Study compares alcohol consumption during pregnancy across European countries

A study among over 7000 women in 11 European countries shows the proportion of women in Europe who drink alcohol when they know they are pregnant is lowest in Norway and highest in the UK. The countries with the highest proportion of women who reported alcohol consumption during pregnancy were the UK (28.5 %), Russia (26.5 %) and Switzerland (20.9 %).

This is the first study that compares alcohol consumption during pregnancy across 11 European countries. The study uses the same method for collecting data, thereby making the results comparable between the countries.

Results
On average, 16% of women in the 11 European countries reported that they drank alcohol after they knew that they were pregnant.

• The countries with the highest proportion of women who reported alcohol consumption during pregnancy were the UK (28.5 %), Russia (26.5 %) and Switzerland (20.9 %).
• The countries with the lowest proportion of women who reported  alcohol consumption were Norway (4.1 %), Sweden (7.2 %) and Poland (9.7 %).
• Women who reported alcohol consumption during pregnancy were more likely to be older, more highly educated, in employment, and had smoked before pregnancy than women who did not report this consumption.

Why do so few women in Norway drink during pregnancy compared to the UK?

Although the British population in general drink more than Norwegians (ref: Report: Drugs in Norway in 2016, FIG. 2.6.2, p. 30), the study found that countries with a comparable drinking culture to the UK - like Poland and France - had relatively low proportions of women drinking during pregnancy.  Therefore, the drinking culture in the overall population may not necessarily apply to those who are pregnant.

"Differences in pregnant women's drinking behaviour between countries can have many explanations besides variations in willingness of women to provide information about their alcohol consumption during pregnancy. There could be differences in national guidelines or educational campaigns about drinking during pregnancy, differences in prenatal care and attitudes towards alcohol use in pregnancy, or a combination of all these factors," saysProfessor Hedvig Nordeng from the Norwegian Institute of Public Health, who is the principal investigator of the study in Norway.

Who drinks most?

Of those women who said they drank alcohol during pregnancy, 39 % consumed at least one unit of alcohol per month. Those who drank most frequently (more than one to two units per week) were in Italy (7.8 % of the women said they drank during pregnancy) and the UK (2.8 %).

Those who drank the least (1-2 units during the whole pregnancy) were in Norway and Sweden (over 80 % of the women who said they drank during pregnancy) and France, Poland, Finland and Russia (70-80 %).

Therefore, even though a larger proportion of Russian women continue to drink during pregnancy, compared to the other countries they do not actually drink that much. The women who drink during pregnancy in Italy seem to drink a lot more than the women in the other countries. Again, this may be due to a combination of factors.

Post doc Angela Lupattelli from the University of Oslo, who coordinated the study in Norway and Italy, explains:

"We can speculate that both social and cultural factors play a role. Women's attitudes on the one hand, and national alcohol-related guidelines and policies on the other, may influence women's drinking behaviour during pregnancy," saysLupattelli.

Smokers and highly educated women drink most
The association between smoking before pregnancy and alcohol use during pregnancy has been observed in earlier research. A plausible explanation for this association is the underlying risk-taking health behaviour among these women.

It seems like a paradox that older and more highly educated women were more likely to drink during pregnancy, which also confirms prior research on the topic.

This study did not look at the relationship between education and the amount or frequency of drinking during pregnancy.

The study authors speculate whether older, more educated women might be more critical towards guidelines that recommend complete abstinence from alcohol during pregnancy. The authors wonder whether older women are less exposed than younger women to the health campaigns that warn against alcohol use during pregnancy, especially if they drank a little during previous pregnancies and had healthy children.

The study authors believe it is important for national campaigns to target all women of childbearing age:

"There is no defined safe minimum amount of alcohol to drink during pregnancy. We therefore recommend that all pregnant women should adhere to the guidelines for total alcohol abstinence during pregnancy," says Nordeng.

Data
The study consisted of 7905 women, 53 % were pregnant, and 46 % were new mothers (with a child up to one-year-old).

The countries included were Croatia, Finland, France, Italy, Norway, Poland, Russia, Serbia, Sweden, Switzerland and the UK.

The women completed an anonymous online questionnaire, which was available on selected websites intended for pregnant women in the respective countries. Since the questionnaire was anonymous, the authors believe that underreporting was minimal.