Running head: ALCOHOL CONSUMPTION DURING PREGNANCY

Alcohol Consumption during Pregnancy

Paloma Garcia Duran, Alexis Lopez, Kali Robinson, and Adam Trojacek
Sam Houston State University

ALCOHOL CONSUMPTION DURING PREGNANCY

Alcohol Consumption during Pregnancy

Introduction
Centers for Disease Control and Protection (CDC) (2015a) identified that one in ten women
in the US consumed alcohol during pregnancy. These staggering numbers suggest childbearing
women may not have the necessary knowledge regarding the teratogenicity of alcohol. This lack of
knowledge can possibly contribute to poor decision making in terms of alcohol consumption while
being pregnant. As AWHONN (2009) stated any reproductive health care decision is best made by
the informed woman in consultation with her health care provider (p. 742), which means that the
decision regarding whether or not to consume alcohol during pregnancy lies with the informed
mother. Therefore, responsibility lies with the nurse to inform pregnant women about the possible
effects of alcohol consumption on the fetus, while respecting the womens confidentiality, values,
and ethics. The purpose of this paper is to help persuade pregnant women not to consume alcohol by
informing them about the results of two research studies, in which the authors worked to prove the
negative effects of alcohol consumption during pregnancy (Niclasen, Anderson, Strandberg-Larsen,
& Teasdale, 2014; Sayal et al., 2014), and argue against research that states alcohol intake in low to
moderate amounts does not have negative consequences for the child (Mortensen, Stvring, &
Kesmodel, 2012).
Supporting Research Studies
Two significant studies that address the negative impacts of maternal alcohol
consumption are Prenatal exposure to binge pattern of alcohol consumption: mental health and
learning outcomes at age 11 and "Is alcohol binge drinking in early and late pregnancy
associated with behavioural and emotional development at age 7 years?" Both of these articles
support the position of recommending that women avoid alcohol consumption during pregnancy
because the results of both studies indicate that alcohol consumption during pregnancy has

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negative impact on the childrens mental and social well-being. In addition, the results can be
used to inform pregnant women in order to help them to make pertinent decisions regarding
whether or not to consume alcohol.
Prenatal exposure to binge pattern of alcohol consumption: mental health and learning
outcomes at age 11 by Sayal et al. (2014) is a quantitative non-experimental study with a
longitudinal follow up design. The purpose of the study was to determine the effects on mental
health and academic achievement in children born from mothers who consumed alcohol in binge
patterns during pregnancy. The study was conducted in Avon, England beginning in April, 1991
and lasted eleven years. The sample size was 7,965 and consisted of white-European women
carrying only one child. Information was initially gathered using postal questionnaires to
determine episodes of binge drinking (i.e., more than four drinks per day at least one time),
quantity of daily drinking, as well as other aspects of the mothers lives. Once the child reached
11 years of age, postal Strengths and Difficulties Questionnaires (SDQ) were used to determine
the mental health status of the children, as it pertained to hyperactivity and conduct disorders,
and Key Stage 2 results were used to determine their academic success. Also, a linear regression
model was used to analyze the relationship between binge pattern drinking and the SDQ scores
and Key Stage 2 outcomes, with high confidence intervals, and multivariable regression models
were used to adjust for possible confounding effects of other variables. The researchers reported
that the children of women who binge drank alcohol during pregnancy had higher levels of
hyperactivity and inattention problems and lower academic attainment at age 11 years.
Although the authors of this study indicated that the results were statistically significant,
with high confidence intervals, and despite that v2 and t tests were used to check for possible
selection bias, some threats to internal and external validity were identified. In terms of internal
validity, the researchers analyzed confounding variables and identified that mothers who were

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heavier drinkers, unmarried, living in rental homes, or consuming illicit drugs during their
pregnancy were less likely to respond to the questionnaires, which may have impacted the
significant findings of the study. Construct validity was the largest threat to the external validity
of this study. One threat was that mothers were asked to answer postal questionnaires but were
not routinely monitored or tested by doctors in any way; therefore, the results rely on the
participants honesty. Furthermore, the follow-up questionnaires given 11 years later only asked
about the childrens level of hyperactivity or inattention and did not account for the level of at
home education, the types of home environments, or parenting styles. Other threats recognized
in the study were in terms of generalizability and selection bias. Because the study was only
focused on white-European pregnant woman, the study may not be extrapolated to other races or
ethnicities.
In summary, the results of this article support the position of recommending that pregnant
women abstain from drinking alcohol, especially in a binge pattern. This behavior seems to have
negative psychological outcomes, in terms of hyperactivity and conduct disorders, as well as
negative effects on the childs academic success. Providing this information to pregnant women
supports AWHONN's position that by informing women, they are able to make better healthcare
decisions. Thus, by reporting the results found in this article to the mother, she would have a
better understanding of the negative consequences of alcohol on the fetus and may make the
informed decision of abstaining from drinking alcohol while she is pregnant.
The second article analyzed, Is alcohol binge drinking in early and late pregnancy
associated with behavioural and emotional development at age 7 years? by Niclasen et al.
(2014) is a quantitative non-experimental study that used a predictive, correlational, longitudinal
follow up design. The purpose of this study was to compare the impact of binge drinking at
different periods of time during pregnancy on emotional and behavioral development at age

