Women Still Drinking During Pregnancy

Despite the Surgeon General's warning that alcohol can affect unborn children, pregnant women haven't changed their drinking habits much over the past two decades, the CDC saidAbout 40% of women realize they're pregnant at four weeks' gestation, a critical period for fetal organ development,

The U.S. Surgeon General has consistently advised women against drinking alcohol during pregnancy. National prevalence of fetal alcohol syndrome is about 0.5 to 2.0 cases per 1,000 births, but the other fetal alcohol spectrum disorders occur about three times as often, the researchers said.

Women with the highest rates of drinking during pregnancy were older, college graduates, employed, and unmarried.

Between 2001 and 2005, 17.7% of pregnant women ages 35 to 44 reported having at least one drink in the past 30 days, compared with 8.6% of women ages 18 to 24.

While it's not well understood why drinking habits differ across certain aspects of social status, the researchers had a few possible explanations. It could be that older women may be more alcohol dependent and have more difficulty abstaining from alcohol while pregnant, they speculated. Also, they said, more-educated women and employed women might have more discretionary money to spend on alcohol. And unmarried women might attend more social occasions where alcohol is served, the researchers said. They emphasized that healthcare providers should routinely ask women of childbearing age about their alcohol use and inform them of the risks of drinking during pregnancy.

Alcohol use levels before pregnancy are a strong predictor of alcohol use during pregnancy, the researchers said. Many women who use alcohol continue to do so during the early weeks of gestation because they don't realize they're pregnant, as about half of all births are unplanned.

Denny CH, et al "Alcohol use among pregnant and nonpregnant women of childbearing age -- U.S., 1991 -- 2005 MMWR 2009; 58(19): 529-32

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FOLIC ACID AND PREGNANCY

Recent evidence suggested that folic acid might decrease the birth prevalence of congenital heart defects, the most common of all birth defects.

Believe it or not, the existing evidence for an association between folic acid and congenital heart defects, however, was still inconclusive in 2007—even though doctors have been prescribing it for a long time. This lack of solid evidence even necessitated a statement from the American Heart Association Council which emphasized the importance of this possible association and the need for corroborative evidence from population based studies.

Canadian researchers examined rates of severe congenital heart defects during the 9 years before folic acid fortification of grains was implemented (1990–1998) and during the 7 years afterward (1999–2005).
They found that while the heart defect rate remained stable before fortification, it dropped an average of 6% per year in the period after.
The authors conclude that the data "support the hypothesis that folic acid has a preventive effect on heart defects.”

SUMMARY:

What is already known on this topic
Animal studies show that folic acid might prevent congenital heart defects. Evidence from one randomized controlled trial and several case-control studies is supportive but not conclusive because prior to this study evidence was lacking from from population based studies.

What this study adds

The birth prevalence of severe congenital heart defects in Quebec, Canada, decreased after the implementation of a public health policy to increase the folic acid intake at the population level. This population based study supports previous evidence that intake of folic acid around conception has a preventive effect on congenital heart defects
BMJ 2009;338:b1673

COMMENT: The evidence now is irrefutable. Folic acid must be part of the nutritional supplements taken in pregnancy.


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Please remember, as with all our articles we provide information, not medical advice.

For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.