Alcohol consumption during pregnancy and infant birth weight.

Heavy maternal alcohol consumption during pregnancy has been consistently linked to decreased infant birth weight but the effects of low and moderate levels of drinking on infant birth weight remain unclear. This study addresses the relationship of low to moderate alcohol consumption and birth weight in a nationally representative cohort sample (National Longitudinal Survey of Youth, n = 4409 births). Statistical methods that account for the complex sample design were used in the analysis. Multiple linear regression and logistic regression were used to adjust the relationship between drinking and birth weight for relevant covariates. Results of this study revealed a nonstatistically significant trend in the direction of greater numbers of low-birth-weight babies born to mothers who drank more frequently during pregnancy. A significant interaction between drinking and smoking was found in which the negative effects on birth weight of smoking were less for those women who drank more heavily (P = 0.046).

Maternal substance use during pregnancy and developmental outcome at age three.

PURPOSE: The data from the National Maternal and Infant Health Survey (NMIHS) and its 3-year follow-up offer a unique opportunity to study the effects of substance (alcohol, marijuana, and tobacco) use during gestation on development at age three in a nationally representative sample. Using this data, the relationship of development (language, gross motor, fine motor, and adaptive behavior) and specific behaviors (eating problems, length of play, activity level, difficulty of management, level of happiness, fearfulness, ability to get along with peers, tantrums, eating nonfood) and maternal drinking, marijuana use, and cigarette smoking was studied in a sample of live births who had been followed up at age three. METHODS: The data were analyzed using a cumulative logit model of ordinal responses. RESULTS: Higher activity level, greater difficulty of management, tantrums, eating problems, and eating nonfood were related to maternal drinking during pregnancy. Increased fearfulness, poorer motor skills, and shorter length of play were associated with maternal marijuana use during pregnancy. Less well developed language, higher activity level, greater difficulty of management, fearfulness, decreased ability to get along with peers, and increased tantrums were associated with maternal cigarette smoking during pregnancy. The preponderance of significant effects involved the behaviors studied rather than the developmental indices. IMPLICATIONS: It may be that the effects of substance use during pregnancy, especially more subtle ones, show up in behavior before they can be measured by developmental scales.

Marriage: does it protect young women from alcoholism?

The literature is replete with conflicting articles about the relationship of marital status and drinking in women. This study is an analysis of the drinking practices of women, 24 through 32 years old, who were respondents in the National Longitudinal Survey of Youth (NLSY). Variations in drinking patterns for the years 1982 through 1988 as a function of changes in marital status are detailed. Findings indicated that women who married or remarried decreased drinking, whereas those who became separated or divorced increased drinking. In the present study, women with alcoholic spouses exhibited similar changes in drinking as did other young women. Our conclusion was that the instability created by a change in social position, namely marital status, led to changes in drinking patterns during the study interval in the direction of those associated with the new social position.

The motivational correlates of drinking, smoking, and illicit drug use during pregnancy.

Despite attempts to eliminate the consumption of alcohol, tobacco, and other substances of abuse by women of childbearing age, especially during gestation, apparently many do not curtail these negative lifestyle behaviors, as evidenced by the number of poor birth outcomes and developmentally disabled children born each year. This study examined the relationship of depression, attitude toward pregnancy, a number of sociodemographic variables, and substance use by women of child-bearing age prior to and after learning of their pregnancies. Results indicated that attitude independently, and depression independently and in interaction with socio-demographic factors are associated with substance use at both time points. From this we conclude that preventive efforts should be designed and targeted at those women who are depressed, especially those who have the sociodemographic characteristics associated with heavier substance use.

The long- and short-term effects of marriage on drinking.

Descriptive and multiple regression analyses of data from the National Longitudinal Survey of Youth (NLSY), a longitudinal survey conducted annually since 1979, offer support for the many studies that demonstrate a relationship between marital status and alcohol consumption. Race, gender, history of heavy drinking, and alcoholic relatives were additional key variables utilized in the analysis. Data from this ongoing survey indicate that long-term marriage is associated with decreased drinking, except among women with a history of heavy drinking. Separation and divorce are not associated with long-term effects on current drinking. Divorce is associated with decreased drinking, at least in the short term, for men and women with a family history of alcoholism.

The relationship of drinking and birth outcome in a US national sample of expectant mothers.

Alcohol consumption by pregnant women and birth outcome were studied in 9953 livebirths, 3309 fetal deaths and 5332 infant deaths from the 1988 National Maternal and Infant Health Survey. In crude analyses, race, age, mother's education, prenatal care, parity, low birthweight, gestational age, smoking and alcohol consumption during pregnancy were significantly related to the occurrence of fetal deaths and infant deaths. Among women having livebirths, race, age, mother's education, prenatal care, prematurity, gestational age, smoking and alcohol consumption during pregnancy were significantly related to having a low birthweight baby (< 2500 g). In this group, women who drank more during pregnancy also smoked more, were younger and less educated than women who drank at lower levels or not at all. The relationship of alcohol consumption during pregnancy and infant birthweight for those women having livebirths was studied using multivariable linear regression. The results indicated that race, mother's education, baby's sex, parity, mother's height, mother's body mass index and smoking, but not alcohol consumption, were significantly related to birthweight. Multivariable logistic regressions were performed for the occurrence of low birthweight, fetal death and infant death. The effect of alcohol was significant in all these analyses. These results indicate that alcohol has an important relationship with birth outcome, but that for the drinking reported in this study, the alcohol effect on mean birthweight is small relative to that of other risk factors, accounting for the non-significant result in the multiple linear regression.

