Numerous studies have clearly shown that heavy drinking during pregnancy is the largest preventable cause of birth defects and mental retardation in the United States. Among most Western countries, the medical and official position on drinking during pregnancy has been to recommend abstention. However, research has shown that information about the potentially harmful effects of drinking alcohol during pregnancy does not necessarily lead to knowledge of the issue, nor do information and knowledge necessarily affect a pregnant woman’s attitude toward drinking. A study in the October issue of Alcoholism: Clinical & Experimental Research examines where a group of pregnant Danish women obtained their information about drinking during pregnancy, their knowledge of the subject, and their attitudes toward it.
“Several studies have suggested that passive receipt of information may possibly – but not necessarily – influence awareness and knowledge, but not attitudes or behavior,” said Ulrik Kesmodel, associate professor of epidemiology and social medicine at the University of Aarhus and lead author of the study. “Yet it seems that many politicians and people working with public health believe that just more information will help people change their lifestyle. In reality, information is just one element in changing attitudes and behavior. Knowledge, previous experiences, social influences, current health habits, and underlying possibilities of change are the key determinants of change in attitudes and motivation and, eventually, health habits. The current policy of informing each pregnant woman when she presents herself for prenatal care may affect her knowledge, at best, but none of the other elements are targeted. In this sense, health authorities do not seem to have understood how information, knowledge, and attitudes interact.”
In Denmark, all pregnant women are offered and most take advantage of free prenatal care at centers run by midwives. For this 1998 study, researchers recruited and interviewed 439 pregnant, Danish-speaking women who were seeking prenatal care at 15 to 16 weeks of gestation. The women were asked about their sources and levels of information about drinking during pregnancy; their beliefs about and knowledge of drinking during pregnancy, as well as their attitudes toward drinking during pregnancy.
Only one third of the women had discussed drinking during pregnancy with their general practitioner (GP) or midwife. Most of their information was gleaned from the mass media (65%) and relatives (40%). A majority of the women (76%) considered some alcohol during pregnancy to be acceptable, mostly on a weekly level; however, 85 percent regarded binge drinking as harmful. The women’s attitudes toward drinking during pregnancy appeared to exist independent of their knowledge of the subject.
“It is true that only one third said they had discussed alcohol in pregnancy with their GP or a midwife,” said Kesmodel, “however, some pregnant women had probably forgotten discussing this, so the figures are likely higher. Still, this number is quite low, and seems to suggest two things: first, that GPs and midwives could probably do more to get the message across, and second, that health authorities should not rely on this method alone of getting the message across.” Kesmodel suggested that health authorities also target the two most trusted sources of information that were cited: media and family.
“The mass media is a powerful medium for providing information to the general public,” said Kesmodel, “including the families of pregnant women. In addition, we know that pregnant women judge the information they receive from health personnel according to information available from the media, education, friends and family. Furthermore, by targeting the media and family as sources of information, health authorities may also affect social influences on pregnant women, a key determinant of change in attitude.”
“We see many studies of risk factors,” said Jørn Olsen, professor and head of the Danish Epidemiology Science Centre at the University of Aarhus, “and too few studies of how we could best handle health promotion. We need to track what kinds of effects different health information strategies have.”
Another finding – that a majority of the women believed drinking some alcohol during pregnancy was acceptable – existed independently of whether or not the women had been informed or were knowledgeable about the topic. Kesmodel said this finding raises fundamental questions about how and why women form their beliefs about drinking during pregnancy.
“What is the evidence,” he asked, “that alcohol consumption of a few drinks per month or even per week, as opposed to daily intake, may be harmful in pregnancy? If there is no consistent data to suggest that an occasional drink is harmful, it is possible that a large proportion of pregnant women and health personnel will not be convinced by repeated statements that total abstinence is necessary during pregnancy. Many obstetricians in the U.S. do not appear to believe that a few drinks per week in pregnancy does harm to the fetus. If health professionals cannot reach a consensus on the issue, how can we expect pregnant women to follow an ‘official’ recommendation?”
Kesmodel said that it’s important to ask some tough, albeit unpopular, questions. “The lack of information on thresholds for adverse outcomes in many countries,” he said, “has been mentioned as a barrier to managing women’s alcohol use in pregnancy. There are a substantial number of women who drink small amounts of alcohol [during] pregnancy, and many of them seem to be told by doctors and midwives that an occasional drink is all right. If the only official recommendation is to not drink, [then] these women are not told that there is a limit, nor approximately what the limit is. So we need to ask the question: Where is the limit? Reaching a consensus on this would allow us to standardize information for these women.”
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Kesmodel, U., Schioler Kesmodel, P. (October, 2002). Drinking during pregnancy: Attitudes and knowledge among pregnant Danish women, 1998. Alcoholism: Clinical & Experimental Research, 26(10), 1553-1560.