk Factor Surveillance System (BRFSS) survey. The BRFSS is a state-based, random-digit-dialed telephone survey that collects self-reported data from a representative sample of civilian, noninstitutionalized persons aged greater than or equal to 18 years (3).

In 1991, the BRFSS included questions about the amount of alcohol consumed and the number of times alcohol was consumed during the month preceding the survey. Women of childbearing age were classified as nondrinker (no alcohol use reported during the preceding month), light drinker (less than or equalto 30 drinks during the preceding month), moderate drinker (31-59 drinks during the preceding month), and heavy drinker (greater than or equal to 60 drinks during the preceding month). The survey also asked about the prevalence of binge drinking (five or more drinks on at least one occasionduring the preceding month). All women who reported moderate, heavy, or binge drinking during the preceding month were classified as frequent drinkers. Weighted prevalence estimates were age-adjusted using the 1991 U.S. census of women aged 18-44 years (4). States were grouped into fourcategories according to quartiles of the prevalence of frequent alcohol consumption (3.6%-8.6%, 8.7%-11.4%, 11.5%-14.3%, and 14.4% 21.0%).

Alcohol consumption patterns during the month preceding the survey could be determined for 26,615 respondents. A total of 13,389 (50%) were nondrinkers; 11,927 (45%), light drinkers; 899 (3%), moderate drinkers; and 400 (2%), heavy drinkers. Among all drinkers, 2778 (21%) reported bingedrinking. Among the binge drinkers, 1907 (69%) were light drinkers; 581 (21%), moderate drinkers; and 291 (11%), heavy drinkers. A total of 3205(12%) were frequent drinkers.

A total of 1067 women reported being pregnant at the time of the interview. Of these, 14 (1.3%) reported binge drinking. A total of 143 (13.4%) reported light drinking; three (0.3%), heavy drinking; and one (0.1%), moderate drinking.

Estimates of frequent alcohol consumption varied widely between states, with a median of 11.5%. The highest prevalences of frequent drinking were reported in Wisconsin (21.0%), New Hampshire (20.4%), Massachusetts (19.8%), Minnesota (18.2%), and Alaska (17.6%). The lowest prevalences were reported in Mississippi (3.6%), Tennessee(3.9%), North Carolina (6.3%), Kentucky (6.9%), and Oklahoma (6.9%).

Reported by the following BRFSS coordinators: L Eldridge, Alabama; P Owen, Alaska; J Contreras, PhD, Arizona; J Senner, Arkansas; L Lund, PhD, California; M Leff, Colorado; M Adams, Connecticut; F Breukelman, Delaware; C Mitchell, District of Columbia; D McTague, Florida; E Pledger, Georgia; VF Ah Cook, Hawaii; J Mitten, Idaho; B Steiner, Illinois; R Guest, Indiana; S Schoon, Iowa; K Bramblett, Kentucky; S Kirkconnell, Louisiana; R Schwartz, Maine; A Weinstein, Maryland; R Lederman, Massachusetts; H McGee, Michigan; N Salem, PhD, Minnesota; E Jones, Mississippi; J Jackson-Thompson, PhD, Missouri; P Smith, Montana; S Huffman, Nebraska; K Zaso, New Hampshire; G Boeselager, New Jersey; L Pendley, New Mexico; CBaker, New York; CR Washington, MPH, North Carolina; M Maetzold, North Dakota; E Capwell, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, Oregon; CBecker, Pennsylvania; J Buechner, Rhode Island; M Lane, South Carolina; B Miller, South Dakota; D Ridings, Tennessee; R Diamond, Texas; R Giles,Utah; P Brozicevic, Vermont; R Schaeffer, Virginia; T Jennings, Washington;
F King, West Virginia; E Cautley, Wisconsin. Behavioral Risk Factor
Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion; Developmental Disabilities Br, Div of Birth Defects and Developmental Disabilities, National Center for Environmental Health, CDC.

Editorial Note: The findings in this report indicate a higher prevalence of frequent drinking among women of childbearing age in the northern regions of the United States than in other regions of the country. These findings are consistent with previous studies that found regional differences in drinking patterns (5). Results of this study indicate the need for surveillance of alcohol consumption patterns during pregnancy and for scrutiny of alcohol-related congenital anomalies in states with high prevalences of frequent drinking.

Women of childbearing age who are frequent drinkers are at risk for delivering an alcohol-affected infant if they become pregnant, especially if they continue to drink during pregnancy. Moderate consumption of one or more drinks per day and binge drinking have been associated with adverse birth outcomes, such as physical anomalies and lower intelligence quotients (6,7). Because no known safe level of alcohol use has been determined for pregnant women, those who are pregnant or who may become pregnant shouldabstain from alcohol.

The findings in this report are subject to at least two limitations. First, the estimates of frequent drinking are based on self-reported data,which usually underestimate actual alcohol use. Second, because the BRFSS does not include households without a telephone, the findings may not reflect patterns among population subgroups (e.g., low income and less educated women).

The findings in this report can assist states in targeting women of childbearing age and educating them about the importance of abstaining from alcohol during pregnancy and in planning health-promotion programs that help reduce alcohol use among women of childbearing age. Further analysis of these data is being conducted to determine patterns of alcohol use by demographic characteristics (e.g., income, education, and race).

References
1. Streissguth AP, Landesman-Dwyer S, Martin JC, Smith DW. Teratogenetic effects of alcohol in humans and laboratory animals. Science 1980;209:353-61.
2. Little RE, Graham JM Jr, Samson HH. Fetal alcohol effects in humans andanimals. Adv Alcohol Subst Abuse 1982;1:103-25.
3. Frazier EL, Franks AL, Sanderson LM. Behavioral risk factor data. In: CDC. Using chronic disease data: a handbook for public health practitioners. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1992:4-14-4-17.
4. Bureau of the Census. U.S. population estimates, by age, sex, race, and Hispanic origin: 1980 to 1991. Washington, DC: US Department of Commerce,Bureau of the Census, 1993. (Current population reports; series P25, no.1095).
5. Hilton ME. Regional diversity in United States drinking practices. Br J Addict 1988;83:519-32.
6. Day NL, Richardson G, Geva D, et al. The effects of prenatal alcohol use on growth of children at three years of age. Alcohol Clin Exp Res 1991;15:67-71.
7. Streissguth AP, Barr HM, Sampson PD. Moderate prenatal alcohol exposure:effects on child IQ and learning problems at age 7 1/2 years.