Wine consumption by hazardous drinkers before and after pregnancy recognition.

OBJECTIVE: To investigate patterns of wine consumption among hazardous drinkers before and after pregnancy recognition. STUDY DESIGN: Using a standard alcohol survey, hazardous drinking was defined as either frequent or binge drinking with related consequences. Patients identified at our clinic during their first prenatal visit as being hazardous drinkers were interviewed during the prenatal and postpartum periods. The numbers of drinking days and drinks per drinking day were sought before and after pregnancy recognition. RESULTS: A total of 203 of 4494 women met the criteria as hazardous drinkers before pregnancy recognition and completed the prenatal and postpartum interviews. Wine was consumed by approximately one fourth (49, 24.1%) of these women, usually with other alcoholic beverages (45, 91.8%). Wine alone was not consumed heavily. Nearly half (46.9%) continued their wine consumption after pregnancy confirmation, although the numbers of drinking days and drinks per drinking day became significantly lower than before pregnancy awareness (p < 0.01). Thirty-five hazardous drinkers switched to wine after pregnancy recognition. CONCLUSION: Hazardous drinkers were inclined to drink wine with other alcoholic beverages yet tended to abstain or minimize consumption after pregnancy recognition.

Effect of a specialized prenatal clinic on medical student attitudes toward women with drinking problems.

OBJECTIVE: To determine if student attendance at a specialized prenatal clinic would yield any change in their comfort level and in their attitudes toward pregnant women with drinking problems. METHODS: A total of 117 third-year students rotating consecutively on our core obstetrics-gynecology clerkship consented to enrolling in this prospective cohort study between February 2004 and June 2005. Each was assigned either to attend a half-day prenatal clinic designed specifically for women with alcohol and substance use disorders (study group) or not to attend the clinic (control group). The students answered anonymously a 15-question survey (using a 5-point Likert scale from 'strongly disagree' to 'strongly agree') at the beginning and at the midway point of the eight-week clerkship. Scores averaged for each question at the two points were compared within and between the two groups using paired-samples and independent-samples t-tests. RESULTS: No differences in responses to the survey were found between the study and control groups at the beginning of the clerkship. Students who attended the clinic became more comfortable in inquiring about patient alcohol consumption (p<0.001) and about social problems such as domestic violence (p<0.001). After attending the clinic, students reported that alcoholism was associated less with a weak will (p<0.01) and that group therapy has more importance (p<0.05). In contrast, the control group disagreed less that alcohol use was more of a moral and legal problem than a medical problem (p<0.05). CONCLUSIONS: An experience at this special prenatal clinic improved medical student awareness of complexities faced by problem drinkers, enhanced their comfort in talking to pregnant alcohol drinkers, and favored more sympathy toward alcoholism in general but not necessarily during pregnancy.

Impact of alcohol exposure after pregnancy recognition on ultrasonographic fetal growth measures.

BACKGROUND: More than 3 decades after Jones and Smith (1973) reported on the devastation caused by alcohol exposure on fetal development, the rates of heavy drinking during pregnancy remain relatively unchanged. Early identification of fetal alcohol exposure and maternal abstinence led to better infant outcomes. This study examined the utility of biometry for detecting alcohol-related fetal growth impairment. METHODS: We obtained fetal ultrasound measures from routine ultrasound examinations for 167 pregnant hazardous drinkers who were enrolled in a brief alcohol intervention study. The fetal measures for women who quit after learning of their pregnancies were compared with measures for women who continued some drinking throughout the course of their pregnancies. Because intensity of alcohol consumption is associated with poorer fetal outcomes, separate analyses were conducted for the heavy (average of >or=5 drinks per drinking day) alcohol consumers. Fetal measures from the heavy-exposed fetuses were also compared with measures from a nondrinking group that was representative of normal, uncomplicated pregnancies from our clinics. Analyses of covariance were used to determine whether there were differences between groups after controlling for influences of gestational age and drug abuse. RESULTS: Nearly half of the pregnant drinkers abstained after learning of their pregnancies. When women reportedly quit drinking early in their pregnancies, fetal growth measures were not significantly different from a non-alcohol-exposed group, regardless of prior drinking patterns. Any alcohol consumption postpregnancy recognition among the heavy drinkers resulted in reduced cerebellar growth as well as decreased cranial to body growth in comparison with women who either quit drinking or who were nondrinkers. Amphetamine abuse was predictive of larger cranial to body growth ratios. CONCLUSIONS: Alterations in fetal biometric measurements were observed among the heavy drinkers only when they continued drinking after becoming aware of their pregnancies. Although the reliance on self-reported drinking is a limitation in this study, these findings support the benefits of early abstinence and the potential for ultrasound examinations in the detection of fetal alcohol effects.

Beer consumption among hazardous drinkers during pregnancy.

