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Figure.  Prevalence of Binge Drinking and Heavy Alcohol Consumption Among Pregnant and Nonpregnant Women, 2011 to 2020
Prevalence of Binge Drinking and Heavy Alcohol Consumption Among Pregnant and Nonpregnant Women, 2011 to 2020

Data are from the public use Behavioral Risk Factor Surveillance System. A, Estimated average annual percent change for binge drinking was 8.9% (95% CI, 4.8%-12.9%; P = .003) among pregnant women and 0.7% (95% CI, −0.5% to 1.8%; P = .28) among nonpregnant women. B, Estimated average annual percent change for heavy alcohol consumption was 11.6% (95% CI, 4.0%-19.3%; P = .02) among pregnant women and 2.3% (95% CI, 0.9%-3.7%; P = .01) among nonpregnant women.

Table.  Descriptive Statistics of Study Characteristics for Binge Drinking and Heavy Alcohol Consumption Samples, Behavioral Risk Factor Surveillance System, 2011 Through 2020
Descriptive Statistics of Study Characteristics for Binge Drinking and Heavy Alcohol Consumption Samples, Behavioral Risk Factor Surveillance System, 2011 Through 2020
1.
Spillane  S, Shiels  MS, Best  AF,  et al.  Trends in alcohol-induced deaths in the United States, 2000-2016.   JAMA Netw Open. 2020;3(2):e1921451. doi:10.1001/jamanetworkopen.2019.21451 PubMedGoogle ScholarCrossref
2.
Howard  JT, Sparks  CS, Santos-Lozada  AR, Olowolaju  SA, Janak  JC, Howard  KJ.  Trends in mortality among pregnant and recently pregnant women in the US, 2015-2019.   JAMA. 2021;326(16):1631-1633. doi:10.1001/jama.2021.13971 PubMedGoogle ScholarCrossref
3.
Denny  CH, Acero  CS, Terplan  M, Kim  SY.  Trends in alcohol use among pregnant women in the US, 2011-2018.   Am J Prev Med. 2020;59(5):768-769. doi:10.1016/j.amepre.2020.05.017 PubMedGoogle ScholarCrossref
4.
Gosdin  LK, Deputy  NP, Kim  SY, Dang  EP, Denny  CH.  Alcohol consumption and binge drinking during pregnancy among adults aged 18-49 years—United States, 2018-2020.   MMWR Morb Mortal Wkly Rep. 2022;71(1):10-13. doi:10.15585/mmwr.mm7101a2 PubMedGoogle ScholarCrossref
5.
Taylor  K, Compton  S, Kolenic  GE,  et al.  Financial hardship among pregnant and postpartum women in the United States, 2013 to 2018.   JAMA Netw Open. 2021;4(10):e2132103. doi:10.1001/jamanetworkopen.2021.32103 PubMedGoogle ScholarCrossref
6.
Eick  SM, Goin  DE, Izano  MA,  et al.  Relationships between psychosocial stressors among pregnant women in San Francisco: a path analysis.   PLoS One. 2020;15(6):e0234579. doi:10.1371/journal.pone.0234579 PubMedGoogle ScholarCrossref
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    Research Letter
    Obstetrics and Gynecology
    August 1, 2022

    Trends in Binge Drinking and Heavy Alcohol Consumption Among Pregnant Women in the US, 2011 to 2020

    Author Affiliations
    • 1College for Health, Community and Policy, Department of Public Health, University of Texas at San Antonio
    • 2Department of Psychology, Texas State University, San Marcos
    JAMA Netw Open. 2022;5(8):e2224846. doi:10.1001/jamanetworkopen.2022.24846
    Introduction

    Alcohol-related mortality has been increasing among women in the US during the past 2 decades.1 Although no recent studies have found increased alcohol-related mortality specifically among pregnant women, 1 study2 found increases in combined drug- and alcohol-related mortality. Recent data on binge drinking among pregnant women suggests a modest increase from 2011 to 20183 and no increase from 2018 to 2020.4 However, little is known about how longer trends in problematic alcohol use may differ between pregnant and nonpregnant women. We sought to compare trends in prevalence of binge drinking and heavy alcohol consumption among pregnant and nonpregnant women from 2011 through 2020.

    Methods

    This cross-sectional study obtained public use data from the Behavioral Risk Factor Surveillance System (BRFSS) from January 1, 2011, to December 31, 2020. The BRFSS is a nationally representative, cross-sectional sample of US adults that measures alcohol consumption based on 30-day recall. The BRFSS defines binge drinking as 4 or more drinks during a single occasion and heavy alcohol consumption as 8 or more drinks per week (eMethods and eTable in the Supplement). Pregnancy status (pregnant vs not pregnant) was the primary exposure; sex was self-reported by all participants in the BRFSS data set, and all pregnant participants identified as women. Race and ethnicity (Hispanic or Latino, non-Hispanic Black, non-Hispanic White, non-Hispanic multiple races or ethnicities, and non-Hispanic other race or ethnicity) are reported in the BRFSS, and the distribution differs significantly by the primary exposure (pregnancy), which should be accounted for when comparing prevalence between pregnant and nonpregnant women. Analyses were adjusted for age group (18-24, 25-29, 30-34, 35-39, and 40-44 years) and race and ethnicity. The University of Texas at San Antonio Institutional Review Board waived the need for approval because the research did not involve human participants. This study followed the STROBE reporting guideline.

