title: Prenatal Alcohol Consumption Between Conception and Recognition of Pregnancy.
abstract: Current estimates of the rates of alcohol-exposed pregnancies may underestimate prenatal alcohol exposure if alcohol consumption in early trimester 1, prior to awareness of pregnancy, is not considered. Extant literature describes predictors of alcohol consumption during pregnancy; however, alcohol consumption prior to awareness of pregnancy is a distinct behavior from consumption after becoming aware of pregnancy and thus may be associated with different predictors. The purpose of this study was therefore to examine prevalence and predictors of alcohol consumption by women prior to awareness of their pregnancy, and trajectories of change to alcohol use following pregnancy recognition.
  
  
  
  Pregnant women (n = 1,403) were prospectively recruited from general antenatal clinics of 4 public hospitals in Australian metropolitan areas between 2008 and 2013. Women completed detailed interviews about alcohol use before and after recognition of pregnancy.
  
  
  
  Most women (n = 850, 60.6%) drank alcohol between conception and pregnancy recognition. Binge and heavy drinking were more prevalent than low-level drinking. The proportion of women who drank alcohol reduced to 18.3% (n = 257) after recognition of pregnancy. Of women who drank alcohol, 70.5% ceased drinking, 18.3% reduced consumption, and 11.1% made no reduction following awareness of pregnancy. Socioeconomic status (SES) was the strongest predictor of alcohol use, with drinkers more likely to be of high rather than low SES compared with abstainers (OR = 3.30, p < 0.001). Factors associated with different trajectories (either cessation, reduction, or continuation of drinking) included level of alcohol use prior to pregnancy recognition, age, pregnancy planning, and illicit substance use.
  
  
  
  In this sample of relatively high SES women, most women ceased or reduced drinking once aware of their pregnancy. However, the rate of alcohol-exposed pregnancies was higher than previous estimates when the period prior to pregnancy recognition was taken into account.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.|Australian Centre for Perinatal Science, University of New South Wales, Sydney, New South Wales, Australia.|Department of Psychiatry, Columbia University, New York, New York.
authors.forename: Clare
authors.initials: C
authors.lastname: McCormack
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.|Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia.|Department of Paediatrics, The Murdoch Childrens Research Institute and The University of Melbourne, Royal Children's Hospital, Victoria, Australia.
authors.forename: Delyse
authors.initials: D
authors.lastname: Hutchinson
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Lucy
authors.initials: L
authors.lastname: Burns
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Elliott
authors.affiliation: National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Allsop
authors.affiliation: Queensland Alcohol & Drug Research Education Centre, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jake
authors.initials: J
authors.lastname: Najman
authors.affiliation: Department of Obstetrics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Jacobs
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Larissa
authors.initials: L
authors.lastname: Rossen
authors.affiliation: Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia.|Department of Paediatrics, The Murdoch Childrens Research Institute and The University of Melbourne, Royal Children's Hospital, Victoria, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Olsson
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Mattick
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000523:psychology; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D063425:Binge Drinking / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D005193:Family Planning Services; D005260:Female; D005306:Fertilization; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology
keywords: Alcohol; Epidemiology; Obstetrics; Pregnancy; Public Health