Knowledge Gaps Regarding Alcohol Consumption During Pregnancy and Its Effect on the Fetus: A Systematic Review Focused on Women
Abstract
1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Selection/Exclusion Criteria
2.3. Data Extraction
3. Results
3.1. Search and Study Selection
3.2. Methodological Quality
3.3. Study Characteristics
Authors & Sample Country | Participants | Variables/Instruments | Main Results |
---|---|---|---|
EUROPE | |||
McKnight & Merret (1987) Northern Ireland [46] | n = 380 pregnant women. | V/I. Interview at 2 time points: before and after birth: OH consumption, knowledge of fetal OH effects, healthcare professionals who provided information about GAC, intentions regarding future drinking patterns, prenatal classes and health awareness. | Risk perception: majority believed OH harms the fetus. In prenatal interview, 5.8% believed that OH did not affect the fetus, and 10.5% didn’t know. In postnatal interview, the figures were 4.5% and 10%, respectively. Participants were unaware of a safe level of intake. Knowledge: more effects were mentioned in the postnatal interview, but few referred specifically to FAS. Lack of knowledge about specific effects decreased in the postnatal stage. They associated low birth weight more with smoking than OH. |
Lelong et al. (1995) France [44] | n = 176 pregnant or postpartum, ≥30 years, ≤16 years of education. | V/I. Sociodemographics; prenatal care; pregnancy course; OH, tobacco and coffee consumption before and during pregnancy; paternal OH and tobacco use; general attitude toward OH; reasons for changing behavior regarding OH and tobacco during pregnancy; and influence of healthcare professionals, family and friends. | Risk perception: 11% believe that drinking ≥3 glasses of wine/day is reasonable, and 17% believe the same for beer. Consuming larger amounts of beer than wine was seen as more acceptable; the acceptable OH limit increased with level of consumption. Little advice to stop drinking was received (7% from professionals, 14% from family). Knowledge: most recognized OH effects on the baby, but sustained heavy drinkers were significantly less likely to mention it |
Kristjanson et al. (2007) Russia [41] | n = 899 pregnant and women of childbearing age, 18–43 years. | V/I. 2 questionnaires (based on interview location). Quantity and frequency of OH; OH-related problems and dependence symptoms; demographics, social roles, health, smoking, prescription/illicit drug use; attitudes toward OH intake, expected effects, drinking contexts and companions; contraception, nutrition and diet; and knowledge of the effects of OH on health and pregnancy; pregnancy history; OH consumption before and during pregnancy. | Groups: 3 groups based on interview location: employment centers (n = 308, 31.8 years, SD = 7.2), educational institutions (n = 391, 18.5 years, SD = 3.1), and OB/GYN clinics (n = 200, 26.7 years, SD = 5.6). GAC: women at OB/GYN reported lower current OH consumption (34%) vs. those at educational institutions (86.7%) and employment centers (90.3%). OB/GYN participants drank less and did not exceed 2 drinks/day. Last month: wine was the most consumed beverage (pregnant and non-pregnant women); beer consumption was higher in educational institutions, and liquor in employment centers. Risk perception: over 80% of pregnant women (both abstainers and drinkers) believed that heavy OH use increases risk of miscarriage, intellectual disability, low birth weight, and birth defects. 99.5% of pregnant and 96.7% of non-pregnant women recognized at least 1 harmful effect. Risk perception was higher among abstinent pregnant women vs. drinkers. Knowledge: <50% pregnant women had heard of FAS, but over 70% correctly identified its definition. Knowledge levels were similar between pregnant drinkers and abstainers. |
Balachova et al. (2016) Russia [29] | n = 648 women (301 pregnant), 28.2 years (SD = 6.2), primary (36%) and higher education (41%). | V/I. Harmfulness or appropriateness of drinking during pregnancy, knowledge about FASDs, whether they have heard of FASDs, OH consumption (amount, frequency and BD) and risky consumption: T-ACE [60] and TWEAK [59], sexual relations and use of contraceptive methods. | Risk perception: GAC is acceptable (or uncertain) for 40%. 28% believe that there is a safe trimester for consumption, but there is no consensus on which one. 37% think OH type matters: vodka (93%) is the most harmful, wine (73%) is the least harmful. Differences by geographical area: St. Petersburg more permissive. No differences in pregnancy status. Knowledge: only 8% have reliable knowledge about FASDs. 34% have heard of FASDs, of these, 46% associate FASDs with birth defects, 42% with lifelong effects. Less knowledge among pregnant drinkers than non-pregnant. Pregnant women’s knowledge about OH effects and FASDs is related to attitudes and GAC, but this is not associated with risky consumption in non-pregnant women. |
Howlett et al. (2017) England [38] | n = 212: 171 pregnant and 41 partners. | V/I. Belief about safe levels of GAC, timing of OH cessation during pregnancy and gestational week of cessation, willingness to undergo blood testing in future pregnancies and meconium testing to detect GAC. | Risk perception: 89.2% believe that OH should not be consumed during pregnancy. 9.4% consider it safe to drink 1–2 units/week, 1.4% believe it is safe to drink +3 units/occasion. GAC: 64.3%. Among those who believed it was not safe, 54.9% continued drinking until pregnancy was confirmed. |
Dumas et al. (2018) France [34] | n = 3.603 pregnant and postpartum, 66.5% 25–34 years, 51.9% higher education. | V/I. Sociodemographics, perceived risks associated with OH consumption, knowledge of risks associated with GAC, differences in harmful effects depending on type of alcoholic beverage, awareness and labeling of OH drinks, information on smoking and drinking, internet search for information on OH and tobacco use during pregnancy, information provided by healthcare professionals. | Risk perception: 92.1% perceive 1–2 drinks/day during pregnancy as harmful (higher among drinkers and those with higher education). 21.1% of drinkers and 14.9% of abstainers do not perceive harm in occasional intake. Higher education is associated with perceiving harm from occasional consumption. 89.5% believe that a single BD episode could affect the fetus. 40.8% believe that spirits are more harmful than wine or beer (more common among those with lower education). 65% reported reading about OH and tobacco in pregnancy health booklet. Among women who drank before pregnancy, 30.2% received a recommendation to abstain or reduce consumption, compared to 63.2% of smokers. Knowledge: 56.4% identified only 1 effect: brain damage (34.2%), malformations (30.2%), growth delay/low birth weight (28.6%). Lack of awareness was greater among those aged ≥35, with lower education levels and among single women. |