OBJECTIVE: The objective of this study was to examine the prevalence of beer consumption among hazardous drinkers in our pregnant patient population. METHODS: This prospective clinic-based cohort study involved women who were surveyed during their first prenatal visit. Hazardous drinking was identified on alcohol surveys as frequent or binge drinking habits with related consequences. Participants completed initial and postpartum interviews about the quantity, frequency, and type (beer, wine, liquor, and/or combinations) of alcoholic beverages consumed before and after pregnancy recognition. RESULTS: Of the total 4,494 patients who completed the survey, 203 (4.52%) met criteria for hazardous drinking, met study eligibility criteria, and completed the interviews. Beer was consumed most often (n = 151, 74.4%) and in greater quantities than wine (P < .05) or liquor (P < .01). Beer continued to be consumed by 52.3% women after pregnancy recognition. Although abstinence for prolonged periods was common during pregnancy, beer was consumed more than wine and liquor per drinking episode (2.7 versus 0.9 drinking units per drinking day; P = .002) indicating a binging pattern. Very few switched to drinking either a light beer (n = 6) or a nonalcoholic beer (n = 1). CONCLUSION: Beer is the most consumed among women with hazardous drinking habits before and after pregnancy awareness. Focusing on binge beer drinking is worthwhile during routine prenatal questioning. LEVEL OF EVIDENCE: II-2.

Sensitivity of over-the-counter pregnancy tests: comparison of utility and marketing messages.

OBJECTIVE: To determine the sensitivity of seven over-the-counter pregnancy tests (OTC-PTs) using urine containing a mixture of human chorionic gonadotropin (hCG)-related molecules as found on the first day of missed menstrual period. DESIGN: Blinded in vitro sensitivity analysis. SETTING: Medical school laboratory. PARTICIPANTS: None. INTERVENTIONS: Urine was tested with OTC-PT devices at titers of 100, 50, 25, 12.5, 6.3, and 0 mIU/mL hCG immunoreactivity, and laboratory workers rated their confidence in the test result based on whether the test result was a clear, sharp, and unquestionable band in the test window. MAIN OUTCOME MEASURES: Analytical sensitivity, defined as the urine concentration at which all OTC-PTs tested gave a positive result regardless of operator confidence score; clinical sensitivity of OTC-PTs, defined as the proportion of pregnancies likely to be detected on the first day of a missed period and calculated from the analytical sensitivity and a recently published regression curve for total urine hCG immunoreactivity in 25 urine samples from this period of gestation; percentage of tested devices showing a band in the test window at a specific hCG concentration measured devices positive; percentage faulty devices, defined as the proportion of tested devices failing to yield a band in the control window; and confidence score, determined from operator ratings for each device at each concentration of hCG. RESULTS: First Response Early Result had an analytical sensitivity of 6.3 mIU/mL, which was estimated to detect greater than 95% of pregnancies on the day of missed period. The sensitivity of Clearblue Easy Earliest Results was 25 mIU/mL, which indicated detection of 80% of pregnancies. The sensitivity of the five other products was 100 mIU/mL or greater, indicating detection of 16% or less of pregnancies. Three of these last products included faulty devices. CONCLUSION: Universal claims for OTC-PTs of more than 99% laboratory accuracy and use as early as the first day of missed period, while cleared for use by the U.S. Food and Drug Administration, are ambiguous and inappropriate for many products, according to these data. The majority of products tested were found to detect only a small percentage of pregnancies on the first day of a missed menstrual period. Until more data become available on the actual clinical sensitivity of these products, pharmacists should advise consumers to be cautious in interpreting test results.

Selecting an external light source for fetal biophysical testing.

OBJECTIVE: To select the most intense light source that penetrates tissues and is safe for fetal biophysical testing STUDY DESIGN: A 3-step series of experiments was undertaken using a digital light meter (Extech Light Probe Meter, Extech Instruments, Waltham, Massachusetts). First, the density of light through a light filter was compared between the sun and 4 commercially available light sources. Second, penetration of light through the abdominal subcutaneous tissue (3-4 cm thick) of 6 pigs was compared between these light sources. Last, the skin reaction to the preferred light source and the distance in penetrating the uterine cavity were assessed in 50 pregnant women. RESULTS: Light emitted from a halogen bulb was significantly more intense than from a photographic flash, krypton bulb or penlight. Maximal intensity was gained with the light source placed against the skin. The halogen bulb penetrated a pig's abdominal wall more than the photographic flash or krypton bulb. The thickness of a pig's abdominal wall is similar to the distance in pregnant humans near term from the skin to the uterine cavity. No thermal injury or discomfort to the skin was observed for exposures <10 seconds. CONCLUSION: The halogen bulb was safe, penetrated tissues most effectively and was the best light source for fetal biophysical testing.