Only 16% of pregnant people with recent alcohol use advised to stop

In 2017 and 2019, about 16% of pregnant people with past 30-day alcohol use were advised by a health care provider to quit or reduce their consumption, a recent study in MWWR found.

According to Jackie Luong, an epidemiology research assistant at the CDC, and colleagues, alcohol screening and brief intervention (ASBI) is an evidence-based tool that can be used in the primary care setting to reduce prenatal drinking.

Prior MWWR data showed that 17.8% of pregnant adults without a usual care provider reported current drinking compared with 11.9% of those who did. However, previous research has not characterized the use of ASBI during health care visits among pregnant women.

For the current study, Luong and colleagues used 2017 and 2019 survey data from the Behavioral Risk Factor Surveillance System to examine the prevalence of ABSI among pregnant persons and nonpregnant women of reproductive age (18 to 49 years).

Of the 950 pregnant people included in the study, 13.3% reported current drinking and 6.9% reported binge drinking. Overall, 80.1% of pregnant people and 86.1% of reproductive-aged women were screened for alcohol use during their last visit.

Pregnant people who did not graduate high school reported a lower prevalence of alcohol screening (53.5%) than those who did (83.4%) and those who had at least some college education (84.5%).

Additionally, pregnant people who reported behaviors that could increase HIV transmission risk were screened more often (95.8%) than those who did not report risk behaviors (78.6%).

Luong and colleagues reported that 25% (95% CI, 19.6-31) of pregnant people who were screened for alcohol use were also offered advice about harmful drinking levels and 12.3% (95% CI, 7.6-17) were advised by a health care provider to reduce alcohol intake or quit drinking. Among pregnant people who reported current drinking, 28.8% (95% CI, 12.2-45.4) were offered advice about the harms of drinking and 16.1% (95% CI, 6.9-25.3) were advised to reduce or stop alcohol consumption.

There was no statistically significant difference in screening prevalence among pregnant people regarding race and ethnicity, frequent mental distress or insurance. In reproductive-aged women, however, lower screening rates were observed among non-Hispanic individuals and those of another race or ethnicity — such as American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander or multiracial — compared with non-Hispanic Black individuals, non-Hispanic white individuals and Hispanic individuals.

While there are barriers to successfully implementing more frequent ABSI, the researchers highlighted several strategies that could help reduce obstacles, which include:

• integrating screenings in electronic health records;
• increasing reimbursement for ABSI services;
• implementing electronic ABSI; and
• developing tools and training for ABSI in both traditional and nontraditional settings.

“Disparities in brief intervention highlight opportunities for expanding communication with patients who report alcohol consumption during pregnancy about associated risks to prevent and reduce adverse alcohol-associated pregnancy outcomes,” they concluded.

References:

• Gosdin K, et al. MMWR Morb Mortal Wkly Rep. 2022;doi:10.15585/mmwr.mm7101a2.
• Luong J, et al. MMRW Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7203a2.