The use of record linkage to examine alcohol use in pregnancy

Babies born to women hospitalized for alcohol-related reasons during pregnancy are smaller, have lower Apgar scores and are more likely to be admitted to a special care unit, a large Australian study finds.

These women have a higher number of previous pregnancies, smoke more heavily and are less likely to be privately insured, according to the study in the April issue of Alcoholism: Clinical and Experimental Research.

"To reduce alcohol consumption by pregnant women, there needs to be a government-society approach to the issue, rather than simply regarding it as a health problem," said lead researcher Lucy Burns, Ph.D., of the National Drug and Alcohol Research Centre in Sydney."

Burns' team studied 416,834 admissions of pregnant women from 1998 through 2002 and found that 342 women had at least one alcohol-related diagnosis at admission. Their babies had lower Apgar scores - which rate appearance, pulse, responsiveness, muscle activity and breathing - than the other newborns at five minutes after birth.

In addition, 30 percent of the babies in the alcohol group had low birth weight compared with 10 percent in the non-alcohol group. Sixteen percent were born prematurely, compared with 6 percent in the non-alcohol group.

Deliveries in the alcohol group were more likely to be induced due to intrauterine growth retardation and premature rupture of membranes. Of babies in the alcohol group, 29 percent were delivered by Caesarean section for fetal distress compared with 14 percent for the other babies, and they were 1.6 times more likely to be transferred to the special care unit.

"It seems critical to get the message to women before they become pregnant that alcohol and pregnancy do not mix," said Janet Harkin, Ph.D., of Wayne State University in Detroit. "It is also important to screen women at their first prenatal visit for alcohol use….Other providers like WIC workers can be involved in this process."

The Australian study suggests that risky health practices during pregnancy are likely underreported due to the mothers' fear of consequences and the reluctance of health-care workers to ask invasive personal questions.

"Problematic alcohol use is often symptomatic of a range of life stressors and supportive early intervention programs should be made more available to families at risk," Burns said. However, she said that among health-care workers, "there remains a reluctance to routinely ask about alcohol and tobacco consumption as it is regarded as secondary to other issues or seen as ‘interfering' with the lives of others."

Burns recommended that routine alcohol screening of pregnant women "should be undertaken by all health professionals, with appropriate follow-ups put into place."