Associations of education and income with alcohol use among Japanese pregnant women

Abstract

Abstract Background Alcohol use during pregnancy can lead to adverse health consequences for the fetus. Identification of pregnant women who are most likely to drink is essential for targeting interventions. However, evidence on associations of education and income with alcohol use during pregnancy is inconsistent. Methods We analyzed data from 11484 pregnant women who agreed to participate in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan from 2013 to 2017. Women were dichotomized as current drinker and non-drinker (past drinker, never drinker, constitutionally never drinker) during early pregnancy and during middle pregnancy, respectively. Multivariate logistic regression analyses were conducted to examine whether educational attainment or equivalent household income was associated with alcohol use, after adjusting for women's age, work status, smoking, income/education, and their partners' education. Results Prevalence of alcohol use during early and middle pregnancy was 21.1% and 6.5%, respectively. Higher education and higher income were significantly associated with an increased risk of alcohol use during early pregnancy; the odds ratio (OR) of ≥university education compared with ≤high school education was 1.54 (95% confidence interval [CI], 1.35-1.76), and the OR of ≥ 4 million compared with <2 million Japanese yen was 1.39 (95% CI, 1.20-1.61). Education and income were not associated with alcohol use during middle pregnancy; the corresponding ORs were 1.08 (95% CI, 0.87-1.35) and 1.03 (95% CI, 0.82-1.29), respectively. Conclusions Associations of education and income with alcohol use were observed during early pregnancy, not during middle pregnancy. No amount of alcohol and no time to drink can be considered safe during pregnancy. More public health awareness is needed to prevent alcohol use during early pregnancy. Key messages Different strategies for preventing alcohol use are required during early pregnancy and during middle pregnancy. Interventions for alcohol use during early pregnancy should focus on women with higher education and/or higher income.