title: Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences.
abstract: BACKGROUND
  South Africa has one of the world's highest rates of fetal alcohol spectrum disorder (FASD) and interpersonal trauma. These co-occurring public health problems raise the need to understand alcohol consumption among trauma-exposed pregnant women in this setting. Since a known predictor of drinking during pregnancy is drinking behavior before pregnancy, this study explored the relationship between women's drinking levels before and after pregnancy recognition, and whether traumatic experiences - childhood abuse or recent intimate partner violence (IPV) - moderated this relationship.
  
  
  METHODS
  Women with incident pregnancies (N = 66) were identified from a longitudinal cohort of 560 female drinkers in a township of Cape Town, South Africa. Participants were included if they reported no pregnancy at one assessment and then reported pregnancy four months later at the next assessment. Alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT), and traumatic experiences of childhood abuse and recent IPV were also assessed. Hierarchical linear regressions controlling for race and age examined childhood abuse and recent IPV as moderators of the effect of pre-pregnancy recognition drinking on post-pregnancy recognition AUDIT scores.
  
  
  RESULTS
  Following pregnancy recognition, 73% of women reported drinking at hazardous levels (AUDIT ≥ 8). Sixty-four percent reported early and/or recent exposure to trauma. While drinking levels before pregnancy significantly predicted drinking levels after pregnancy recognition, t(64) = 3.50, p < .01, this relationship was moderated by experiences of childhood abuse, B = -.577, t(60) = -2.58, p = .01, and recent IPV, B = -.477, t(60) = -2.16, p = .04. Pregnant women without traumatic experiences reported drinking at levels consistent with levels before pregnancy recognition. However, women with traumatic experiences tended to report elevated AUDIT scores following pregnancy recognition, even if low-risk drinkers previously.
  
  
  CONCLUSIONS
  This study explored how female drinkers in South Africa may differentially modulate their drinking patterns upon pregnancy recognition, depending on trauma history. Our results suggest that women with traumatic experiences are more likely to exhibit risky alcohol consumption when they become pregnant, regardless of prior risk. These findings illuminate the relevance of trauma-informed efforts to reduce FASD in South Africa.
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC 27708, USA. karmel.choi@duke.edu.
authors.forename: Karmel W
authors.initials: KW
authors.lastname: Choi
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Abler
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Eaton
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.forename: Desiree
authors.initials: D
authors.lastname: Pieterse
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D017579:Domestic Violence / Q000706:statistics & numerical data*; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology* / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D012742:Sex Offenses / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D014947:Wounds and Injuries / Q000150:complications* / Q000453:epidemiology