The effect of positive and negative health behavior during gestation on pregnancy outcome.

This study examined the effects of substance use (alcohol, tobacco and/or drugs (cocaine and/or marijuana)) and healthy maternal behavior (prenatal care, prenatal class, vitamins, regular exercise) during gestation on pregnancy outcome. Live births from the nationally representative 1988 National Maternal and Infant Health Survey were analyzed. Pregnancy outcomes (infant birth weight, weeks gestation, one and five minute Apgar scores, whether or not the infant was transferred to another hospital after delivery and whether or not the infant was rehospitalized) were studied in multiple linear regression and logistic regression models. The relationship of the interaction of substance use and healthy behaviors and outcome was studied in all models. It was found that women engaging in substance use while pregnant were less likely to engage in healthy behavior. However, in general, engaging in healthy behaviors had the largest positive effects on outcome for those women who engaged in multiple substance use while pregnant. Significant interactions between healthy and unhealthy behavior were found for birth weight, weeks gestation and five minute Apgar scores, indicating that engaging in positive health behavior may help moderate some of the deleterious consequences of substance use during pregnancy.

The effects of substance use during gestation on birth outcome, infant and maternal health.

This study examines the relationship of substance use to birth outcome, infant, and maternal health in a large, nationally representative sample. Multiple regression analyses, accommodating the nature of the survey data using the SUDAAN software package, indicated that drinking and smoking independently and/or interactively with depression account for poor health and serious medical conditions among pregnant women as well as negative birth outcomes or adverse health consequences in those infants who are live births. In addition, African American women and their infants are more likely than those of other racial groups to suffer these adverse outcomes. Given the risk profiles of individual illnesses, this study suggests the need for developing and targeting health education and preventive efforts specific to those groups that are clearly at greater risk.

Screening for high- and moderate-risk drinking during pregnancy: a comparison of several TWEAK-based screeners.

PURPOSE: This study investigated the use of the TWEAK and nine alternative screeners for predicting high-risk and moderate-risk drinking during pregnancy. METHOD: The analysis was based on self-reports from 404 lifetime drinkers who presented for an initial visit at nine prenatal clinics in Washington, DC. Data were collected anonymously by having women directly enter their responses onto an audio, computer-assisted interview that was programmed onto a laptop computer. Pregnancy risk drinking status was based on both average daily volume of intake and frequency of drinking 3+ drinks in a day. Each of the alternative screeners was constructed by adding one additional risk indicator to the TWEAK, and three different scoring options were explored. RESULTS: Using thresholds of 2 points for high-risk drinking and 1 point for moderate-risk drinking, the TWEAK demonstrated a sensitivity and specificity of 70.6% and 73.2% for high-risk drinking and a sensitivity and specificity of 65.6% and 63.7% for any (high- or moderate-) risk drinking during pregnancy. None of the alternative screeners resulted in significant improvement, but the addition of current smoking status showed enough promise to warrant further testing in larger samples. CONCLUSIONS: Despite some loss in sensitivity and specificity, the TWEAK, in its original or a modified form, can be extended to measures of high-risk drinking that incorporate infrequent heavy intake and can be used to test for moderate- as well as high-risk drinking. Because identification of moderate-risk drinkers substantially increases the pool of women targeted for intervention, cost implications must be considered in designing appropriate interventions.

A double-blind controlled trial of lithium carbonate primary anorexia nervosa.

In this 4-week, double-blind, parallel group study, eight young women with primary anorexia nervosa were evaluated on lithium carbonate, and eight patients were treated with placebo and served as a control. All patients participated in a behavior modification treatment program. The lithium-treated and placebo groups were comparable on nearly all findings measured at baseline (t tests), with no significant differences observed except for calories per day, percent fat composition of the daily calories, "interpersonal sensitivity" on the Hopkins Symptom Checklist-90 (HSCL-90), "self-care" on the Goldberg Anorectic Attitude Questionnaires, (GAAQ) and "manipulation of others" on the physician-rated Psychiatric Rating Scale (PRS). The data were analyzed using repeated measures analysis of covariance (ANCOVA) with the baseline measure as the covariate. Group differences appeared in the areas of "denial or minimization of illness" on the GAAQ, "selective appetite" on the PRS, and weight. Although the repeated measures ANCOVA for weight revealed a significant group-by-time interaction, indicating nonparallelism and invalidating the test for group differences, ANCOVAs performed for each individual time point showed greater weight gain in the lithium group at weeks 3 and 4.