Changes in drinking patterns during and after pregnancy among mothers of children with fetal alcohol syndrome: A study in three districts of South Africa.
Mixed ancestry populations in South Africa have amongst the highest rates of fetal alcohol syndrome (FAS) worldwide. Defining the drinking patterns of women with a FAS child guides FAS preventive interventions.



Data were drawn from FAS prevalence surveys conducted in three districts: Witzenberg (Cape Winelands), Frances Baard (inland mining town) and Saldanha Bay (coastal towns). 156 mothers and 50 proxy informants of school-entry children diagnosed with FAS and partial-FAS were interviewed, and compared with 55 controls recruited in Saldanha Bay.



Study participants were of low socio-economic status (SES), and a majority of children were either in foster care (12%) or had been cared for by relatives for long periods (44%). Of cases, 123/160 (77%) reported current drinking, similar between sites. During pregnancy, only 35% (49/139) of cases had stopped drinking, varying between sites (from 21% to 54% in chronological order of surveys; p<0.001), while 6% (7/109) increased drinking. Though many women who stopped in pregnancy resumed postpartum, cessation in pregnancy was strongly associated with discontinuation in the long run (OR=3.3; 95%CI=1.2-8.9; p=0.005). At interview, 36% of cases (54/151) and 18% of controls (9/51) were at risk of an alcohol-exposed pregnancy (p=0.02). Median maternal mass of cases was 22kg lower than controls, with 20% being underweight and 14% microcephalic.



Increasing rates of drinking cessation during pregnancy over time suggest rising awareness of FAS. Cessation is associated with recidivism after pregnancy but also with reduced long-term drinking. Interventions should target alcohol abstinence in pregnancy, but extend into the puerperium.
Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602 Stellenbosch, South Africa; International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZ P114-9000 Ghent, Belgium. Electronic address: urban@sun.ac.za.
Michael F
MF
Urban
Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602 Stellenbosch, South Africa; Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa; Governor Kremer's Centre, Maastricht University Medical Centre, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands.
Leana
L
Olivier
Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa.
Jacobus G
JG
Louw
Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa.
Chanelle
C
Lombard
Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa.
Denis L
DL
Viljoen
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Fiona
F
Scorgie
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZ P114-9000 Ghent, Belgium.
Matthew F
MF
Chersich
D000328:Adult; D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D004327:Drinking Behavior / Q000502:physiology*; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class; D013019:South Africa / Q000453:epidemiology
Drinking patterns; Fetal alcohol syndrome; Maternal risk factors; South Africa