Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences

BMC Pregnancy and Childbirth

Kathleen J Sikkema¹  Desiree Pieterse³  Donald Skinner³  Seth C Kalichman⁴  Lisa A Eaton⁴  Melissa H Watt¹  Laurie A Abler¹  Karmel W Choi² 

[1] Duke Global Health Institute, Duke University, Durham, NC, USA;Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC 27708, USA;Stellenbosch University, Unit for Research on Health and Society, Tygerberg, South Africa;Department of Psychology, University of Connecticut, Storrs, CT, USA

关键词: Intimate partner violence;    Childhood abuse;    Trauma;    Drinking;    Fetal alcohol spectrum disorder;    Pregnancy;    South Africa;   

Others  :  1127521
DOI  :  10.1186/1471-2393-14-97

 received in 2013-08-30, accepted in 2014-02-26,  发布年份 2014

【 摘 要 】

Background

South Africa has one of the world’s highest rates of fetal alcohol spectrum disorder (FASD) and interpersonal trauma. These co-occurring public health problems raise the need to understand alcohol consumption among trauma-exposed pregnant women in this setting. Since a known predictor of drinking during pregnancy is drinking behavior before pregnancy, this study explored the relationship between women’s drinking levels before and after pregnancy recognition, and whether traumatic experiences – childhood abuse or recent intimate partner violence (IPV) – moderated this relationship.

Methods

Women with incident pregnancies (N = 66) were identified from a longitudinal cohort of 560 female drinkers in a township of Cape Town, South Africa. Participants were included if they reported no pregnancy at one assessment and then reported pregnancy four months later at the next assessment. Alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT), and traumatic experiences of childhood abuse and recent IPV were also assessed. Hierarchical linear regressions controlling for race and age examined childhood abuse and recent IPV as moderators of the effect of pre-pregnancy recognition drinking on post-pregnancy recognition AUDIT scores.

Results

Following pregnancy recognition, 73% of women reported drinking at hazardous levels (AUDIT ≥ 8). Sixty-four percent reported early and/or recent exposure to trauma. While drinking levels before pregnancy significantly predicted drinking levels after pregnancy recognition, t(64) = 3.50, p < .01, this relationship was moderated by experiences of childhood abuse, B = -.577, t(60) = -2.58, p = .01, and recent IPV, B = -.477, t(60) = -2.16, p = .04. Pregnant women without traumatic experiences reported drinking at levels consistent with levels before pregnancy recognition. However, women with traumatic experiences tended to report elevated AUDIT scores following pregnancy recognition, even if low-risk drinkers previously.

Conclusion

This study explored how female drinkers in South Africa may differentially modulate their drinking patterns upon pregnancy recognition, depending on trauma history. Our results suggest that women with traumatic experiences are more likely to exhibit risky alcohol consumption when they become pregnant, regardless of prior risk. These findings illuminate the relevance of trauma-informed efforts to reduce FASD in South Africa.

