Alcohol use in pregnancy: mixed methods applied to the Australian Longitudinal Study on Women’s Health

Research Doctorate - Doctor of Philosophy (PhD)Population health guidelines aim to reduce the burden of disease by providing evidence-based recommendations that can inform health behaviours. Such guidelines are used internationally, as well as in Australia, to assist in preventing the burden associated with alcohol use during pregnancy. Consuming alcohol during pregnancy at high levels may lead to severe outcomes such as Fetal Alcohol Spectrum Disorder, stillbirth, miscarriage and growth restriction. The impact of low level alcohol use during pregnancy is unclear and complex, leading to an inability to define a specific threshold at which harm occurs. The lack of clarity has led to inconsistent alcohol guidelines for pregnant women, particularly in Australia. The Australian alcohol guidelines in 1992 initially recommended abstinence, before revising the recommendation in 2001 to condone low intake, and then reverting back to abstinence in 2009. At the time of commencing this thesis, no study had assessed the population-based prevalence and predictors of alcohol use during pregnancy in respect to the change of guidelines in 2009. This thesis used a mixed methods approach applied to the Australian Longitudinal Study on Women’s Health, a prospective cohort, to investigate predictors of alcohol use during pregnancy, within the context of the changing Australian alcohol guidelines. The two specific thesis aims were to identify: (i) the prevalence of alcohol use during pregnancy since the introduction of the 2009 alcohol guidelines; and (ii) the factors contributing to alcohol use among pregnant women within Australia. The results suggest that more than 70% of women consume alcohol during pregnancy, even with the message of abstinence; although such a message did correspond with a lower prevalence compared to the prevalence under the low intake guidelines. The most consistent indicator of alcohol use during pregnancy was pre-pregnancy alcohol patterns, particularly weekly and binge drinking. These behaviours were often continued into pregnancy, putting both the woman and fetus at an increased risk of potential adverse outcomes. Qualitative interviews with women who were pregnant after 2009 suggest that the message of “not drinking is the safest option” has not filtered down in a clear and consistent manner. Such communication was desired by the women, particularly via healthcare professionals, to enable them to make informed choices about alcohol use during pregnancy. These findings taken together suggest that the change of population alcohol guidelines to an abstinence message for pregnant women requires systematic dissemination via policy and practice to ensure that women are provided with information and support to reduce and abstain from alcohol use during pregnancy