    Age- and race and ethnicity–adjusted prevalence of binge drinking and heavy alcohol consumption were estimated using logistic regression models adjusted for complex survey design and weighting. Log linear regression models were used to estimate average annual percentage change (AAPC) in prevalence rates with 95% CIs. Two-sided P < .05 was considered statistically significant. Data were analyzed using R, version 4.0.2 (R Foundation for Statistical Computing).

    Results

    Among the 49 098 pregnant women included in the study, 28.8% were 18 to 24 years of age and 3.7% were 40 to 44 years of age compared with 26.2% and 19.1%, respectively, for the 1 243 402 nonpregnant women (P < .001). Pregnant women were less likely to be non-Hispanic White (50.5%) compared with nonpregnant women (54.4%) (P < .001) (Table). The prevalence of binge drinking increased from 2.5% (95% CI, 1.6%-3.4%) in 2011 to 6.1% (95% CI, 2.2%-10.0%) in 2020 for pregnant women, an AAPC of 8.9% (95% CI, 4.8%-12.9%; P = .003) (Figure). Binge drinking for nonpregnant women decreased from 18.6% (95% CI, 17.8%-19.3%) in 2011 to 17.6% (95% CI, 16.8%-18.5%) in 2020 with an AAPC of 0.7% (95% CI, −0.5% to 1.8%; P = .28), reflecting an increase from 2012 to 2019. Prevalence of heavy alcohol consumption increased from 0.7% (95% CI, 0.3%-1.0%) in 2011 to 3.2% (95% CI, 0.6%-5.8%) in 2020 for pregnant women, an AAPC of 11.6% (95% CI, 4.0%-19.3%; P = .02). Prevalence of heavy alcohol consumption for nonpregnant women increased from 6.6% (95% CI, 6.1%-7.1%) in 2011 to 7.5% (95% CI, 6.9%-8.1%) in 2020, an AAPC of 2.3% (95% CI, 0.9%-3.7%; P = .01).

    Discussion

    In this cross-sectional study, we found that binge drinking and heavy alcohol consumption were higher among nonpregnant women than pregnant women, but the AAPC for both behaviors was significantly greater among pregnant women than nonpregnant women. Binge drinking increased by 0.7% per year between 2012 and 2019, and heavy alcohol consumption increased by 2.3% per year among nonpregnant women. However, binge drinking increased 8.9% per year and heavy alcohol consumption increased 11.6% per year among pregnant women.

    Study limitations include the cross-sectional design, self-reported alcohol consumption, and wide CIs for estimates in 2019 and 2020. These results suggest worsening behavioral risks among pregnant women, potentially owing to changes in socioeconomic5 and psychosocial stressors6 that may have been exacerbated by the COVID-19 pandemic.

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    Article Information

    Accepted for Publication: June 15, 2022.

    Published: August 1, 2022. doi:10.1001/jamanetworkopen.2022.24846

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Howard JT et al. JAMA Network Open.

    Corresponding Author: Jeffrey T. Howard, PhD, College for Health, Community and Policy, Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 (jeffrey.howard@utsa.edu).

    Author Contributions: Dr J. T. Howard had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: J. T. Howard, K. J. Howard.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: J. T. Howard, Flores, Leong, Nocito, K. J. Howard.

    Critical revision of the manuscript for important intellectual content: J. T. Howard, Perrotte, K. J. Howard.

    Statistical analysis: J. T. Howard, Flores, Leong, Nocito.

    Administrative, technical, or material support: J. T. Howard, Perrotte, K. J. Howard.

    Supervision: J. T. Howard, K. J. Howard.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This study was supported in part through the Lutcher Brown Endowed Fellowship (Dr J. T. Howard).

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Meeting Presentation: An early version of the figure was presented in a poster at a University of Texas at San Antonio Public Health Week Research Showcase; April 7, 2022.

    References
    1.
    Spillane  S, Shiels  MS, Best  AF,  et al.  Trends in alcohol-induced deaths in the United States, 2000-2016.   JAMA Netw Open. 2020;3(2):e1921451. doi:10.1001/jamanetworkopen.2019.21451 PubMedGoogle ScholarCrossref
    2.
    Howard  JT, Sparks  CS, Santos-Lozada  AR, Olowolaju  SA, Janak  JC, Howard  KJ.  Trends in mortality among pregnant and recently pregnant women in the US, 2015-2019.   JAMA. 2021;326(16):1631-1633. doi:10.1001/jama.2021.13971 PubMedGoogle ScholarCrossref
    3.
    Denny  CH, Acero  CS, Terplan  M, Kim  SY.  Trends in alcohol use among pregnant women in the US, 2011-2018.   Am J Prev Med. 2020;59(5):768-769. doi:10.1016/j.amepre.2020.05.017 PubMedGoogle ScholarCrossref
    4.
    Gosdin  LK, Deputy  NP, Kim  SY, Dang  EP, Denny  CH.  Alcohol consumption and binge drinking during pregnancy among adults aged 18-49 years—United States, 2018-2020.   MMWR Morb Mortal Wkly Rep. 2022;71(1):10-13. doi:10.15585/mmwr.mm7101a2 PubMedGoogle ScholarCrossref
    5.
    Taylor  K, Compton  S, Kolenic  GE,  et al.  Financial hardship among pregnant and postpartum women in the United States, 2013 to 2018.   JAMA Netw Open. 2021;4(10):e2132103. doi:10.1001/jamanetworkopen.2021.32103 PubMedGoogle ScholarCrossref
    6.
    Eick  SM, Goin  DE, Izano  MA,  et al.  Relationships between psychosocial stressors among pregnant women in San Francisco: a path analysis.   PLoS One. 2020;15(6):e0234579. doi:10.1371/journal.pone.0234579 PubMedGoogle ScholarCrossref
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