【 授权许可】

   
2014 Choi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Behnke M, Smith VC: Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics 2013, 131(3):e1009-e1024.
• [2]Lebel C, Mattson SN, Riley EP, Jones KL, Adnams CM, May PA, Bookheimer SY, O'Connor MJ, Narr KL, Kan E, Abaryan Z, Sowell ER: A longitudinal study of the long-term consequences of drinking during pregnancy: heavy in utero alcohol exposure disrupts the normal processes of brain development. J Neurosci 2012, 32(44):15243-15251.
• [3]Meyer-Leu Y, Lemola S, Daeppen JB, Deriaz O, Gerber S: Association of moderate alcohol use and binge drinking during pregnancy with neonatal health. Alcohol Clin Exp Res 2011, 35(9):1669-1677.
• [4]Sithisarn T, Granger DT, Bada HS: Consequences of prenatal substance use. Int J Adolesc Med Health 2012, 24(2):105-112.
• [5]Welch-Carre E: The neurodevelopmental consequences of prenatal alcohol exposure. Adv Neonatal Care 2005, 5(4):217-229.
• [6]Green JH: Fetal alcohol spectrum disorders: understanding the effects of prenatal alcohol exposure and supporting students. J Sch Health 2007, 77(3):103-108.
• [7]Irner TB: Substance exposure in utero and developmental consequences in adolescence: a systematic review. Child Neuropsychol 2012, 18(6):521-549.
• [8]Rehm J, Rehn N, Room R, Monteiro M, Gmel G, Jernigan D, Frick U: The global distribution of average volume of alcohol consumption and patterns of drinking. Eur Addict Res 2003, 9(4):147-156.
• [9]Martinez P, Roislien J, Naidoo N, Clausen T: Alcohol abstinence and drinking among African women: data from the world health surveys. BMC Public Health 2011, 11:160. BioMed Central Full Text
• [10]May PA, Gossage JP, Marais A-S, Adnams CM, Hoyme HE, Jones KL, Robinson LK, Khaole NCO, Snell C, Kalberg WO, Hendricks L, Brooke L, Stellavato C, Viljoen DL: The epidemiology of fetal alcohol syndrome and partial FAS in a South African community. Drug Alcohol Depend 2007, 88(2–3):259-271.
• [11]May PA, Blankenship J, Marais AS, Gossage JP, Kalberg WO, Barnard R, De Vries M, Robinson LK, Adnams CM, Buckley D, Manning M, Jones KL, Parry C, Hoyme HE, Seedat S: Approaching the prevalence of the full spectrum of fetal alcohol spectrum disorders in a South African population-based study. Alcohol Clin Exp Res 2013, 37(5):818-830.
• [12]May PA, Brooke L, Gossage JP, Croxford J, Adnams C, Jones KL, Robinson L, Viljoen D: Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province. Am J Public Health 2000, 90(12):1905-1912.
• [13]Ethen MK, Ramadhani TA, Scheuerle AE, Canfield MA, Wyszynski DF, Druschel CM, Romitti PA: Alcohol consumption by women before and during pregnancy. Matern Child Health J 2009, 13(2):274-285.
• [14]Skagerstrom J, Chang G, Nilsen P: Predictors of drinking during pregnancy: a systematic review. J Womens Health (Larchmt) 2011, 20(6):901-913.
• [15]Mallard SR, Connor JL, Houghton LA: Maternal factors associated with heavy periconceptional alcohol intake and drinking following pregnancy recognition: a post-partum survey of New Zealand women. Drug Alcohol Rev 2013, 32(4):389-397.
• [16]La Flair LN, Reboussin BA, Storr CL, Letourneau E, Green KM, Mojtabai R, Pacek LR, Alvanzo AA, Cullen B, Crum RM: Childhood abuse and neglect and transitions in stages of alcohol involvement among women: a latent transition analysis approach. Drug Alcohol Depend 2013, 132(3):491-498.
• [17]Wilsnack SC, Vogeltanz ND, Klassen AD, Harris TR: Childhood sexual abuse and women's substance abuse: national survey findings. J Stud Alcohol 1997, 58(3):264-271.
• [18]La Flair LN, Bradshaw CP, Storr CL, Green KM, Alvanzo AA, Crum RM: Intimate partner violence and patterns of alcohol abuse and dependence criteria among women: a latent class analysis. J Stud Alcohol Drugs 2012, 73(3):351-360.
• [19]Eaton LA, Kalichman SC, Sikkema KJ, Skinner D, Watt MH, Pieterse D, Pitpitan EV: Pregnancy, alcohol intake, and intimate partner violence among men and women attending drinking establishments in a Cape Town, South Africa townships. J Community Health 2012, 37(1):208-216.
• [20]Fanslow J, Silva M, Robinson E, Whitehead A: Violence during pregnancy: associations with pregnancy intendedness, pregnancy-related care, and alcohol and tobacco use among a representative sample of New Zealand women. Aust N Z J Obstet Gynaecol 2008, 48(4):398-404.
• [21]Gass JD, Stein DJ, Williams DR, Seedat S: Gender differences in risk for intimate partner violence among South African adults. J Interpers Violence 2011, 26(14):2764-2789.
• [22]Seedat M, Van Niekerk A, Jewkes R, Suffla S, Ratele K: Violence and injuries in South Africa: prioritising an agenda for prevention. Lancet 2009, 374(9694):1011-1022.
• [23]Dunkle KL, Jewkes RK, Brown HC, Yoshihama M, Gray GE, McIntyre JA, Harlow SD: Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa. Am J Epidemiol 2004, 160(3):230-239.
• [24]Geller PA: Pregnancy as a stressful life event. CNS Spectr 2004, 9(3):188-197.
• [25]Rholes WS, Simpson JA, Campbell L, Grich J: Adult attachment and the transition to parenthood. J Pers Soc Psychol 2001, 81(3):421-435.
• [26]Statistics South Africa: City of Cape Town – 2011 Census – Ward 020. Pretoria: Statistics South Africa; 2013.
