Background
The association between alcohol use and numerous adverse health consequences for the fetus and the developing child later on in life has been well documented since the 1970s. Research on the effects of small amounts has shown differing results. In a review of published studies, Henderson and colleagues concluded that there is no consistent evidence of the harm caused by small to moderate amounts of alcohol consumed during pregnancy. Further studies on specific outcomes published after the review support this conclusion. However, no level of alcohol consumption has been determined as completely safe during pregnancy. Therefore, total abstinence during pregnancy is recommended by policy makers in many countries, including Sweden.
Sweden has experienced an increase in alcohol consumption during the last decades. Simultaneously, there has been a progressive increase in the age of Swedish women giving birth to their first child, from 23.8 years in 1973 to 28.9 years in 2009 and many women have consumed alcohol for 15 years or more when they begin their first pregnancy. This potentially makes it more difficult to cease drinking when becoming pregnant and abstain throughout the pregnancy.
Previous studies in Sweden have been conducted at single antenatal care centers in three large cities (Stockholm, Linköping, and Uppsala) and have reported prevalence rates of drinking during pregnancy ranging from 6% to 30%. However, differences in methodology make it difficult to compare the results of these studies. Population-based studies show that alcohol consumption in Sweden varies between different regions of the country; consumption is higher in larger cities than in rural areas. The extent to which there might be corresponding patterns of drinking during pregnancy has not previously been investigated in Sweden.
Predictors for drinking during pregnancy identified in previous Swedish studies include the Alcohol Use Disorder Identification Test (AUDIT) score for drinking prior to pregnancy, higher frequency of pre-pregnancy drinking, higher maternal age, having given birth before, and nicotine use in early pregnancy. International studies have reported on the relevance of a wide range of potential predictors for drinking during pregnancy that have not been confirmed in a Swedish context, including education level, employment status, civil status, and social support. Research on behavioral changes in various domains suggests that it might be important to explore the extent to which pre-pregnancy drinking constitutes a habit that inhibits the ability to cease drinking when becoming pregnant. The aim was to investigate alcohol use before and during pregnancy and predictors for drinking during pregnancy in Sweden. This knowledge could potentially inform and improve preventive efforts in antenatal care.