Alcohol Use, Screening, and Brief Intervention Among Pregnant Persons — 24 U.S. Jurisdictions, 2017 and 2019

Abstract

Alcohol use during pregnancy is a major preventable cause of adverse alcohol-related outcomes, including birth defects and developmental disabilities.* Alcohol screening and brief intervention (ASBI) is an evidence-based primary care tool that has been shown to prevent or reduce alcohol consumption during pregnancy; interventions have resulted in an increase in the proportion of pregnant women reporting abstinence (odds ratio = 2.26; 95% CI = 1.43-3.56) (1). Previous national estimates have not characterized ASBI in populations of pregnant persons. Using 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) data, CDC examined prevalence of ASBI and characteristics of pregnant persons and nonpreg-nant women aged 18-49 years (reproductive-aged women) residing in jurisdictions that participated in the BRFSS ASBI module. During their most recent health care visit within the past 2 years, approximately 80% of pregnant persons reported being asked about their alcohol use; however, only 16% of pregnant persons who self-reported current drinking at the time of the survey (at least one alcoholic beverage in the past 30 days) were advised by a health care provider to quit drinking or reduce their alcohol use. Further, the prevalence of screening among pregnant persons who did not graduate from high school was lower than that among those who did graduate from high school or had at least some college education. This gap between screening and brief intervention, along with disparities in screening based on educational level, indicate missed opportunities to reduce alcohol use during pregnancy. Strategies to enhance ASBI during pregnancy include integrating screenings into electronic health records, increasing reimbursement for ASBI services, developing additional tools, including electronic ASBI, that can be implemented in a variety of settings (2,3). There is no known safe amount of alcohol, type of alcohol, or timing of alcohol use during pregnancy or while trying to become pregnant. Alcohol use among pregnant persons remains a public health concern. During 2015-2017, 11.5% of pregnant U.S. women aged 18-44 years reported current drinking (4), and during 2018-2020, 13.5% of pregnant adults aged 18-49 years reported current drinking (5). Brief * https://www.cdc.gov/ncbddd/fasd/alcohol-use.html intervention or behavioral counseling conducted in a primary care setting has been shown to increase the likelihood of abstaining from alcohol during pregnancy (1). The U.S. Preventive Services Task Force recommends implementing ASBI for all adults aged ≥18 years in primary health care settings , including those who are pregnant, to reduce excessive alcohol use, which includes any alcohol use while pregnant (6). Despite these recommendations for universal screening, some populations might not be screened as frequently as others (7). BRFSS is a cross-sectional, random-digit-dialed, annual telephone survey of noninstitutionalized U.S. adults aged ≥18 years † that collects data on health-related behaviors. CDC analyzed data from 23 states and the District of Columbia § that participated in an optional BRFSS ASBI module in 2017 and 2019 ¶ (unweighted sample size = 248,901; median response rate = 45.9% [2017] and 49.4% [2019]). For states that participated in the ASBI module both years (California, Kansas, and Nebraska), analytic weights were adjusted proportionally to their sample size for each year. Pregnant persons** and reproductive-aged women were compared by age, race and ethnicity, † † education level, § § employment status, ¶ ¶ disability † https://www.cdc.gov/brfss/