Corrales-Gutierrez et al. (2019) Spain [33] | n = 426 women, 31.9 years (SD = 5.3), 45.5% secondary education. | V/I. Sociodemographic and obstetric factors; general belief about whether OH consumption harms the mother or fetus; type of risk from OH; belief about the duration of consequences; belief about the risk of OH consumption according to quantity, frequency and type of drink; and frequency of OH consumption (AUDIT [57]). | GAC: No: 75.4%; Yes: 14.6% (once or less/month), 8.4% (2–4 times/month), 1.2% (2–3 times/week). Risk perception: 69.7% believe that any consumption is harmful; 0.4% believe it is harmless; 3.9% believe that a small daily amount is harmless; 6.6% see no risk in moderate consumption; 48% believe there is a risk to the baby; 42.6% believe there is a risk to both baby and mother. Types of beverages in GAC: perception of harm from beer (31.5%), wine (38.4%), spirits (88%); perception of small daily amount as not harmful: beer 14.8%, wine 5.9%, spirits 1.9%. Knowledge: 27.1% unable to specify any; malformations (72.9%), developmental problems (24.6%), premature birth (2.5%). Duration of risk: 48.1% always, 15.5% brief, 27.5% do not know. |
Franco et al. (2020) Spain, France & Portugal [36] | n = 68: Spanish women (n = 30, 34.26 years, SD = 3.67), French (n = 20, 33.3 years, SD = 4.6), and Portuguese (n = 18, 30.67 years, SD = 5.21), all pregnant/mothers, majority higher education. | V/I. AUDIT [57]: prior to and during pregnancy, sociodemographics, OH consumption, information and knowledge about GAC consequences, and assessment and selective prevention (information available in primary care context), indicated and universal prevention. | GAC: in Spain, 66% reduced consumption and 34% abstained completely, in France and Portugal total abstinence ranged between 70–75%. Risk perception: women who drink believed that low and occasional doses do not harm the fetus. Social environment supported GAC on festive occasions. Knowledge: was limited and often incorrect (e.g., believing abstinence is only necessary during first trimester). |
Oechsle et al. (2020) Germany [47] | n = 209 pregnant, 31.7 years (SD = 4.6), 54% higher education. | V/I. Sociodemographics; knowledge and attitude toward OH consumption; smoking, nutrition and supplementation; physical activity, oral health and medication. | Risk perception: 10.8% believe that only regular intake causes FASDs, 77.9% think that even small amounts affect the fetus, 3.6% believe that occasional champagne consumption is harmless. Knowledge: 97.1% are aware of the recommendation to avoid OH during pregnancy, but 31.8% are unaware of specific adverse health effects. 87.7% believe that any OH exposure can cause lifelong problems. |
Ujhelyi et al. (2022) England [52] | n = 20 women: 6 pregnant and 8 mothers (≥30 years, higher education), and 7 healthcare professionals (>18 years). | V/I. GAC and OH consumption during motherhood; perceived risks, benefits and short- and long-term effects of OH; reasons for and against OH consumption during pregnancy and motherhood; questions for professionals about OH use in mothers and pregnant; sociodemographics and questions for obstetricians, AUDIT [57], PHQ-2 [64], and GAD-2 [65], birth experience and trauma, and other life traumatic events. | GAC: 1 pregnant and 87.5% of mothers. AUDIT scores: pregnant = 0; mothers < 7. Most stopped drinking upon pregnancy confirmation, some consumed low levels (on special occasions or 1–2 times). Risk perception: most pregnant and mothers believe that the safest option is to avoid or limit OH, while others think low levels are acceptable due to a perceived lack of convincing evidence about the risks. All professionals recommend abstaining from OH. Knowledge: OH use during pregnancy is associated with risks to the baby (birth defects, FASDs, developmental problems), to the mother, and to family relationships. |
Piotrkowiz et al. (2023) Poland [49] | n = 471 women (54.6% had been pregnant), 15–49 years, 72.4% higher education. | V/I. Sociodemographics, knowledge of GAC and FASD risks, personal experience with OH and its prevention during pregnancy, religion, reliable sources of information on GAC, and whether they were encouraged to drink during pregnancy and by whom. | Groups: Generation X (ages 42–49, 9.6%), Generation Y (ages 24–41, 55.6%), and Generation Z (ages 15–25, 34.8%). Risk perception: nearly 100% of Generations Y and Z recognized the teratogenicity of OH, while 4% of the older generation believed it was not very harmful. Younger generations received more OH warnings. 12% of older women were advised to drink occasionally by professionals, but none of the younger women were. Knowledge: Generations Y and Z gave more correct responses, but younger individuals (Z) showed less overall knowledge. 97% of Generation Y, 89% of Generation X, and 84% of Generation Z had heard of FASDs. Fewer than 50% answered correctly about the diagnosis of FAS. Belief that only large amounts cause FAS: X (24%), Y (19%), Z (22%). Generation Z showed lower awareness that abstaining from OH is a form of prevention. Knowledge was higher in urban areas. No significant relationship between perception of fetal OH risk and smoking, religion, or general OH consumption frequency. |
Zahumensky et al. (2024) Slovakia [56] | n = 402 postpartum, 32.4 years, 78.6% higher education. | V/I. Demographics, awareness of the effects of GAC, GAC by trimester, pregnancy planning [70]. | GAC: 73.1% did not drink, while 26.9% consumed during at least one trimester. None of the women who were abstinent prior to pregnancy consumed during gestation. Around 60.5% of those who drank before pregnancy stopped drinking during pregnancy. Knowledge: 74.6% knows effects of OH during pregnancy. |
THE AMERICAS | |||
Testa & Riefman (1996) USA [51] | n = 159 pregnant, 27.3 years (SD = 5.68). | V/I. GAC, previous pregnancy outcomes, lifetime OH-related problems, perceived risk of GAC, socioeconomic status (Four Factor Index of Social Position [71]), social desirability (Marlowe–Crowne Social Desirability Scale [69]). | Risk perception: first-time mothers reported higher perceived risk and lower OH consumption. Having had a previous healthy pregnancy was associated with lower risk perception and increased OH intake during the current pregnancy. |
Cornelius et al. (1997) Pennsylvania [32] | n = 415 pregnant, 16.3 years, primary education (56.7%). | V/I. Two-stage interview: (1) Year prior to pregnancy and first trimester: OH and other drug use, demographics, psychosocial and medical factors, sexual history, conception-recognition-confirmation. (2) 24–36 h postpartum: OH/drug use in second and third trimesters, nutritional history, mental health, maternal perception of herself and the newborn, drinking consequences, knowledge/attitudes about OH, paternal initiation and use, knowledge of effects of use, scale of attitudes towards OH. | GAC: 47% (1st trimester), 12% (2nd trimester) and 8% (3rd trimester), <1 drink/day. Knowledge: greater knowledge about the effects of OH on the fetus was associated with lower consumption and greater reduction between trimesters, 99% with high knowledge reduced/stopped drinking (1st–3rd trimester) vs. 90% with low knowledge. |