• [27]Watt MH, Ranby KW, Meade CS, Sikkema KJ, MacFarlane JC, Skinner D, Pieterse D, Kalichman SC: Posttraumatic stress disorder symptoms mediate the relationship between traumatic experiences and drinking behavior among women attending alcohol-serving venues in a South African township. J Stud Alcohol Drugs 2012, 73(4):549-558.
• [28]Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG: The alcohol Use disorders identification test: guidelines for use in primary care. 2nd edition. Geneva: WHO Department of Mental Health and Substance Dependence; 2001.
• [29]Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB: The revised conflict tactics scales (CTS2): development and preliminary psychometric data. J Family Issues 1996, 17(3):283-316.
• [30]Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Stokes J, Handelsman L, Medrano M, Desmond D, Zule W: Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl 2003, 27(2):169-190.
• [31]Palmetto N, Davidson LL, Breitbart V, Rickert VI: Predictors of physical intimate partner violence in the lives of young women: victimization, perpetration, and bidirectional violence. Violence Vict 2013, 28(1):103-121.
• [32]Wilsnack SC, Wilsnack RW, Hiller-Sturmhöfel S: How women drink: epidemiology of women’s drinking and problem drinking. Alcohol Health Res World 1994, 18:173-180.
• [33]Sawyer KM, Wechsberg WM, Myers BJ: Cultural similarities and differences between a sample of black/african and colored women in South Africa: convergence of risk related to substance Use, sexual behavior, and violence. Women Health 2006, 43(2):73-92.
• [34]Myers B, Kline TL, Browne FA, Carney T, Parry C, Johnson K, Wechsberg WM: Ethnic differences in alcohol and drug use and related sexual risks for HIV among vulnerable women in Cape Town, South Africa: implications for interventions. BMC Public Health 2013, 13:174. BioMed Central Full Text
• [35]Russell BS, Eaton LA, Petersen-Williams P: Intersecting epidemics among pregnant women: alcohol use, interpersonal violence, and HIV infection in South Africa. Curr HIV/AIDS Rep 2013, 10(1):103-110.
• [36]Kruse J, Le Fevre M, Zweig S: Changes in smoking and alcohol consumption during pregnancy: a population-based study in a rural area. Obstet Gynecol 1986, 67(5):627-632.
• [37]Croxford J, Viljoen D: Alcohol consumption by pregnant women in the Western Cape. S Afr Med J 1999, 89(9):962-965.
• [38]Desmond K, Milburn N, Richter L, Tomlinson M, Greco E, van Heerden A, van Rooyen H, Comulada WS, Rotheram-Borus MJ: Alcohol consumption among HIV-positive pregnant women in KwaZulu-Natal, South Africa: prevalence and correlates. Drug Alcohol Depend 2012, 120(1–3):113-118.
• [39]Kendall-Tackett KA: Violence against women and the perinatal period: the impact of lifetime violence and abuse on pregnancy, postpartum, and breastfeeding. Trauma, Violence, & Abuse 2007, 8(3):344-353.
• [40]Tomlinson M, O'Connor MJ, le Roux IM, Stewart J, Mbewu N, Harwood J, Rotheram-Borus MJ: Multiple risk factors during pregnancy in South Africa: the need for a horizontal approach to perinatal care. Prev Sci 2013. DOI 10.1007/s11121-013-0376-8
• [41]Alvik A, Haldorsen T, Groholt B, Lindemann R: Alcohol consumption before and during pregnancy comparing concurrent and retrospective reports. Alcohol Clin Exp Res 2006, 30(3):510-515.
• [42]Hutchinson D, Moore EA, Breen C, Burns L, Mattick RP: Alcohol use in pregnancy: prevalence and predictors in the longitudinal study of Australian children. Drug Alcohol Rev 2013, 2013:2013.
• [43]Pretorius L, Naidoo A, Reddy SP: “Kitchen cupboard drinking”: a review of South African women's secretive alcohol addiction, treatment history, and barriers to accessing treatment. Soc Work Public Health 2009, 24(1–2):89-99.
• [44]Scott-Sheldon LA, Carey MP, Carey KB, Cain D, Harel O, Mehlomakulu V, Mwaba K, Simbayi LC, Kalichman SC: Patterns of alcohol use and sexual behaviors among current drinkers in Cape Town, South Africa. Addict Behav 2012, 37(4):492-497.
• [45]Parry CD, Bhana A, Myers B, Pluddemann A, Flisher AJ, Peden MM, Morojele NK: Alcohol use in South africa: findings from the south african community epidemiology network on drug use (SACENDU) project. J Stud Alcohol 2002, 63(4):430-435.
• [46]O'Connor MJ, Tomlinson M, Leroux IM, Stewart J, Greco E, Rotheram-Borus MJ: Predictors of alcohol use prior to pregnancy recognition among township women in Cape Town, South Africa. Soc Sci Med 2011, 72(1):83-90.
• [47]May PA, Blankenship J, Marais AS, Gossage JP, Kalberg WO, Joubert B, Cloete M, Barnard R, De Vries M, Hasken J, Robinson LK, Adnams CM, Buckley D, Manning M, Parry CD, Hoyme HE, Tabachnick B, Seedat S: Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): Quantity, frequency, and timing of drinking. Drug Alcohol Depend 2013, 133(2):502-512.
• [48]O'Leary CM, Nassar N, Kurinczuk JJ, de Klerk N, Geelhoed E, Elliott EJ, Bower C: Prenatal alcohol exposure and risk of birth defects. Pediatrics 2010, 126(4):e843-e850.
• [49]Jennings A: Models for developing trauma-informed behavioral health systems and trauma-specific services. Alexandria, VA: National Association of State Mental Health Program Directors, National Technical Assistance Center for State Mental Health Planning; 2004.