Pregnancy may play a protective role against alcohol use disorder


Edwards AC, et al. Am J Psychiatry. 2018;doi:10.1176/appi.ajp.2018.18050632.

Research findings published in the American Journal of Psychiatry indicated a potential causal relationship between pregnancy and reduced risk for alcohol use disorder among Swedish women.

“Alcohol use during pregnancy can be quite detrimental to the fetus, so reducing alcohol consumption among pregnant women is an important public health goal,” Alexis C. Edwards, PhD, from the department of psychiatry, Virginia Commonwealth University, told Healio Psychiatry.

“Much of the existing research examines whether light or moderate drinkers can reduce their consumption, but we know less about whether women with an alcohol use disorder — a much different group — will reduce their drinking during pregnancy,” she continued. “Changes to volition are frequently a feature of substance use disorders, so it isn’t immediately obvious that women with an alcohol use disorder will change their behavior in response to pregnancy.”

To determine whether rates of alcohol use disorder were lower during pregnancy, the researchers evaluated data from several different longitudinal population-wide Swedish registries. The sample included 322,029 pregnant women born between 1975 and 1992. The investigators matched each mother to five unrelated control women (n = 1,610,145) who had the same year and month of birth, then replicated the matching approach using female cousins and full siblings as controls.

They assessed alcohol use disorder in a within-individual model comparing pre-pregnancy and pregnancy periods and compared alcohol use disorder in the case participant (ie, alcohol use disorder during pregnancy) with alcohol use disorder in the control participants (ie, alcohol use disorder during a nonpregnant period). In additional analysis, Edwards and colleagues further compared alcohol use disorder rates between pregnant women and their partners.

Analysis revealed lower rates of alcohol use disorder among pregnant women than among matched controls (OR = 0.32; 95% CI, 0.27-0.37); this connection was stronger when controlling for parental education and school achievement. The results also showed a negative association between pregnancy and alcohol use disorder among discordant cousins (OR = 0.31; 95% CI, 0.23-0.42) and among discordant biological full sisters (OR = 0.22; 95% CI, 0.13-0.36).

Results from a series of within-individual analyses revealed that regardless of the control time frame prior to the estimated beginning of the pregnancy, the risk for alcohol use disorder remained reduced during pregnancy (ORs = 0.25-0.26). The researchers reported similar results for second pregnancies (OR = 0.23; 95% CI, 0.15-0.35). In addition, the partners of pregnant women were also at reduced risk for alcohol use disorder (OR = 0.45).

“The primary message for clinicians is that pregnancy may represent a window of opportunity for intervention among women with an alcohol use disorder,” Edwards told Healio Psychiatry. “We observed reductions in alcohol use disorder registrations among fathers as well (even though their alcohol misuse doesn’t expose the fetus to alcohol), so the potential benefit is not limited to the mother and fetus.” – by Savannah Demko

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