Kaskutas (2000) USA [40] | n = 321 pregnant, <25 years. No formal education. | V/I. Responses to 5 sources of health warnings about GAC (e.g., point-of-sale signage: “was the message understood?”), perception of GAC risks (including congenital defects associated with FAS), OH consumption (12 months prior to pregnancy recognition and after recognition). | GAC: 27% drank OH after pregnancy recognition (30% African American, 21% Native American), quantity: ≥1 standard drink/day. 18% daily consumption, 39% drank + 3 drinks/day, 14% +5 drinks/day (higher among African American). Risk perception: African American women showed lower accuracy, and those who drank beer believed it was safer than other alcoholic beverages. Heavy drinkers were less aware of the need to reduce consumption, and wine drinkers believed it was safer. <20% believed it was “too late” to reduce OH, wine was perceived as safer. 83% had seen ads about GAC, 43% had seen point-of-sale signs, and 96% had had conversations on the topic. Knowledge: 25% identified at least 1 birth defect, and only 20% recognized OH as the cause. |
Chambers et al. (2005) Canada [31] | n = 100 pregnant,18–40 years (SD= 6.2), 38% higher education. | V/I. OH consumption 3 months prior to pregnancy confirmation and after confirmation; amount, frequency and type of OH; TWEAK [59]; sociodemographic characteristics; acculturation level (ARSMA-II [68]); health history and knowledge of the effects of OH on the fetus and of warning messages. | Risk perception: drinkers, including BD, saw warnings on packaging and in public places. Knowledge: 55% had heard of FAS, and 38% described it correctly. Female drinkers were aware of FAS and its risks vs. non-drinkers. |
Zabotka et al. (2017) USA [55] | n = 11 biological mothers (43 years) of children with full FAS (17 years). | V/I. Substance use and feelings, thoughts, and reactions to the etiology of the disorder. | Knowledge: lack of control (alcoholism–disease model) and lack of knowledge about the risks of OH during pregnancy; advice from friends, family or professionals to drink (“nothing happens if you drink during the first weeks”); or unawareness of the pregnancy. |
Caires & Santos (2020) Brazil [30] | n = 17 GAC women, <30 years, secondary education (58.8%). | V/I. Sociodemographics, OH treatment time, abstinence, reproductive history (pregnancies, abortions, nº of children and type of delivery), GAC and prenatal care received. | Knowledge: lack of information about the harm that OH can cause to her and her child, some notion that OH can harm the fetus. Fetal malformation is only related to a physical defect, and the possibility of neurocognitive disorder is not considered. |
ASIA | |||
Lee et al. (2010) Republic of Korea [43] | n = 646 pregnant, 31.56 years (SD = 3.91), years of education = 15 (SD = 2.17). | V/I. Demographics (age, education level, gestational weeks, pregnancy or miscarriage history, occupation, annual household income, pregnancy planning and smoking habits); OH consumption: AUDIT-C [58], frequency and quantity; knowledge of GAC and FAS effects. | GAC: 83.6% did not drink. Among those who did: 12.4% less than once/month, 3.6% drank 2–4 times/month, and 0.3% 2–3 times/week. 12.7% consumed 1–2 drinks, 1.2% 3–4 drinks, 0.9% 7–9 drinks, and 0.6% 10 drinks/occasion. Beer was the most commonly consumed beverage during pregnancy. 79.88% were classified as abstinent and 20.12% as drinkers during pregnancy. GAC profile: lower education level, lower pregnancy planning, and higher pre-pregnancy OH use. Knowledge: ~50% had heard of FAS, drinkers were less informed about OH impact. |
Kim & Park (2011) Republic of Korea [42] | n = 221 postpartum, 32.97 years (SD = 3.67), secondary education (76%). | V/I. Quantity and frequency of OH (6 months prior to pregnancy and in each trimester), SAQ [61], FAS knowledge. | GAC: 12.7% drank during pregnancy, mostly in first trimester (7.7%) and with their partner (60.7%). Risk perception: common misconception was that GAC is acceptable in certain quantities. No differences found based on information source. Only 2.3% received information from nurses about OH, and 1.8% about FAS. Knowledge: mean OH knowledge score: 15.56/29, mean FASD knowledge score: 3.63/8. GAC was not related to knowledge of OH or FASDs. |
Senecky et al. (2011) Israel [50] | n = 3.815 recent mothers, 30.3 years (SD = 5.3). | V/I. Sociodemographics, GAC education received from professionals, quality and quantity of the information, other sources, GAC knowledge, attitudes toward women who drink during pregnancy, amount of OH consumed before conception and in the last 3 months of pregnancy, BD and T-ACE [60]. | GAC: 17.1% (Jewish and Christian), 23% knew pregnant women who drank. 1.4% engaged in BD in the 3 months prior to pregnancy (0.8% in 3rd trimester). Risk consumption: 0.68%. Risk perception: Among non-drinkers, 25% received education about OH and 52% about nutrition; among drinkers, 17% and 37%, respectively. Knowledge: 71.6% stated that one should not drink during pregnancy, 21.4% believed it is safe to consume up to 2 drinks/week. |
Hen-Herbst et al. (2021) Israel [37] | n = 802 pregnant, 30.76 years (SD = 4.58), 53.2% higher education. | V/I. Sociodemographic and obstetric variables, OH intake before and during pregnancy, information sources on GAC, FASD knowledge and its effects, other habits (nutrition, physical activity, tobacco). | GAC: 67.2% drank in 2 months before pregnancy recognition. 12% consumed OH during pregnancy, and among these: 63.8% drank up to half a glass/occasion, 33% 1 glass, 2.1% 2 glasses, and 1.1% +2 glasses. 86.6% reduced consumption after pregnancy recognition. 28.1% knew pregnant women who drank. Risk perception 39.5% had not received information about GAC. Those who had: doctors (37.4%), nurses (17.2%), social media (5.9%). Knowledge: lower among women who drank in the 2 months before pregnancy, those with more children and those with secondary education. |
Huang et al. (2023) Philippines [39] | n = 100 postpartum, 28.6 years (SD = 5.3), 61% secondary education. | V/I. Perceived importance of maternal health during pregnancy, knowledge that tuba is an alcoholic beverage, self-reported behaviors regarding OH consumption before and during pregnancy, perceived risks/benefits of GAC, OH-related behaviors in infants, perceived risks/benefits of OH consumption in infants, expectations of behavior change if informed about OH risks, influence of external sources (family, friends, and medical personnel) on tuba intake, and perceived interest in obtaining additional information on maternal and fetal health. | GAC: 75% drank tuba or other alcoholic beverages during pregnancy (all consumed tuba, and 5.3% also drank beer). 36% drank between 3–5 glasses/week. Risk perception: nearly 100% considered nutrition, physical exercise, medical visits and reducing/quitting tobacco during pregnancy to be important/very important vs. 60% who considered reducing GAC to be important/very important. Around 50% had not been informed by a doctor about fetal effects of tuba, and 31.1% did not see a doctor during pregnancy. 98% stated that if they had been informed about the effects of fetal OH, they would have stopped drinking. 100% expressed a desire to learn how to have a healthy pregnancy and keep their baby healthy. 59% reported that their families or friends encouraged them to drink tuba during pregnancy. Knowledge: 75% believed that tuba does not contain OH, and 48% believed that tuba or other alcoholic beverages are good for the fetus and mother. 15% gave tuba to their baby during the first year of life (1 tablespoon/day). |
AFRICA | |||
