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Some pregnant women still don’t believe drinking is dangerous

Four decades of research has shown the adverse outcomes associated with prenatal alcohol exposure (Fetal Alcohol Syndrome [FAS], and Fetal Alcohol Spectrum Disorder [FASD]) (1), yet substantial numbers of women continue to consume alcohol during pregnancy. The paper by Eaton et al. (2) in this issue of The American Journal of Drug and Alcohol Abuse provides important insights about the beliefs of both men and women regarding the dangers of alcohol use during pregnancy. This study is a unique exploration of beliefs of both men and women related to pregnancy drinking and the association between these beliefs and actual alcohol consumption in both pregnant and non-pregnant women. The authors found that many people do not have accurate beliefs about pregnancy risk drinking, and that these beliefs predict both the amount and frequency of consumption. These findings have important implications for possible next steps in the development of more effective pregnancy alcohol interventions via increased attention to education and emphasis on the known dangers. That this study was conducted in South Africa is of note as this country is recognized by many in the FASD (Fetal Alcohol Spectrum Disorders) research community as having amongst the highest rates of FAS and FASD in the world. It should be noted, however, that the prevalence rates presented in the first paragraph of the paper may be underestimates. The authors state that the U.S. and Canada have rates of FASD at 1 per 1000 children. Even the most conservative estimates nearly a decade ago placed the rate at 1.5 to 6.0 per 1000 (1). Most recently, the rate of full FAS in the U.S. has been estimated to be at least 2 to 7 per 1000, while the rate of FASD is estimated at 20 to 50 per 1000 (3). The authors are certainly correct, though, that rates of both FAS and FASD are substantially higher in South Africa, at as much as 91 and 207 per 1000, respectively (4). Most of the findings reported in the paper are fairly intuitive, but previously unsupported by empirical data. Given that the sample was drawn from patrons of alcohol-serving establishments, it is not surprising that the rates of alcohol use, including overall amount of consumption, frequency of consumption, and binge type episodes were high for both the men and women in the sample. It is also not unexpected that in a country with such high rates of pregnancy alcohol consumption, a substantial portion of respondents have an inaccurate understanding of how alcohol affects the fetus, believing that even fairly high levels of pregnancy drinking were safe. It is certainly alarming, though, that the pregnant and non-pregnant women did not differ significantly in their amount or frequency of alcohol consumption. This may or may not be a product of the population from which the sample was drawn. However, the most useful information provided by this study is that those women who did not believe that pregnancy drinking was problematic, and who felt that high levels and frequency of consumption were safe during pregnancy, were the heaviest drinkers. This certainly suggests that lack of knowledge, or lack of belief in available information, may play an important role in drinking among both pregnant women and women in general. Although there is a substantial literature on the screening part of SBIRT (Screening, Brief Intervention, Referral to Treatment) for pregnant women, the literature on effective interventions to reduce risky drinking in pregnancy is limited (5). Indeed, it is of grave concern that, to the best of the knowledge of the authors of this commentary, despite 40 years of research there is no convincing public health evidence of a reduction in the incidence of FAS or FASD. Thus, steps forward, as in this paper, in understanding the potential reasons for continued risky drinking during pregnancy are of interest, providing clues to what might increase the effectiveness of intervention strategies. Eaton et al. have done something unique. They have explored the problem of pregnancy alcohol consumption in drinking establishments. This could be expected to provide a Keywords