Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women

Panagiota Kitsantas; Kathleen F. Gaffney; Huichuan Wu

doi:10.1515/jpm-2013-0323

Article

Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women

Panagiota Kitsantas , Kathleen F. Gaffney and Huichuan Wu

Published/Copyright: May 1, 2014

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From the journal Journal of Perinatal Medicine Volume 43 Issue 1

Abstract

Aims: Recent studies indicate that older women are more likely to consume alcohol during pregnancy, but subgroups at highest risk within the context of maternal age have not been identified. This study identifies subgroups at risk for alcohol use during pregnancy among three age categories using classification and regression trees (CART) analysis.

Methods: Using the 2002–2009 Pregnancy Risk Assessment Monitoring System (PRAMS) dataset (311,428 records of U.S. women), logistic regression and classification trees were constructed separately for age groups, ≤24, 25–29, and ≥30 years.

Results: Overall, 6.5% of women reported drinking alcohol during the last trimester of pregnancy. Alcohol consumption by age group was: 3.7% for ≤24, 5.7% for 25–29, and 10.1% for ≥30 years of age. Women ≤24 years were at greater risk of consuming alcohol if they also smoked (5.8%). Among nonsmokers, higher levels of education and being Hispanic were associated with a 35% increase in alcohol use. Distinct high-risk subgroups emerged for the 25–29-year-old group. Specifically, 12.8% of non-obese women who reported having experienced abuse during pregnancy also reported drinking alcohol in the last trimester. About 16% of women ≥30 years with at least 16 years of education, White or Hispanic with normal or underweight BMI, drank alcohol during their last trimester.

Conclusions: Given limited health care resources for prevention and treatment, the early identification of high-risk groups for prenatal alcohol use is critical. This study provides evidence that risk factors contributing to alcohol consumption during pregnancy may differ by maternal age.

Keywords: Alcohol consumption during pregnancy; CART; classification trees; maternal age; PRAMS

Corresponding author: Panagiota Kitsantas, Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA, Tel.: +(703) 993-9164, Fax: +(703) 993-1953, E-mail: pkitsant@gmu.edu

Acknowledgments

This work has been funded by ABRMF/The Foundation for Alcohol Research. We would like to thank the Pregnancy Risk Assessment Monitoring System (PRAMS) Working Group and the Centers for Disease Control and Prevention for providing the PRAMS data set for this study.

References

[1] Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and regression trees. Bemont, CA: Wadsworth; 1984.Search in Google Scholar

[2] Cheng D, Kettinger L, Uduhiri K, Hurt L. Alcohol consumption during pregnancy: prevalence and provider assessment. Obstet Gynecol. 2011;117:212–7.10.1097/AOG.0b013e3182078569Search in Google Scholar PubMed

[3] Ethen MK, Ramadhani TA, Scheuerle AE, Canfield MA, Wyszynski DF, Druschel CM, et al. Alcohol consumption by women before and during pregnancy. Matern Child Health J. 2009;13:274–85.10.1007/s10995-008-0328-2Search in Google Scholar PubMed PubMed Central

[4] Harrison PA, Sidebottom AC. Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation. Matern Child Health J. 2009;13:386–94.10.1007/s10995-008-0355-zSearch in Google Scholar PubMed

[5] Hutson JR, Stade B, Lehotay DC, Collier CP, Kapur BM. Folic acid transport to the humanfetus is decreased in pregnancies with chronic alcohol exposure. PLoS one. 2012;7:e38057.10.1371/journal.pone.0038057Search in Google Scholar PubMed PubMed Central

[6] IBM Corp. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp; 2011.Search in Google Scholar

[7] Johnson SF, McCarter RJ, Ferencz C. Changes in alcohol, cigarette, and recreational drug use during pregnancy: implications for intervention. Am J Epidemiol. 1987;126:695–702.10.1093/oxfordjournals.aje.a114709Search in Google Scholar PubMed

[8] Kitsantas P, Gaffney KF. Risk profiles for overweight/obesity among preschoolers. Early Hum Dev. 2010;86:563–8.10.1016/j.earlhumdev.2010.07.006Search in Google Scholar PubMed

[9] Kitsantas P, Hollander M, Li L. Assessing the stability of classification trees. J Stat Plan Inference. 2007;137: 3917–29.10.1016/j.jspi.2007.04.010Search in Google Scholar