Eaton et al. (2014) South Africa [35] | n = 1.047: 565 men (20% had a pregnant partner), 28 years (SD = 8.96); and 482 women (14% pregnant), 30.4 years (SD = 11.63). | V/I. Demographics and pregnancy status, OH consumption (frequency, quantity, HED, and current consumption in public venues), beliefs about FASDs. | GAC: high-risk patterns were similar between pregnant and non-pregnant women. Pregnant: 53.8% drinking 2–4 times/month, 56.8% consumed 3–4 drinks/occasion, 59.6% reported HED (>6 drinks/occasion). Risk perception: 40% of pregnant and 29% of non-pregnant people disagreed with avoiding GAC. 37% of pregnant and 21% of non-pregnant did not agree that OH use causes fetal harm. 50% of pregnant and partners believed that OH can be consumed without harming the fetus. 31% of pregnant considered ≥3 drinks/day to be safe (vs. 8% of non-pregnant). 35% of pregnant women believed that drinking monthly does not harm the fetus. Lower risk perception was associated with higher drinking frequency. |
Onwuka et al. (2016) Nigeria [48] | n = 380 pregnant, 71.3% 26–35 years, 72.1% higher education. | V/I. Sociodemographics; GAC; awareness of the OH effects on babies (including FASDs); initial source of information about awareness, type and amount of OH consumed; reasons for drinking; and willingness to quit after counseling. | GAC: 22.6% drank during pregnancy; of these, 82.6% drank occasionally (53.5% classified as BD), and 17.4% drank regularly. Average consumption: 5.3 ± 2.7 units/week (68.9 ± 35.23 g ethanol). Beverages: strong beer (62.8%), lager beer (55.8%), red wine (37.2%), palm wine (32.6%), refined gin/liquor (9.3%), and local gin (4.7%). Risk perception: after counseling about GAC effects, 86% said they would be willing to stop drinking, while 13.9% would continue due to habit. Knowledge: 35.5% were aware of the fetal risks of OH, 64.5% were unaware. |
Watt et al. (2016) South Africa [53] | n = 24: pregnant (n = 9) or postpartum (n = 15), 27 years. | V/I. Experiences of gestational OH consumption, norms and attitudes toward maternal OH use, FASD knowledge. | GAC: nearly all participants reported risky patterns of GAC (including BD). Among those who reported risky patterns, they described their consumption as increasing (n = 3), decreasing (n = 3), or unchanged (n = 11) during pregnancy. Risk perception: more than half had received messages advising against drinking during pregnancy. Some believed that only certain types of OH (e.g., spirits) affect the fetus, they placed greater trust in their own “intuition” and optimism about the effects than in external (clinical or family) information. Knowledge: few identified specific effects, most were unfamiliar with the term and had limited or inaccurate information about fetal OH effects. |
Louw et al. (2018) South Africa [45] | n = 129 women, 29 years (SD = 6.45), years of education = 9.4 (SD = 2.62). | V/I. Risk perception regarding OH use during pregnancy (2 measures: one related to personal risk and another to perceived general community risk), demographics, pregnancy history and adverse birth outcomes, smoking history, FASD knowledge, AUDIT [57]. | Risk perception: personal risk perception averaged 4.29/5 and showed a positive correlation with general risk perception (59.5% of variance explained). Predictors of personal risk perception: perceived ease of quitting OH, FASD knowledge, general risk perception, and perceived easy for others to quit drinking. Personal risk perception emerged as the strongest predictor in multivariate models. Predictors of general risk perception (excluding personal risk): FASD knowledge and perceived easy of quitting alcohol (24% of the variance explained). Knowledge: mean score of 8.75/10. |
Addila et al. (2021) Ethiopia [28] | n = 1216 pregnant, 27.2 years, secondary education or above (61.76%). | V/I. Demographics, AUDIT-C [58], EPDS [62], OSSS-3 [67], knowledge and attitude about GAC, socioeconomic status, and OH consumption. | GAC: 30.26%: most in trimester 1 (77.2%) and between 1–2 drinks (71.2%), mainly fermented. 13.32% have depression and of these, 37.04% consumed gestational OH. Risk perception: only 15.26% received prenatal information about the effects of GAC. Knowledge: 43.91% were unaware of the risks of GAC. 73.27% had low knowledge of the effects of GAC. |
West et al. (2024) Tanzania [54] | n= 541 pregnant and non-pregnant, 40.9 years (SD = 16), 36.6% higher education. | V/I. Sociodemographics, OH consumption, AUDIT [57], DrInc [66], and PHQ-9 [63]. | GAC: 56.9% of pregnant did not consume OH, and among the 42.2% who did, 32.8% drank 1–2 drinks and 9.5% consumed 3–4 drinks. Non-pregnant tended to consume 3–4 drinks. AUDIT scores were similar between 2 groups (0–2 in pregnant, 0–4 in non-pregnant). Younger non-pregnant people reported more OH-related consequences. Risk perception: 70% believed that 0 drinks are the safe amount during pregnancy. |
3.4. Alcohol Consumption During Pregnancy: Perceived Risk and Knowledge of Possible Effects Perceived Risk of Gestational Alcohol Consumption
3.5. Knowledge of Possible Efects of Gestational Alcohol Consumption
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AEP | Alcohol-Exposed Pregnancy |
ARCMs | Alcohol-Related Congenital Malformations |
ARND | Alcohol-Related Neurodevelopmental Disorder |
ARSMA-II | Acculturation Rating Scale for Mexican Americans-II |
AUDIT | Alcohol Use Disorders Identification Test |
AUDIT-C | Alcohol Use Disorders Identification Test–Consumption |
BD | Binge Drinking |
CEBM | Centre for Evidence-Based Medicine |
DrInc | Drinker’s Inventory of Consequences |
EDADES | Survey on Alcohol and Drugs in Spain (Encuesta sobre Alcohol y Drogas en España) |
EPDS | Edinburgh Postnatal Depression Scale |
FAE | Fetal Alcohol Effects |
FAS | Fetal Alcohol Syndrome |
FASDs | Fetal Alcohol Spectrum Disorders |
GAC | Gestational Alcohol Consumption |
GAD-2 | Generalized Anxiety Disorder-2 |
HED | Heavy Episodic Drinking |
I1–I8 | Quality assessment items (Table 1) |
IQ | Intelligence Quotient |
OB/GYN | Obstetrics and Gynecology |
OH | Alcohol |
OSSS-3 | Oslo 3-item Social Support Scale |
pFAS | Partial Fetal Alcohol Syndrome |
PAE | Prenatal Alcohol Exposure |
PHQ-2 | Patient Health Questionnaire-2 |
PHQ-9 | Patient Health Questionnaire-9 |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
Q | Quality Score (Table 1) |
SAQ | Student Alcohol Questionnaire |
SD | Standard Deviation |
T-ACE | Tolerance–Annoyed–Cut down–Eye-opener questionnaire |
TWEAK | Tolerance–Worry–Eye-opener–Amnesia–Kut down questionnaire |
V/I | Variables/Instruments |
WOS | Web of Science |
References
- Denny, L.; Coles, S.; Blitz, R. Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders. Am. Fam. Physician 2017, 96, 515–522. [Google Scholar]
- Lemoine, P.; Harousseau, H.; Borteyru, J.P.; Menuet, J.C. Les enfants de parents alcooliques: Anomalies observées à propos de 127 cas. Ouest Médical 1968, 21, 476–482. [Google Scholar]
- Rasmussen, C.; Andrew, G.; Zwaigenbaum, L.; Tough, S. Neurobehavioral outcomes of children with fetal alcohol spectrum disorders: A Canadian perspective. Paediatr. Child Health 2008, 13, 185–191. [Google Scholar] [CrossRef]
- Streissguth, A.P.; O’Malley, K. Neuropsychiatric implications and long-term consequences of fetal alcohol spectrum disorders. Semin. Clin. Neuropsychiatry 2000, 5, 177–190. [Google Scholar] [CrossRef]
- Institute of Medicine. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment; National Academy Press: Washington, DC, USA, 1996.