ALCOHOL CONSUMPTION DURING PREGNANCY

seven. The study derived its participants from the Danish National Birth Cohort. The sample
was further restricted to those who answered all three phone interviews, answered the
questionnaire regarding the child at age seven, and the child was a singleton of a gestational age
above 37 completed weeks. These restrictions resulted in the tested sample size consisting of
37,315 mother-child dyads. The sample was divided in three groups: (a) control/no binge group
(N= 25,781), (b) binge drinking only in the first 16 weeks (N= 3,654), and (c) binge drinking
only after 30 weeks (N=94). Those mothers that did not qualify on any of the previous three
categories were excluded. Maternal age, education, smoking, and other aspects of the
mother/paternal lives were also assessed during interviews. Once the child reached seven years
of age, a SDQ with 25 items regarding five psychological domains (hyperactivity/inattention,
conduct, emotional, peer problems, and prosocial behaviors) was sent to the mothers. Each item
was scored on a three point Likert scale and multivariable linear regressions were used to
associate SDQ scores with binge drinking. To compare the no binge group to the early and late
binge group, ANOVA and Chi squared tests were performed. Analysis of the results indicated
that exposure to one or two binge drinking episodes during early or late pregnancy was linked to
increased risk of subtle behavioral differences at age seven. The authors stated that this link is
even stronger if the binge drinking episode occurs later in the pregnancy.
Although the researchers indicated no conflict of interest, maintained confidentiality, and
obtained consent, many threats to validity weakened the studys results. These threats included
limited generalizability, results never indicated that there was a statistical significance, the
sample sizes were not equally distributed and had three quarters of the participants in the control
group, results were dependent on the participants sincerity, and binge drinking was defined
differently as in other studies (i.e., five or more as compared to four or more alcoholic drinks).
Although researchers attempted to control some of the confounding variables, the study indicated

ALCOHOL CONSUMPTION DURING PREGNANCY

having poor numbers for the late bingers, who could of potentially masked results from having a
stronger effect and thus contributing to less reliable estimates and lower statistical power.
To summarize, the results of the second article helped to validate the position of this
paper that drinking alcohol during pregnancy can have a harmful impact on childs development.
The study concluded that binge drinking during pregnancy increased the possibility for damaging
emotional and behavioral development. Furthermore, the results of the study indicated that late
binge drinking exhibited more negative effects than early binge drinkers. Therefore, nurses can
use this evidence to perform their role in educating women who are pregnant or considering
becoming pregnant on the adverse effects of binge drinking during pregnancy. With this
teaching, women will be able to make better lifestyle choices.
Dissenting Research Study
The third article to be analyzed contradicts the purpose of this paper. The effects of low
to moderate prenatal alcohol exposure in early pregnancy on IQ in 5-year old children by
Mortensen et al. (2012) is a quantitative non-experimental study with a longitudinal follow-up
design performed to examine the effects of low to moderate alcohol consumption during
pregnancy on childrens cognitive development at the age of five. This study was conducted in
four Danish cities from September 2003 to June 2008. The sample, a total of 1628 mother-child
dyads, was divided into groups based on weekly alcoholic drinks (0, 14, 58, or >9
drinks/week) and timing of binge episode (none or at 12, 34, 58, or >9 weeks of gestation).
Initially, the mothers were asked the average number of beers, glasses of wine, glasses of spirits,
and binge drinking consumed weekly during pregnancy. At the 5-year follow-up, these mothers
were asked questions regarding their marital status, parental education, postnatal home
environment, dichotomized child health status, postnatal parental smoking, and if hearing or
vision were impaired. The childrens cognitive development was determined between the ages

