An estimated 3.3 million U.S. women aged 15-44 years risk conceiving children with fetal alcohol spectrum disorders by using alcohol but not birth control.
The finding has officials at the Centers for Disease Control and Prevention urging physicians to screen this group for concomitant drinking and nonuse of contraception. The data come from an analysis of 4,303 nonpregnant, nonsterile women ages 15-44 years from the 2011-2013 National Survey of Family Growth, conducted by the CDC (MMWR. 2016;65:1-7.).
“Alcohol can permanently harm a developing baby before a woman knows she is pregnant,” Dr. Anne Schuchat, the CDC’s principal deputy director, said during a media briefing on Feb. 2. “About half of all pregnancies in the United States are unplanned, and even if planned, most women won’t know they are pregnant for the first month or so, when they might still be drinking. The risk is real. Why take the chance?”
Fetal alcohol spectrum disorders (FASD) can include physical, behavioral, and intellectual disabilities that can last for a child’s lifetime. Dr, Schuchat said the CDC estimates that as many as 1 in 20 U.S. schoolchildren may have FASD. Currently, there are no data on what amounts of alcohol are safe for a woman to drink at any stage of pregnancy.
“Not drinking alcohol is one of the best things you can do to ensure the health of your baby,” Dr. Schuchat said.
For the study, a woman was considered at risk for an alcohol-exposed pregnancy during the past month if she was nonsterile and had sex with a nonsterile male, drank any alcohol, and did not use contraception in the past month. The CDC found the weighted prevalence of alcohol-exposed pregnancy risk among U.S. women aged 15-44 years was 7.3%.
During a 1-month period, approximately 3.3 million U.S. women were at risk for an alcohol-exposed pregnancy. The highest risk group – at 10.4% – were women aged 25-29 years. The lowest risk group were those aged 15-20 years, at 2.2%.
Neither race nor ethnicity were found to be risk factors, although the risk for an alcohol-exposed pregnancy was higher among married and cohabitating women at 11.7% and 13.6% respectively, compared with their single counterparts (2.3%).
The study also found that three-quarters of women who want to get pregnant as soon as possible do not stop drinking alcohol after discontinuing contraception.
Physicians and other health care providers should advise women who want to become pregnant to stop drinking alcohol as soon as they stop using birth control, Dr. Schuchat said.
She added that physicians should screen all adults for alcohol use, not just women, even though that is not currently standard practice. “We think it should be more common to do on a regular basis.” Dr. Schuchat said the federal government requires most health plans to cover alcohol screening without cost to the patient.
The CDC recommends that physicians:
• Screen all adult female patients for alcohol use annually.
• Advise women to cease all alcohol intake if there is any chance at all that she could be pregnant.
• Counsel, refer, and follow-up with patients who need additional support to not drink while pregnant.
• Use correct billing codes to be reimbursed for screening and counseling.
The American College of Obstetricians and Gynecologists, which recommends that women completely abstain from alcohol during pregnancy, praised the CDC’s guidance that physicians routinely screen women regarding their alcohol use.
Dr. Mark S. DeFrancesco, ACOG president, said the other important message from the CDC report is that physicians should counsel women about contraception use.
“As the CDC notes, roughly half of all pregnancies in the United States are unintended. In many cases of unintended pregnancy, women inadvertently expose their fetuses to alcohol and its teratogenic effects prior to discovering that they are pregnant,” he said in statement. “This is just another reason why it’s so important that health care providers counsel women about how to prevent unintended pregnancy through use of the contraceptive method that is right for them. There are many benefits to helping women become pregnant only when they are ready, and avoiding alcohol exposure is one of them.”
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