- Hoyme, H.E.; Kalberg, W.O.; Elliott, A.J.; Blankenship, J.; Buckley, D.; Marais, A.S.; Manning, M.A.; Robinson, L.K.; Adam, M.P.; Abdul-Rahman, O.; et al. Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders. Pediatrics 2016, 138, e20154256. [Google Scholar] [CrossRef]
- Williams, J.F.; Smith, V.C. Committee on Substance Use and Prevention. Fetal Alcohol Spectrum Disorders. Pediatrics 2015, 136, e1395–e1406. [Google Scholar] [CrossRef]
- Bailey, B.A.; Sokol, R.J. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol Res. Health 2011, 34, 86–91. [Google Scholar] [PubMed]
- Cook, J.L.; Green, C.R.; Lilley, C.M.; Anderson, S.M.; Baldwin, M.E.; Chudley, A.E.; Conry, J.L.; LeBlanc, N.; Loock, C.A.; Lutke, J.; et al. Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. CMAJ 2015, 188, 191–197. [Google Scholar] [CrossRef]
- Mamluk, L.; Oddie, S.J.; White, I.R.; Gray, R. The effects of alcohol consumption during pregnancy on maternal and child outcomes: A systematic review and meta-analysis. PLoS ONE 2017, 12, e0171937. [Google Scholar] [CrossRef]
- Conover, E.A.; Jones, K.L. Safety concerns regarding binge drinking in pregnancy: A review. Birth Defects Res. Part A Clin. Mol. Teratol. 2012, 94, 570–575. [Google Scholar] [CrossRef] [PubMed]
- Popova, S.; Lange, S.; Probst, C.; Gmel, G.; Rehm, J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: A systematic review and meta-analysis. Lancet Glob. Health 2017, 5, e290–e299. [Google Scholar] [CrossRef]
- Gomez-Roig, M.D.; Marchei, E.; Sabra, S.; Busardò, F.P.; Mastrobattista, L.; Pichini, S.; Garcia-Algar, O. Maternal hair testing to disclose self-misreporting in drinking and smoking behavior during pregnancy. Alcohol 2018, 67, 1–6. [Google Scholar] [CrossRef]
- Anderson, A.E.; Hure, A.J.; Kay-Lambkin, F.J.; Loxton, D.J. Women’s perceptions of information about alcohol use during pregnancy: A qualitative study. BMC Public Health 2012, 12, 521. [Google Scholar] [CrossRef]
- Anderson, A.E.; Hure, A.J.; Kay-Lambkin, F.J.; Loxton, D.J. Predictors of antenatal alcohol use among Australian women: A prospective cohort study. BJOG 2013, 120, 1366–1374. [Google Scholar] [CrossRef]
- Skagerström, J.; Chang, G.; Nilsen, P. Predictors of drinking during pregnancy: A systematic review. J. Womens Health 2011, 20, 901–913. [Google Scholar] [CrossRef]
- Observatorio Español de las Drogas y las Adicciones. EDADES 2024. Encuesta Sobre Alcohol y Otras Drogas en España (EDADES) 1995–2024; Delegación del Gobierno para el Plan Nacional sobre Drogas; Ministerio de Sanidad: Madrid, Spain, 2024. [Google Scholar]
- Dumas, A.; Toutain, S.; Simmat-Durand, L. Alcohol use during pregnancy or breastfeeding: A national survey in France. J. Womens Health 2017, 26, 798–805. [Google Scholar] [CrossRef] [PubMed]
- Mårdby, A.C.; Lupattelli, A.; Hensing, G.; Nordeng, H. Consumption of alcohol during pregnancy-A multinational European study. Women Birth J. Aust. Coll. Midwives 2017, 30, e207–e213. [Google Scholar] [CrossRef] [PubMed]
- Lanting, C.I.; Van Dommelen, P.; Van der Pal-de Bruin, K.M. Trends in smoking, alcohol consumption, and folic acid supplementation before and during pregnancy: A population-based study in the Netherlands, 2001–2007. Midwifery 2015, 31, 835–841. [Google Scholar] [CrossRef]
- O’Keeffe, L.M.; Kearney, P.M.; McCarthy, F.P.; Khashan, A.S.; Greene, R.A.; North, R.A.; Kenny, L.C. Prevalence and predictors of alcohol use during pregnancy: Findings from international multicentre cohort studies. BMJ Open 2015, 5, e006323. [Google Scholar] [CrossRef]
- Blasco-Alonso, M.; González-Mesa, E.; Montes, M.G.; Bravo, I.L.; Galdón, F.M.; Campos, F.C.; Estévez, I.B. Exposición a tabaco, alcohol y drogas de abuso en gestantes. Estudio de prevalencia en gestantes de Málaga (España). Adicciones 2015, 27, 99–108. [Google Scholar] [CrossRef] [PubMed]
- Iversen, M.L.; Sørensen, N.O.; Broberg, L.; Damm, P.; Hedegaard, M.; Tabor, A.; Hegaard, H.K. Alcohol consumption and binge drinking in early pregnancy: A cross-sectional study with data from the Copenhagen Pregnancy Cohort. BMC Pregnancy Childbirth 2015, 15, 1–10. [Google Scholar] [CrossRef]
- Balachova, T.; Zander, R.; Bonner, B.; Isurina, G.; Kyler, K.; Tsvetkova, L.; Volkova, E. Smoking and alcohol use among women in Russia: Dual risk for prenatal exposure. J. Ethn. Subst. Abus. 2019, 18, 127–147. [Google Scholar] [CrossRef]
- Hammer, R.; Rapp, E. Women’s views and experiences of occasional alcohol consumption during pregnancy: A systematic review of qualitative studies and their recommendations. Midwifery 2022, 111, 103357. [Google Scholar] [CrossRef]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
- Centre for Evidence-Based Medicine (CEBM). Available online: https://www.cebm.ox.ac.uk/resources/ebm-tools/critical-appraisal-tools (accessed on 4 April 2025).
