Trends in Binge Drinking and Heavy Alcohol Consumption Among Pregnant Women in the U.S., 2011 to 2020
Introduction
Alcohol-related mortality has been increasing among women in the U.S. during the past 2 decades. Although no recent studies have found increased alcohol-related mortality specifically among pregnant women, 1 study found increases in combined drug- and alcohol-related mortality. Recent data on binge alcohol use among pregnant women suggests a modest increase from 2011 to 2018 and no increase from 2018 to 2020. However, little is known about how longer trends in problematic alcohol use may differ between pregnant and nonpregnant women. This study sought to compare trends in the prevalence of binge alcohol use 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 U.S. adults that measures alcohol consumption based on a 30-day recall. The BRFSS defines binge alcohol use as 4 or more units of alcohol during a single occasion and heavy alcohol consumption as 8 or more units of alcohol 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 alcohol use 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).
- The prevalence of binge alcohol use 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).
- Binge alcohol use 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, the researchers found that binge alcohol use 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 alcohol use 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 alcohol use 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 socioeconomic and psychosocial stressors that may have been exacerbated by the COVID-19 pandemic.