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60 to 64 months by measuring their IQ level with the Wechsler Primary and Preschool Scales of
Intelligence test. Data was analyzed with Stata 11 using a two-tailed statistical test with
significance at the 5% level. To establish associations between alcohol exposure categories and
the IQ scores, a multiple linear regression was used. Researchers concluded that low to
moderate alcohol consumption during pregnancy did not have statistically significant effects on
the childrens IQ at the age of five. The consumption of higher levels of alcohol was associated
with a decreased IQ in children, but was not statistically significant.
To ensure validity, the researchers avoided selection bias by including the tester
differences as an indicator variable in the statistical analyses, and took into consideration several
confounding variables, such as maternal IQs, maternal smoking, childs age, and gender. The
generalizability of the study was limited because researchers excluded participants that had
multiple pregnancies, unable to speak Danish, and had impaired hearing or vision. Construct
validity was threatened due to the type of interviews being conducted and the fact that results
depended on the honesty of participants.
To conclude, the authors of this third research study disagree with this paper position
regarding discouraging maternal alcohol consumption by suggesting that low to moderate
alcohol consumption may not have a negative impact on children's mental and cognitive health.
Professional healthcare providers should be aware of dissenting studies similar to this because
results that indicate low doses of alcohol do not have negative consequences may be
misinterpreted and used as a justification to drink alcohol during pregnancy. In addition, the
amount of alcohol that the researchers of this article consider to be a "drink" is not necessarily
what women might socially consider to be an appropriate amount of alcohol. Regardless,
alcohol consumption should not be supported in any amount due to its high teratogenicity,
because as indicated in the first two articles, many negative fetal effects have been identified in

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numerous aspects, including but not limited to intellectual and psychological development of the
fetus. Therefore, alcohol intake should not be supported or encouraged.
Relevance of Alcohol Consumption during Pregnancy to Nursing Care
According to the CDC (2015a), in the U.S., 1 in 10 pregnant women reports alcohol use
(at least one alcoholic drink) and 1 in 33 reported binge drinking (more than four alcoholic
drinks in one occasion) in the past 30 days. In addition, reports from the CDC (2015a) indicated
that about half of nonpregnant women between 18 and 44 years old reported any alcohol use and
about 1 in 5 reported binge drinking in the preceding month. Therefore, due to the high
incidence of alcohol consumption, nurses have the responsibility of teaching not only pregnant
women, but also childbearing women about the negative consequences that research has shown
alcohol may have on the fetus.
Aside from the risks indicated in the focus studies, the CDC (2015b) identified several
other problems recognized in children whose mother drank alcohol during pregnancy. These
disorders are categorized as Fetal Alcohol Spectrum Disorders and include: small head size, low
body weight, coordination problems, poor memory, sleep and sucking problems as a baby, and
vision or hearing problems. Thus, alcohol can affect several body systems and have lifelong
consequences on the child. Therefore, alcohol consumption during pregnancy is an important
topic that should be addressed by healthcare providers. Nurses are in the best position to educate
childbearing women in this matter, because nursing is considered the most trustful profession in
America (Gallup, 2014).
Conclusion
Based on the evidence obtained from these research studies, this group developed several
interventions that can be implemented from a nursing care perspective in order to minimize the
number of women consuming alcohol during pregnancy. Within health care facilities, nurses

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should include teaching on alcohol consumption on their care plans for pregnant women. The
teaching should be adapted to the womens learning styles, education level, and previous
knowledge on the topic in order to achieve optimal learning outcomes and behavioral change.
From a community nursing perspective, nurses can have a role as policy developers by
increasing awareness and advocating for children. Within this function, nurses can serve as
experts providing information regarding the negative outcomes of alcohol consumption during
pregnancy. Nurses can help to develop policies, such as mandatory courses for women that
focus on the effects of alcohol consumption during pregnancy. Also, at a local level, nurses can
develop community programs to teach future mothers in several settings such as churches,
schools, and universities.
In conclusion, the research findings from the two supporting articles reinforce this
papers position regarding the discouragement of alcohol consumption during pregnancy.
Through a complete understanding of AWHONN's position statement that any healthcare
decision is best made by the informed women, the group learned that nurses carry the
responsibility to educate childbearing women on the risks of drinking alcohol during pregnancy
to minimize the risk of having children with developmental complications. Additional
information learned is that nurses should help women who might be misled by dissenting articles
to understand the risks that consuming even low to moderate amounts of alcohol could have on
their children.

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10

References
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Centers for Disease Control and Prevention. (2015b). Facts about FASDs. CDC. Retrieved from
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Mortensen, E. L., Stvring, H., & Kesmodel, U. S. (2012). The effects of low to moderate
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