- Addila, A.E.; Azale, T.; Gete, Y.K.; Yitayal, M. Individual and community-level predictors of maternal alcohol consumption during pregnancy in Gondar town, Northwest Ethiopia: A multilevel logistic regression analysis. BMC Pregnancy Childbirth 2021, 21, 419. [Google Scholar] [CrossRef]
- Balachova, T.N.; Bard, D.; Bonner, B.; Chaffin, M.; Isurina, G.; Tsvetkova, L.; Volkova, E. Do attitudes and knowledge predict at-risk drinking among Russian women? Am. J. Drug Alcohol Abus. 2016, 42, 272–281. [Google Scholar] [CrossRef] [PubMed]
- Caires, T.L.G.; Santos, R.S. Malformation and death X alcoholism: Perspective of Nursing the Theory of Transitions for alcoholic pregnant women. Rev. Bras. Enferm. 2020, 73, e20180233. [Google Scholar] [CrossRef] [PubMed]
- Chambers, C.D.; Hughes, S.; Meltzer, S.B.; Wahlgren, D.; Kassem, N.; Larson, S.; Riley, E.P.; Hovell, M.F. Alcohol consumption among low-income pregnant Latinas. Alcohol Clin. Exp. Res. 2005, 29, 2022–2028. [Google Scholar] [CrossRef] [PubMed]
- Cornelius, M.D.; Lebow, H.A.; Day, N.L. Attitudes and knowledge about drinking: Relationships with drinking behavior among pregnant teenagers. J. Drug Educ. 1997, 27, 231–243. [Google Scholar] [CrossRef]
- Corrales-Gutierrez, I.; Mendoza, R.; Gomez-Baya, D.; Leon-Larios, F. Pregnant women’s risk perception of the teratogenic effects of alcohol consumption in pregnancy. J. Clin. Med. 2019, 8, 907. [Google Scholar] [CrossRef]
- Dumas, A.; Toutain, S.; Hill, C.; Simmat-Durand, L. Warning about drinking during pregnancy: Lessons from the French experience. Reprod. Health 2018, 15, 20. [Google Scholar] [CrossRef] [PubMed]
- Eaton, L.A.; Pitpitan, E.V.; Kalichman, S.C.; Sikkema, K.J.; Skinner, D.; Watt, M.H.; Pieterse, D.; Cain, D.N. Beliefs about fetal alcohol spectrum disorder among men and women at alcohol serving establishments in South Africa. Am. J. Drug Alcohol Abus. 2014, 40, 87–94. [Google Scholar] [CrossRef]
- Franco, R.; Charro, B.; Xavier, M.R. Perspectivas y experiencias sobre el consumo de bebidas alcohólicas durante el embarazo: Estudio cualitativo con embarazadas de España, Francia y Portugal. Ex Aequo 2020, 41, 107–121. [Google Scholar] [CrossRef]
- Hen-Herbst, L.; Tenenbaum, A.; Senecky, Y.; Berger, A. Pregnant women’s alcohol consumption and knowledge about its risks: An Israeli survey. Drug Alcohol Depend. 2021, 228, 109023. [Google Scholar] [CrossRef]
- Howlett, H.; Gray, W.K.; Dismore, L.; Mackenzie, S.; Langley, K.; Davidson, C.; Rankin, J. A survey of attitudes, beliefs and practice regarding alcohol use and screening in pregnancy: An opportunity for support and education? J. Res. Nurs. 2017, 22, 618–633. [Google Scholar] [CrossRef]
- Huang, A.M.; Neale, M.N.; Darveau, S.C.; Sagliba, M.J.; Moreno, A.J.; Urbina, M.P.G.; Tallo, V.; McDonald, E.A.; Jiz, M.A.; Friedman, J.F. Knowledge, attitudes, practices, and beliefs regarding prenatal alcohol consumption among women in Leyte, the Philippines. Front. Glob. Womens Health 2023, 4, 1156681. [Google Scholar] [CrossRef]
- Kaskutas, L.A. Understanding drinking during pregnancy among urban American Indians and African Americans: Health messages, risk beliefs, and how we measure consumption. Alcohol Clin. Exp. Res. 2000, 24, 1241–1250. [Google Scholar] [CrossRef]
- Kristjanson, A.F.; Wilsnack, S.C.; Zvartau, E.; Tsoy, M.; Novikov, B. Alcohol use in pregnant and nonpregnant Russian women. Alcohol Clin. Exp. Res. 2007, 31, 299–307. [Google Scholar] [CrossRef] [PubMed]
- Kim, O.; Park, K. Prenatal alcohol consumption and knowledge about alcohol consumption and fetal alcohol syndrome in Korean women. Nurs. Health Sci. 2011, 13, 303–308. [Google Scholar] [CrossRef]
- Lee, S.H.; Shin, S.J.; Won, S.D.; Kim, E.J.; Oh, D.Y. Alcohol use during pregnancy and related risk factors in Korea. Psychiatry Investig. 2010, 7, 86–92. [Google Scholar] [CrossRef] [PubMed]
- Lelong, N.; Kaminski, M.; Chwalow, J.; Bean, K.; Subtil, D. Attitudes and behavior of pregnant women and health professionals towards alcohol and tobacco consumption. Patient Educ. Couns. 1995, 25, 39–49. [Google Scholar] [CrossRef] [PubMed]
- Louw, J.G.; Tomlinson, M.; Olivier, L. Unrealistic optimism with regard to drinking during pregnancy among women of childbearing age in a South African community. S. Afr. J. Psychol. 2018, 48, 219–229. [Google Scholar] [CrossRef]
- McKnight, A.; Merrett, D. Alcohol consumption in pregnancy—A health education problem. Br. J. Gen. Pract. 1987, 37, 161–164. [Google Scholar]
- Oechsle, A.; Wensing, M.; Ullrich, C.; Bombana, M. Health knowledge of lifestyle-related risks during pregnancy: A cross-sectional study of pregnant women in Germany. Int. J. Environ. Res. Public Health 2020, 17, 8626. [Google Scholar] [CrossRef]
- Onwuka, C.I.; Ugwu, E.O.; Dim, C.C.; Menuba, I.E.; Iloghalu, E.I.; Onwuka, C.I. Prevalence and predictors of alcohol consumption during pregnancy in South-Eastern Nigeria. J. Clin. Diagn. Res. 2016, 10, QC10–QC13. [Google Scholar] [CrossRef]
- Piotrkowicz, E.; Kowalik, I.; Szymusik, I. The changes in the level of knowledge about the effects of alcohol use during pregnancy among three last generations of women in Poland. Int. J. Environ. Res. Public Health 2023, 20, 2479. [Google Scholar] [CrossRef]
- Senecky, Y.; Weiss, N.; Shalev, S.A.; Peleg, D.; Inbar, D.; Chodick, G.; Nachum, Z.; Bar-Hamburger, R.; Shuper, A. Alcohol consumption during pregnancy among women in Israel. J. Popul. Ther. Clin. Pharmacol. 2011, 18, e261–e272. [Google Scholar] [PubMed]
- Testa, M.; Reifman, A. Individual differences in perceived riskiness of drinking in pregnancy: Antecedents and consequences. J. Stud. Alcohol. 1996, 57, 360–367. [Google Scholar] [CrossRef]
