The primary purpose of this project is to describe trajectories of alcohol consumption before, during, and after pregnancy among women with unwanted pregnancies, and assess how the pregnancy is resolved (having the child versus termination) influences these trajectories. In this study, unwanted refers to pregnancies women sought to terminate. These alcohol trajectories can affect fetal and women's health in both the short and long term. In the short term, for women who carry unwanted pregnancies to term, failure to stop alcohol consumption during pregnancy can cause a range of fetal alcohol effects including, but not limited to, Fetal Alcohol Syndrome, and alcohol consumption after pregnancy can impair the ability to breastfeed safely. In the long term, continuation or resumption of binge or heavy drinking after pregnancy has implications for women's health and health of future pregnancies. While some research examines these alcohol trajectories among women in general, the research focuses mainly on demographic and alcohol pattern influences on changes and does not focus on women with unintended pregnancies (of which pregnancies women sought to terminate are a subset). This lack of research is surprising given that half of pregnancies are unintended and the possibility that women with unintended pregnancies may drink more or be less likely to stop drinking during pregnancy than other women. This developmental study will use data from the innovative Turn away Study dataset. The Turn away Study is a prospective, longitudinal study of women with unwanted pregnancies who sought, but did not necessarily receive elective pregnancy terminations at 30 sites across the U.S. Preliminary analyses suggest women in the sample binge drink at rates notably higher than other women. This secondary analysis study will use Structural Equation Modeling to analyze changes in alcohol consumption from baseline through two-year follow-up interviews, including whether trajectories differ by whether the woman terminates or carries the pregnancy to term. In addition, this study will extend previous research on changes in alcohol consumption over the course of pregnancy and parenting transitions by identifying modifiable risk factors (e.g. feelings about pregnancy, partner violence, stress, depression/anxiety) associated with failure to stop or reduce alcohol consumption. Findings will contribute to our scientific understanding of how having a child from an unwanted pregnancy and pregnancy termination affects alcohol consumption. Further, findings from this developmental study will be used to inform interventions to prevent and limit alcohol-exposed pregnancies and alcohol-impaired parenting among women with unwanted pregnancies. Specifically, findings will inform adaptation of alcohol interventions by 1) identifying modifiable risk factors for failure to stop/reduce alcohol consumption after pregnancy recognition and failure to maintain pregnancy-related reductions in consumption and 2) exploring the possibility of reaching this high risk population to deliver the intervention in a range of health care settings either before pregnancy or in the postpartum or interconception periods.

Public Health Relevance

The changes women make in alcohol consumption before, during, and after pregnancy can affect both fetal and women's health. While unwanted pregnancy is common in the United States, we have little information about pregnancy-related alcohol changes among women with unwanted pregnancy. Understanding these changes, as well as factors that influence these changes, is crucial to our ability to design and implement effective alcohol interventions for this population.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Exploratory/Developmental Grants (R21)
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Biomedical Research Review Subcommittee (AA)
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Scott, Marcia S
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University of California San Francisco
Obstetrics & Gynecology
Schools of Medicine
San Francisco
United States
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Roberts, S C M; Subbaraman, M S; Delucchi, K L et al. (2016) Moderators and mediators of the relationship between receiving versus being denied a pregnancy termination and subsequent binge drinking. Drug Alcohol Depend 159:117-24
Roberts, S C M; Ralph, L J; Wilsnack, S C et al. (2016) Which women are missed by primary health-care based interventions for alcohol and drug use? Addict Behav 55:32-7
Roberts, Sarah C M; Delucchi, Kevin; Wilsnack, Sharon C et al. (2015) Receiving Versus Being Denied a Pregnancy Termination and Subsequent Alcohol Use: A Longitudinal Study. Alcohol Alcohol 50:477-84
Roberts, Sarah C M; Wilsnack, Sharon C; Foster, Diana Greene et al. (2014) Alcohol use before and during unwanted pregnancy. Alcohol Clin Exp Res 38:2844-52