Key Findings: Prevalence and characteristics of women at risk for an alcohol-exposed pregnancy

Many women in the United States are at risk for an alcohol-exposed pregnancy, including those who are trying to become pregnant, because they continue drinking alcohol even after they have stopped using contraception (birth control).  

The Maternal and Child Health Journal published a study that used data from the National Survey of Family Growth (NSFG) to estimate the number and characteristics of women in the United States who are at risk for an alcohol-exposed pregnancy. Read the article’s summary here.

Main Findings from this Study

• Estimates from NSFG show that nearly 2 million non-pregnant women in the United States (or 1 in 30) were at risk for an alcohol-exposed pregnancy in the month before they were interviewed, including more than 600,000 women who were binge drinking^{1, 2}. These women are therefore at risk of having children born with birth defects and developmental disabilities known as fetal alcohol spectrum disorders. Alcohol use during pregnancy can also cause loss of the pregnancy (such as miscarriage and stillbirth), as well as prematurity (early birth), and sudden infant death syndrome (SIDS).
• While the study looked at several demographic (such as age, race, ethnicity, and marital status) and behavioral characteristics (such as number of sex partners, cigarette smoking, and marijuana use), women’s plans for pregnancy were the biggest predictor of risk.
• Women who said they were trying to get pregnant by not using contraception (birth control) were at increased risk for an alcohol-exposed pregnancy because they continued to drink even after they stopped using contraception.
• Other characteristics such as number of sex partners, age, and education were not consistently associated with alcohol-exposed pregnancy risk.

Implications of the Main Findings

• These findings stress the importance of preventing alcohol use during pregnancy, including before a woman knows she is pregnant. This is because many women, including those who are intending to become pregnant, might not be aware of their pregnancy until several weeks to months after conception.
• Women often continue to drink alcohol even after they have stopped using contraception. This means that if they get pregnant, they will be exposing their developing baby to alcohol before realizing they are pregnant.
• Many women could benefit from interventions that try to reduce the risk of an alcohol-exposed pregnancy by changing drinking behaviors and using contraceptives.
• Messages about the risks of alcohol use during pregnancy should be discussed with women before they realize they are pregnant; these messages should be included in other preconception care and women’s health efforts.
• There is an urgent need for wider implementation of prevention programs and policy approaches that can reduce the risk of this serious public health problem.

About this Study

This is the first study to combine an analysis of drinking behaviors and contraception use to provide national estimates of woman at risk for an alcohol-exposed pregnancy. Data from in-person interviews with women of reproductive age (15–44 years) were obtained from the NSFG. This survey uses a nationally representative sample with a high response rate of 80% among women, and collects detailed and comprehensive contraceptive and sexual behavior histories.

Data were analyzed to estimate the number and characteristics of women who are at risk for an alcohol-exposed pregnancy. Women were considered at risk of an alcohol-exposed pregnancy if they met the following criteria in the last month:  1) drank alcohol, 2) had vaginal intercourse with a man, and 3) did not use contraception.

More Information

To learn more about fetal alcohol spectrum disorders, please visit https://www.cdc.gov/fasd.

To learn more about alcohol and pregnancy, please visit
https://www.cdc.gov/NCBDDD/fasd/alcohol-use.html

Paper Reference

Cannon MJ, Guo J, Denny CH, Green PP, Miracle H, Sniezek JE, Floyd RL. Prevalence and characteristics of women at risk for an alcohol-exposed pregnancy (AEP) in the United States: Estimates from the National Survey of Family Growth. Maternal and Child Health Journal 2014; DOI 10.1007/s10995-014-1563-3.

Preventing Alcohol Use During Pregnancy and FASDs: CDC Activities

The Centers for Disease Control and Prevention (CDC) has been involved in FASD-related activities since 1991, which have enabled the prevention, identification, and treatment of FASDs. Key activities include:

• Monitoring alcohol consumption among women of reproductive age
• Tracking fetal alcohol syndrome (FAS) in certain areas of the United States
• Supporting implementation, adoption, and promotion of alcohol screening and brief intervention, including CHOICES, within primary care systems
• Developing and promoting effective interventions for children, adolescents, and young adults living with FASDs and their families
• Enhancing healthcare provider education on the prevention, identification, and treatment of FASDs
• Offering FASD-related educational information and materials for women of reproductive age, healthcare providers, and the general public

¹At the time of this survey, binge drinking was defined as having consumed five or more drinks within a couple of hours. The definition of binge drinking has since been changed for women to four or more drinks on an occasion.

² Women were asked questions about their sexual behaviors and contraception use for each of the 12 months before they were interviewed. However, the two questions about drinking alcohol were not broken down by month. Instead women were asked about their alcohol use during the past 12 months. Based on these questions, women had to report drinking at least once a month to be at risk of an alcohol-exposed pregnancy.