- Ujhelyi, K.; Goodwin, L.; Chisholm, A.; Rose, A.K. Alcohol use during pregnancy and motherhood: Attitudes and experiences of pregnant women, mothers, and healthcare professionals. PLoS ONE 2022, 17, e0275609. [Google Scholar] [CrossRef] [PubMed]
- Watt, M.H.; Eaton, L.A.; Dennis, A.C.; Choi, K.W.; Kalichman, S.C.; Skinner, D.; Sikkema, K.J. Alcohol use during pregnancy in a South African community: Reconciling knowledge, norms, and personal experience. Matern. Child. Health J. 2016, 20, 48–55. [Google Scholar] [CrossRef]
- West, K.; Pauley, A.; Buono, M.; Mikindo, M.; Sawe, Y.; Kilasara, J.; Sakita, F.; Sharla, R.; Mchome, B.; Mmbaga, B.T.; et al. The burden of generational harm due to alcohol use in Tanzania: A mixed method study of pregnant women. PLoS Glob. Public Health 2024, 4, e0003681. [Google Scholar] [CrossRef]
- Zabotka, J.; Bradley, C.; Escueta, M. “How could I have done this?” Thoughts of mothers of children with fetal alcohol syndrome. J. Soc. Work. Pract. Addict. 2017, 17, 258–274. [Google Scholar] [CrossRef]
- Zahumensky, J.; Boda, M.; Serator, V.; Psenkova, P.; Ostatnikova, M.; Gajdosova, M.; Peskovicova, P.; Danfarova, S.; Sirotna, M.; Papcun, P. Risk factors for self-reported alcohol consumption during pregnancy. Bratisl. Med. J. Bratisl. Lekárske List. 2024, 125, 661–665. [Google Scholar] [CrossRef]
- Saunders, J.B.; Aasland, O.G.; Babor, T.F.; de la Fuente, J.R.; Grant, M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption–II. Addiction 1993, 88, 791–804. [Google Scholar] [CrossRef] [PubMed]
- Bush, K.; Kivlahan, D.R.; McDonell, M.B.; Fihn, S.D.; Bradley, K.A. The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Arch. Intern. Med. 1998, 158, 1789–1795. [Google Scholar] [CrossRef] [PubMed]
- Russell, M.; Martier, S.S.; Sokol, R.J.; Mudar, P.; Bottoms, S.; Jacobson, S.; Jacobson, J. Screening for pregnancy risk drinking: The utility of TWEAK and other brief screening questionnaires. Alcohol Clin. Exp. Res. 1994, 18, 1156–1161. [Google Scholar] [CrossRef]
- Sokol, R.J.; Martier, S.S.; Ager, J.W. The T ACE questions: Practical prenatal detection of risk drinking. Am. J. Obstet. Gynecol. 1989, 160, 863–868. [Google Scholar] [CrossRef]
- Engs, R.C.; Hanson, D.J. The Student Alcohol Questionnaire: An updated reliability of the drinking patterns, problems, knowledge, and attitude subscales. Psychol. Rep. 1994, 74, 12–14. [Google Scholar] [CrossRef]
- Cox, J.L.; Holden, J.M.; Sagovsky, R. Detection of postnatal depression. Development of the 10 item Edinburgh Postnatal Depression Scale. Br. J. Psychiatry 1987, 150, 782–786. [Google Scholar] [CrossRef]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 2001, 16, 606–613. [Google Scholar] [CrossRef]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B. The Patient Health Questionnaire-2: Validity of a two-item depression screener. Med. Care 2003, 41, 1284–1292. [Google Scholar] [CrossRef] [PubMed]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B.; Monahan, P.O.; Löwe, B. Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Ann. Intern. Med. 2007, 146, 317–325. [Google Scholar] [CrossRef]
- Miller, W.R.; Tonigan, J.S.; Longabaugh, R. The Drinker Inventory of Consequences (DrInC): An Instrument for Assessing Adverse Consequences of Alcohol Abuse. Test Manual; National Institute on Alcohol Abuse and Alcoholism, Project MATCH Monograph Series No. 95-3911; The U.S. Department of Health and Human Services: Rockville, MD, USA, 1995. [Google Scholar]
- Kocalevent, R.D.; Berg, L.; Beutel, M.E.; Hinz, A.; Zenger, M.; Härter, M.; Nater, U.; Brähler, E. Social support in the general population: Standardization of the Oslo social support scale (OSSS 3). BMC Psychol. 2018, 6, 31. [Google Scholar] [CrossRef]
- Cuéllar, I.; Arnold, B.; Maldonado, R. Acculturation Rating Scale for Mexican Americans–II: A revision of the original ARSMA scale. Hisp. J. Behav. Sci. 1995, 17, 275–304. [Google Scholar] [CrossRef]
- Reynolds, W.M. Development of reliable and valid short forms of the Marlowe-Crowne Social Desirability Scale. J. Clin. Psychol. 1982, 38, 119–125. [Google Scholar] [CrossRef]
- Barrett, G.; Wellings, K. What is a ‘planned’ pregnancy? Empirical data from a British study. Soc. Sci. Med. 2002, 55, 545–557. [Google Scholar] [CrossRef]
- Hollingshead, A.B. Four-Factor Index of Social Status; Unpublished manuscript; Department of Sociology, Yale University: New Haven, CT, USA, 1975. [Google Scholar]
- Peltier, M.R.; Verplaetse, T.L.; Bici, V.; Mokwuah, A.A.; Chavez, C.L.J.; Zakiniaeiz, Y.; KohLer, R.; Garcia-Rivas, V.; Banini, B.A.; Zhou, H.; et al. Alcohol use during pregnancy: The impact of social determinants of health on alcohol consumption among pregnant women. Biol. Sex. Differ. 2025, 16, 49. [Google Scholar] [CrossRef]
- Fletcher, T.M.; Mullan, B.; Finlay-Jones, A. Intention to engage in alcohol use during pregnancy: The role of attitudes and prototypes. Subst. Use Misuse 2023, 58, 1333–1342. [Google Scholar] [CrossRef] [PubMed]
- Pehlke-Milde, J.; Radu, I.; Gouilhers, S.; Hammer, R.; Meyer, Y. Women’s views on moderate and low alcohol consumption: Stages of the subjective transition from pregnancy to postpartum. BMC Pregnancy Childbirth 2022, 22, 902. [Google Scholar] [CrossRef] [PubMed]
- Schölin, L.; Arkell, R. Representations of ‘risky’ drinking during pregnancy on Mumsnet: A discourse analysis. Drug Alcohol. Rev. 2025, 44, 26–36. [Google Scholar] [CrossRef]
- Keenan, K.; Grundy, E.; Kenward, M.G.; Leon, D.A. Women’s risk of repeat abortions is strongly associated with alcohol consumption: A longitudinal analysis of a Russian National Panel Study, 1994–2009. PLoS ONE 2014, 9, e90356. [Google Scholar] [CrossRef] [PubMed]
