title: Educational differences in continuing or restarting drinking in early and late pregnancy: role of psychological and physical problems.
abstract: OBJECTIVE
  Many women continue drinking alcohol during pregnancy. This study aimed to describe educational differences in continued drinking in early and late pregnancy and to examine the contribution of psychological and physical factors to the explanation of educational differences.
  
  
  METHODS
  We examined 4,885 women enrolled in the Amsterdam Born Children and their Development study. Information on alcohol intake during pregnancy was based on self-reports at the 16th week of gestation and at 3 months postpartum. Only women who reported alcohol intake before pregnancy were included. Explanatory factors were alcohol intake before pregnancy, psychological problems, and physical problems.
  
  
  RESULTS
  The risk of continued drinking in early pregnancy was increased in higher educated women (odds ratio [OR] = 1.41, 95% CI [1.25, 1.60]); in addition, in late pregnancy, higher educated women had an increased risk of restarting (OR = 1.67, 95% CI [1.37, 2.04]) and continuing drinking (OR = 1.77, 95% CI [1.36, 2.30]). The intensity of alcohol intake before pregnancy and all physical and psychological problems together explained 17.1% and 8.8% of the educational differences in continued drinking in early pregnancy, respectively.
  
  
  CONCLUSIONS
  Higher educated women are more likely to continue drinking during pregnancy. The intensity of alcohol intake before pregnancy and physical and psychological problems contributed to the explanation of continued drinking. However, other factors may play a greater role, such as cultural factors and social norms.
authors.affiliation: Bielefeld Graduate School in History and Sociology, Faculty of Sociology, Bielefeld University, Bielefeld, Germany, Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands, FAS Ambulance, Polyclinic for Children's and Youth Medicine, University Hospital Munster, Munster, Germany.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pfinder
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.affiliation: FAS Ambulance, Polyclinic for Children's and Youth Medicine, University Hospital Munster, Munster, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Feldmann
authors.affiliation: Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands, Department of Health Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: Manon
authors.initials: M
authors.lastname: van Eijsden
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Tanja G M
authors.initials: TG
authors.lastname: Vrijkotte
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology*; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult