title: Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary.
abstract: OBJECTIVE
  The aim of this study was to evaluate the use of a 7-day Retrospective Diary to assess peri-conceptual and mid-pregnancy alcohol consumption.
  
  
  BACKGROUND
  Alcohol consumption among women has increased significantly and is of international concern. Heavy episodic ('binge') drinking is commonplace and is associated with unintended pregnancy. Pre-pregnancy drinking is strongly associated with continued drinking in pregnancy. Routine antenatal assessment of alcohol history and current drinking is variable; potentially harmful peri-conceptual drinking may be missed if a woman reports low or no drinking during pregnancy.
  
  
  METHODS
  Cross-sectional study (n = 510) in two Scottish health board areas.
  
  
  METHODS
  Face-to-face Retrospective Diary administration from February to June 2015 assessing alcohol consumption in peri-conceptual and mid-pregnancy periods. Women were recruited at the mid-pregnancy ultrasound clinic.
  
  
  RESULTS
  Of 510 women, 470 (92·0%) drank alcohol before their pregnancy; 187 (39·9%) drank every week. Retrospective assessment of peri-conceptual consumption identified heavy episodic drinking (more than six units on one occasion) in 52·2% (n = 266); 19·6% (n = 100) reported drinking more than 14 units per week, mostly at the weekend; 'mixing' of drinks was associated with significantly higher consumption. While consumption tailed off following pregnancy recognition, 5·5% (n = 28) still exceeded the recommended daily two-unit limit in pregnancy. Multivariable logistic regression identified that women who 'binged' peri-conceptually were 3·2 times more likely to do this.
  
  
  CONCLUSIONS
  Statistically significant peri-conceptual consumption levels suggest a substantial proportion of alcohol-exposed pregnancies before pregnancy recognition. Not taking a detailed alcohol history, including patterns of consumption, will result in under-detection of alcohol-exposed pregnancies. The Retrospective Diary offers practitioners a detailed way of enquiring about alcohol history for this population.
authors.affiliation: Mother and Infant Research Unit, University of Dundee, UK.
authors.forename: Andrew
authors.identifier: http://orcid.org/0000-0001-9269-940X
authors.initials: A
authors.lastname: Symon
authors.affiliation: Maternal, Child and Family Health, School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Rankin
authors.affiliation: NHS Fife, Victoria Hospital, Kirkcaldy, UK.
authors.forename: Hazel
authors.initials: H
authors.lastname: Sinclair
authors.affiliation: NHS Ayrshire and Arran, Crosshouse Hospital, Kilmarnock, UK.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Butcher
authors.affiliation: School of Nursing and Health Sciences, University of Dundee, UK.
authors.forename: Kylie
authors.initials: K
authors.lastname: Barclay
authors.affiliation: School of Nursing and Health Sciences, University of Dundee, UK.
authors.forename: Rhona
authors.initials: R
authors.lastname: Gordon
authors.affiliation: School of Nursing and Health Sciences, University of Dundee, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: MacDonald
authors.affiliation: Department of Psychology, Social Work and Public Health, Oxford Brookes University, Marston, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000434:Alcoholic Beverages / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008499:Medical Records; D016742:Preconception Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D012606:Scotland / Q000453:epidemiology; D055815:Young Adult
keywords: alcohol consumption; antenatal; binge drinking; midwives; pregnancy; prenatal care; questionnaires; teratogenesis