“When Was Your Last Drink?” – A Prenatal Screening in Brazzaville
Andrew D. Williams,
1,3
MPH ;
Yannick
2
Nkombo ;
Gery
2
Nkodia ;
Larry Burd,
1
PhD ;
Chunzi Peng,
1
PhD
1. North Dakota Fetal Alcohol Syndrome Center, University of North Dakota, Grand Forks, ND
2. Congolese Association for Research and Prevention of Fetal Alcohol Spectrum Disorders, Brazzaville, Congo
3. University of Maryland School of Public Health, College Park, MD
Methods
Congo Background
Definitions
Birth Rate: 36 per 1000 (30th Highest)
Pop. Reference Bureau, 2011
Late-Pregnancy Woman: Woman 27 weeks or later in pregnancy
PAE: Prenatal Alcohol Exposure
Binge Episode: 4 or more drinks at a time
Non-Exposed Pregnancy: No alcohol use or quit before pregnancy
At Risk Pregnancy: Quit using alcohol upon pregnancy recognition
High Risk Pregnancy: Continued using alcohol after pregnancy recognition
Population: 1142 urban dwelling pregnant
women, 18 years of age and older, screened
at 10 clinics in Brazzaville, Congo.
Study participants were approached
during regular prenatal care visits.
Premature Birth Rate: 167 per 1000 (2nd Highest)
March of Dimes, 2012
Infant Mortality: 74.2 per 1000 (17th Highest)
CIA, 2012
Maternal Mortality: 58 per 1000 (19th Highest)
WHO, 2010
Annual Per Capita Health Expenditure: $108 (145th Highest)
Language: All documents prepared in English
and translated to French. Screeners conducted
screenings in local languages if needed.
References
Central Intelligence Agency. The World Factbook: Country Comparison: Infant Mortality Rate. Online:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html Accessed February 3, 2012. Published 2012.
WHO, 2011
• As of December 2011, no known prenatal alcohol use screening, education
or prevention in Brazzaville or Republic of Congo.
1. Determine prevalence of PAE in Brazzaville, especially in
late-term pregnancies
Data Collection: Screeners utilized the
1-Question Screen, a brief, in-office method
to identify self-reported prenatal alcohol use. A
smoking-related question was added for this study.
Croxford J & Viljoen D. Alcohol Consumption by Pregnant Women in the Western Cape. South African Medical Journal. 1999 (89)9; 962962.
Marchetta CM, Denny CH, Floyd RL, et al. Alcohol Use and Binge Drinking Among Women of Childbearing Age – United States 2006 –
2010. MMWR. July 20, 2012. 61(28);534-538.
Training: Screening and data collection training
was conducting via teleconference with the
assistance of a translator. Screening and training
documents were also translated and emailed to Brazzaville.
March of Dimes, PMNCH, Save the Children & WHO. Born Too Soon: The Global Action Report on Preterm Birth. Eds CP Howson, MV
Kinney, JE Lawn. World Health Organization. Geneva, 2012. Online:
http://www.who.int/pmnch/media/news/2012/preterm_birth_report/en/index4.html Accessed May 15, 2012.
Population Reference Bureau. Birth Rate (annual number of births per 1,000 total population). 2011. Online:
http://www.prb.org/DataFinder/Topic/Rankings.aspx?ind=3. Accessed June 7, 2012.
Whitehead N & Lipscomb L. Patterns of Alcohol Use Before and During Pregnancy and the Risk of Small-for-Gestational-Age Birth.
American Journal of Epidemiology. 2003. 158(7);654-662.
2. Compare Brazzaville data with widely reported PAE rates
World Health Organization, World Health Statistics 2011, Geneva 2011, 128-135.
3. Discuss next steps in research and intervention
World Health Organization, Trends in Maternal Mortality 1990-2008, Geneva 2010, 23.
Conclusions
Discussion
Late-Pregnancy Women
N = 529
Highest Risk Profile
Brazzaville PAE Compared to Established PAE Rates
• Prenatal alcohol exposure in Brazzaville is very high, especially in
late-term women. With many women drinking in the 3rd trimester, a
high number of pregnancies have been exposed to high amounts of
alcohol. Screening early in pregnancy may reduce or eliminate
alcohol use in the 2nd and 3rd trimesters.
(8% of population)
• I am 27 years old.
• I am in my 3rd Trimester.
• I weigh 122 pounds.
50.0%
45.0%
40.0%
N = 398 (75.2%)
• We found that the 1-Question screen may not have accurately
gathered information on binge episodes. If a binge episode is 4 drinks
per day, 11.5% of participants may have binged each time they drank.
For some women, an equation for high-end estimation may be
“Drinking days per week” X “Gestational Weeks” = Cumulative Binge
Episodes.
• I will smoke 98 cigarettes
during
my pregnancy.
35.0%
30.0%
25.0%
• I will have 485 drinks during
my pregnancy.
• I will drink 130
days during my
pregnancy.
N = 23 (4.3%)
20.0%
15.0%
N = 108 (20.4%)
10.0%
5.0%
• Only 75 women smoked (6.5%). While this number is small, we
know the “High Risk” women are more likely to smoke, and are more
likely to smoke more cigarettes per day. Smoking and drinking
through all stages of pregnancy poses an even higher risk for adverse
pregnancy outcomes.
0.0%
United States PAE
Urban South
Africa PAE
Marchetta et al, 2012
Late-Pregnancy Women Who
Self-Reported Binging
N = 110
Croxford and
Viljoen, 1999
Brazzaville 3rd Tri. United States 3rd
PAE
Tri. PAE
Croxford and
Viljoen, 1999
Whitehead and
Lipscomb, 2003
LPWB Have Highest Risk for Adverse Pregnancy Outcomes
Late Pregnancy
Women who
Binge
All Other
Exposed
Pregnancies
Non-Exposed
Pregnancy
P
3.25
(sd=1.28)
2.71
(sd=1.35)
0.01
(sd=0.14)
.00 **
Average drinks per
drinking day
3.73
(sd=1.61)
3.28
(sd=1.53)
0.01
(sd=0.27)
.00**
Most drinks at once
3.81
(sd=2.56)
2.49
(sd=2.63)
0.00
(sd=0.10)
.00**
6.94
(sd=1.70)
5.31
(sd=2.61)
0.01
(sd=0.34)
.00**
0.35
(sd=0.55)
0.26
(sd=0.55)
0.01
(sd=0.12)
.00 **
Drinking days
per week
N = 19 (17.3%)
Rural South Africa Brazzaville PAE
PAE
N = 91 (82.7%)
Binges
Cigarettes per day
**Significance between these groups at p<.01
Cigarettes Per Day by Risk Group
Cigarettes
Per Day
Non Exposed
Pregnancies
N = 862
At Risk
Pregnancies
N = 54
High Risk
Pregnancies
N = 233
0.01
(sd = 0.12)
0.15
(sd=.41)
0.33
(sd = .57)
Post hoc tests (we used Hochberg’s GT2 test due to sample sizes) indicated that there is significant
difference among these three groups. (p<.05).
Next Steps
• Partner with Ministry of Health other clinics to fully implement early
pregnancy PAE screenings in Congo.
• Design, implement, and study cost-effective and culturally appropriate
intervention.
• Collect data to accurately describe “one drink” and binge episodes in this
population.