Factors associated with continued alcohol use in adolescent pregnancy

Abstract

Background Prenatal exposure to alcohol has been associated with adverse perinaraI outcomes. Although as many as 1 in 2 adolescents drink alcohol at some point in pregnancy rates of continued alcohol use during adolescent pregnancy are consistently lower than pre-pregnancy use rates. Methods To identify factors that differentiate pregnant adolescents who quit drinking alcohol from those who continue, we interviewed 483 patients ≤ 17 years of age at their first prenatal visit to the University Adolescent Obstetric Clinic between January 1992 and December 1994. A structured questionnaire elicited information on demographic and reproductive characteristics; health endangering behaviors, including the use of tobacco, alcohol, marijuana and other drugs, and attempts to inflict self-injury; peer, partner and parental substance use; and depressive symptoms (BDI). Medical charts were reviewed and data entered into a computerized data base by a trained research assistant. Results 385 pregnant adolescents (80%) denied using alcohol since their last menstrual period and were removed from subsequent analyses. Of the 98 adolescents who stated they had consumed alcohol since becoming pregnant, 46 (47%) had done so in the last 30 days (continuers) while 52 (53%) denied recent alcohol use (quitters). Adolescents who denied current alcohol use were more likely to be in school (74% vs. 51%; p = .00), and to report that their own mother had her first baby as a teenager (44% vs. 28%; p = .05). Those who continued to drink alcohol reported more lifetime drinking episodes (p = .00), started drinking alcohol at younger ages (13.8 vs. 14.5 years; p = .00), and were more likely to report recent tobacco (37% vs. 11%; p = .00) or marijuana (32% vs. 8%; p = .00) use. 13% of those who continued to use alcohol admitted to having drank 5 or more drinks in a row within the last 2 weeks. Adolescents who continued to drink alcohol were also more likely to be depressed (P = .01); to have tried to inflict self-injury (p = .01); to report that one or more parents currently used alcohol (p = ,01), cocaine (p = .0l) or other illegal drugs (P = .00), or lo report that their friends used alcohol (p = .04), marijuana (p = ,03), and other illegl drugs (p = .00). Planned nature of the pregnancy, marital or employment status and household composition did not differentiate between adolescents who continued versus quit drinking alcohol in pregnancy. Conclusion These data strongly suggest that patient responses to questions about depression, parental and peer substance use, and age at first alcohol use may be used by clinicians as markers to identify adolescents who are at especially high risk of continued alcohol use in pregnancy.