- Green, F.O.; Harlowe, A.K.; Edwards, A.; Alford, D.P.; Choxi, H.; German, J.S.; Ling, D.; Pawlukiewicz, I.; Peterson, R.; Sternberg, K.; et al. Multi-level approaches to fetal alcohol spectrum disorders prevention education and training for health professionals. Subst. Use Addict. J. 2025, 46, 430–438. [Google Scholar] [CrossRef]
- Chu, J.T.W.; Wilson, H.; Pi, S.; McCormack, J.C.; Marsh, S.; Newcombe, D.; Bullen, C. Knowledge, attitudes and practices towards fetal alcohol spectrum disorder among healthcare workers in New Zealand. J. Intellect. Dev. Disabil. 2025, 50, 10–20. [Google Scholar] [CrossRef]
- Okurame, J.C.; Cannon, L.; Carter, E.; Thomas, S.; Elliott, E.J.; Rice, L.J. Fetal alcohol spectrum disorder resources for health professionals: A scoping review protocol. BMJ Open 2022, 12, e065327. [Google Scholar] [CrossRef]
- Frennesson, N.F.; Merouani, Y.; Barnett, J.; Attwood, A.; Zuccolo, L.; McQuire, C. Prenatal alcohol exposure before pregnancy awareness: A thematic analysis of online forum comments and misinformation. Front. Public. Health 2025, 13, 1525004. [Google Scholar] [CrossRef]
- Saxov, K.R.; Pristed, S.G.; Kesmodel, U.S. Characteristic associated with alcohol drinking in early pregnancy: A cross sectional study. Sci. Rep. 2023, 13, 10925. [Google Scholar] [CrossRef] [PubMed]
- Lyall, V.; Wolfson, L.; Reid, N.; Poole, N.; Moritz, K.M.; Egert, S.; Browne, A.J.; Askew, D.A. “The problem is that we hear a bit of everything…”: A qualitative systematic review of factors associated with alcohol use, reduction, and abstinence in pregnancy. Int. J. Environ. Res. Public. Health 2021, 18, 3445. [Google Scholar] [CrossRef]
- Okulicz-Kozaryn, K.; Segura-García, L.; Bruguera, C.; Braddick, F.; Zin-Szedek, M.; Gandin, C.; Słodownik-Przybyłek, L.; Scafato, E.; Ghirini, S.; Colom, J.; et al. Reducing the risk of prenatal alcohol exposure and FASD through social services: Promising results from the FAR SEAS pilot project. Front. Psychiatry 2023, 14, 1243904. [Google Scholar] [CrossRef] [PubMed]
- Bruguera, C.; Segura-García, L.; Okulicz-Kozaryn, K.; Gandin, C.; Matrai, S.; Braddick, F.; Zin-Sędek, M.; Slodownik, L.; Scafato, E.; Colom, J. Prevention of alcohol exposed pregnancies in Europe: The FAR SEAS guidelines. BMC Pregnancy Childbirth 2024, 24, 246. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention. CDC efforts on Fetal Alcohol Spectrum Disorders (FASDs). Available online: https://www.cdc.gov/fasd/about/cdc-efforts.html (accessed on 12 September 2025).
- World Health Organization. Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders; World Health Organization: Geneva, Switzerland, 2024.
Total Score | Q | I1–I4–I6–I7 | I2 | I3 | I5 | I8 | |
---|---|---|---|---|---|---|---|
Addila et al. (2021) [28] | 7 | high | + | + | + | + | ? |
Balachova et al. (2016) [29] | 7 | high | + | + | + | + | ? |
Caires & Santos (2020) [30] | 6 | moderate | + | − | + | + | − |
Chambers et al. (2005) [31] | 6 | moderate | + | ? | + | + | ? |
Cornelius et al. (1997) [32] | 7 | high | + | + | + | + | ? |
Corrales-Gutierrez et al. (2019) [33] | 8 | high | + | + | + | + | + |
Dumas et al. (2018) [34] | 8 | high | + | + | + | + | + |
Eaton et al. (2014) [35] | 7 | high | + | + | + | + | − |
Franco et al. (2020) [36] | 6 | moderate | + | ? | + | + | ? |
Hen-Herbst et al. (2021) [37] | 6 | moderate | + | ? | + | + | ? |
Howlett et al. (2017) [38] | 7 | high | + | + | + | + | ? |
Huang et al., 2023 [39] | 6 | moderate | + | ? | + | − | + |
Kaskutas (2000) [40] | 7 | high | + | + | + | + | ? |
Kristjanson et al. (2007) [41] | 6 | moderate | + | + | + | − | ? |
Kim & Park (2011) [42] | 5 | moderate | + | − | + | − | − |
Lee et al. (2010) [43] | 6 | moderate | + | + | + | − | ? |
Lelong et al. (1995) [44] | 7 | high | + | + | + | + | ? |
Louw et al. (2018) [45] | 6 | moderate | + | − | + | + | ? |
McKnight & Merret (1987) [46] | 6 | moderate | + | + | + | − | ? |
Oechsle et al. (2020) [47] | 6 | moderate | + | + | + | − | ? |
Onwuka et al. (2016) [48] | 5 | moderate | + | + | − | − | ? |
Piotrkowicz et al. (2023) [49] | 5 | moderate | + | ? | + | − | ? |
Senecky et al. (2011) [50] | 6 | moderate | + | ? | + | + | ? |
Testa & Riefman (1996) [51] | 5 | moderate | + | ? | + | − | − |
Ujhelyi et al. (2022) [52] | 7 | high | + | + | + | + | ? |
Watt et al. (2016) [53] | 7 | high | + | + | + | + | ? |
West et al., (2024) [54] | 8 | high | + | + | + | + | + |
Zabotka et al. (2017) [55] | 4 | moderate | + | − | ? | − | − |
Zahumensky et al. (2024) [56] | 5 | moderate | + | ? | + | − | − |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Botella-López, M.; Cortés-Tomás, M.-T. Knowledge Gaps Regarding Alcohol Consumption During Pregnancy and Its Effect on the Fetus: A Systematic Review Focused on Women. J. Clin. Med. 2025, 14, 7047. https://doi.org/10.3390/jcm14197047
Botella-López M, Cortés-Tomás M-T. Knowledge Gaps Regarding Alcohol Consumption During Pregnancy and Its Effect on the Fetus: A Systematic Review Focused on Women. Journal of Clinical Medicine. 2025; 14(19):7047. https://doi.org/10.3390/jcm14197047
Chicago/Turabian StyleBotella-López, María, and María-Teresa Cortés-Tomás. 2025. "Knowledge Gaps Regarding Alcohol Consumption During Pregnancy and Its Effect on the Fetus: A Systematic Review Focused on Women" Journal of Clinical Medicine 14, no. 19: 7047. https://doi.org/10.3390/jcm14197047
APA StyleBotella-López, M., & Cortés-Tomás, M.-T. (2025). Knowledge Gaps Regarding Alcohol Consumption During Pregnancy and Its Effect on the Fetus: A Systematic Review Focused on Women. Journal of Clinical Medicine, 14(19), 7047. https://doi.org/10.3390/jcm14197047