Many people are aware that drinking alcohol during pregnancy can place the developing fetus at risk of Fetal Alcohol Syndrome (FAS), the largest preventable cause of birth defects and mental retardation in the United States. Fewer people are aware of the role that beverage preference may play in the amount of alcohol exposure. A study in the February issue of Alcoholism: Clinical & Experimental Research (ACER) examines beverage preference among urban women from two ethnic groups at highest risk for infants with FAS, Native Americans and African Americans.
"Both Native American and Black women have higher rates of FAS than white women," said Lee Ann Kaskutas, a research scientist with the Alcohol Research Group at Berkeley and lead author of the study. "Yet most of the research on Native Americans has been conducted on reservations, even though many Native Americans live in urban settings. We wanted to find out what these women were drinking, and whether they were drinking in the same way as their counterparts on reservations. In general, there is little information on drinking during pregnancy among urban minority women."
Three groups of urban pregnant women were interviewed – Native Americans (n=70), African Americans (n=129), and whites (n=22) – about their drinking during the 12 months before their pregnancies. The women were asked about their consumption of six types of alcoholic beverages – beer, wine, spirits, malt liquor, fortified wine, and wine coolers – during this time period.
"We included a number of beverage types to be sure that we were indeed capturing most of the alcoholic beverages consumed," explained Kaskutas. "We had evidence from some focus groups conducted with minority pregnant women that they were consuming a variety of alcoholic beverages, which included malt liquor, fortified wine and wine coolers. We were particularly interested in malt liquor and fortified wine because they contain more absolute alcohol per ounce than beer or wine, respectively. In most surveys on drinking, information is only collected for beer, wine and spirits."
The Native American women in the study preferred beer, which accounted for one-third of their total intake, followed by spirits, which accounted for one-quarter of their intake. The African American women in the study had an equal preference for malt liquor and spirits, each accounting for approximately one-quarter of their intake.
"These women were not drinking like a middle-class, more educated white woman, whose beverage of choice is wine," said Kaskutas. "Instead they were drinking beer, malt liquor and spirits. Malt liquor is stronger than regular beer; it contains about one-quarter to one-third more alcohol per ounce than does a regular beer. This means that for those women who were drinking the stronger product, the amount of alcohol being consumed is greatly underestimated."
"Different U.S. states and regions have very different market shares of lighter versus heavier alcohol-content malt and wine products," said Tom Greenfield, Center director at the Alcohol Research Group. "This study, though small, is absolutely critical. It reinforces the fact that beverage-specific differences seen among at-risk subgroups are large and ‘clinically significant’ in terms of their impact on the doses consumed and the subsequent FAS risks. Kaskutas has added to a small but important literature arguing for greater specificity in terms not only of the three main beverage types – wine, beer and spirits – but of the respective products’ high-strength classes like malt liquor and fortified wine."
Both Greenfield and Kaskutas noted that this study’s findings add to those of an earlier study (see the August 2000 issue of ACER), which found serious misconceptions about alcohol among minority women who continued to drink while pregnant. Some women would claim they only had one drink per day, considered by researchers to be the equivalent of a 12-ounce can of beer or a four-ounce glass of wine. That one drink, however, was in fact a 40-ounce bottle of malt liquor. Some women thought alcohol was only bad for the baby "if it burns going down."
"We believe that our findings are timely," said Kaskutas, "and, when combined, we hope they will spur other researchers to expand upon the list of the types of beverages they include in questionnaires, as well as to include questions which get at what a respondent considers to be the size of a drink. We are currently in the process of a controlled trial at a large health maintenance organization, in which the assessment of drink size is being used as an intervention in their prenatal clinics. Women are often very surprised to discover how large their drinks really are, and to learn that the alcohol content is not the same across all the beverages they drink. We use this ‘vessels’ intervention as a vehicle for opening the door for honest communication about their pregnancy drinking, which is usually a taboo subject with many women denying their consumption. We are hopeful that other clinics will use our computerized intervention once we have the results of the trial, in another two years or so."
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:
Graves, K., & Kaskutas, L.A. (2002, February). Beverage choice among Native-American and African American urban women. Alcoholism: Clinical and Experimental Research, 26(2), 218-222.