[10] Kitsantas P, Moore T, Sly DF. Using classification trees to profile adolescent smoking behaviors. Addict Behav. 2007;32:9–23.10.1016/j.addbeh.2006.03.014Search in Google Scholar PubMed

[11] Maloney E, Hutchinson D, Burns L, Mattick RP, Black E. Prevalence and predictors of alcohol use in pregnancy and breastfeeding among Australian women. Birth. 2011;38:3–9.10.1111/j.1523-536X.2010.00445.xSearch in Google Scholar PubMed

[12] Martin SL, Beaumont JL, Kupper LL. Substance use before and during pregnancy: links to intimate partner violence. Am J Drug Alcohol Abuse. 2003;29:599–617.10.1081/ADA-120023461Search in Google Scholar

[13] Meschke LL, Hellerstedt W, Holl JA, Messelt S. Correlates of prenatal alcohol use. Matern Child Health J. 2008;12:442–51.10.1007/s10995-007-0261-9Search in Google Scholar

[14] O’Connor MJ, Whaley SE. Alcohol use in pregnant low-income women. J Stud Alcohol. 2003;64:773–83.10.15288/jsa.2003.64.773Search in Google Scholar

[15] Ockene JK, Ma Y, Zapka JG, Pbert L, Valentine Goins K, Stoddard A. Spontaneous cessation of smoking and alcohol use among low-income pregnant women. Am J Prev Med. 2002;23:150–9.10.1016/S0749-3797(02)00492-0Search in Google Scholar

[16] Pawloski LR, Kitsantas P. Classification tree analysis of stunting in Malian adolescent girls. Am J Hum Biol. 2008;20:285–92.10.1002/ajhb.20716Search in Google Scholar

[17] Pirie PL, Lando H, Curry SJ, McBride CM, Grothaus LC. Tobacco, alcohol, and caffeine use and cessation in early pregnancy. Am J Prev Med. 2000;18:54–61.10.1016/S0749-3797(99)00088-4Search in Google Scholar

[18] Salford Systems. CART Software Release 6.0 edition. San Diego, CA: Salford Systems; 2008.Search in Google Scholar

[19] Skagerstrom J, Chang G, Nilsen P. Predictors of drinking during pregnancy: a systematic review. J Womens Health (Larchmt). 2011;20:901–13.10.1089/jwh.2010.2216Search in Google Scholar PubMed PubMed Central

[20] Strandberg-Larsen K, Grønboek M, Andersen AM, Andersen PK, Olsen J. Alcohol drinking pattern during pregnancy and risk of infant mortality. Epidemiology. 2009;20:884–91.10.1097/EDE.0b013e3181bbd46cSearch in Google Scholar PubMed

[21] Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O’Malley K, Young JK. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004;26:228–38.10.1097/00004703-200408000-00002Search in Google Scholar PubMed

[22] Substance Abuse and Mental Health Services Administration, Office of Applied Studies. The NSDUH Report: Alcohol use among pregnant women and recent mothers: 2002 to 2007. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2008.Search in Google Scholar

[23] Tsai J, Floyd RL, Green PP, Boyle CA. Patterns and average volume of alcohol use among women of childbearing age. Matern Child Health J. 2007;11:437–45.10.1007/s10995-007-0185-4Search in Google Scholar PubMed

[24] United States Department of Health and Human Services. U.S. Surgeon General releases advisory on alcohol use in pregnancy: urges women who are pregnant or who may become pregnant to abstain from alcohol. Washington, DC: United States Department of Health and Human Services; 2007. Available at: http://www.surgeongeneral.gov/pressreleases/sg02222005.html (accessed 30 July 2012).Search in Google Scholar

[25] Walker MJ, Al-Sahab B, Islam F, Tamim H. The epidemiology of alcohol utilization during pregnancy: an analysis of the Canadian Maternity Experiences Survey (MES). BMC Pregnancy Childbirth. 2011;11:52.10.1186/1471-2393-11-52Search in Google Scholar PubMed PubMed Central

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-11-28

Accepted: 2014-4-4

Published Online: 2014-5-1

Published in Print: 2015-1-1

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Articles in the same Issue

https://doi.org/10.1515/jpm-2013-0323

Keywords for this article

Alcohol consumption during pregnancy; CART; classification trees; maternal age; PRAMS