Watt Melissa H, Eaton Lisa A, Choi Karmel W, Velloza Jennifer, Kalichman Seth C, Skinner Donald, Sikkema Kathleen J
Duke University, Duke Global Health Institute, Durham, NC 27708, USA.
University of Connecticut, Department of Human Development and Family Studies, Storrs, CT, USA.
Soc Sci Med. 2014 Sep;116:119-25. doi: 10.1016/j.socscimed.2014.06.048. Epub 2014 Jun 27.
The Western Cape of South Africa has one of the highest rates of fetal alcohol spectrum disorders (FASD) globally. Reducing alcohol use during pregnancy is a pressing public health priority for this region, but insight into the experiences of women who drink during pregnancy is lacking. Convenience sampling in alcohol-serving venues was used to identify women who were currently pregnant (n = 12) or recently post-partum (n = 12) and reported drinking during the pregnancy period. In-depth qualitative interviews were conducted between April and August 2013. Interviews explored drinking narratives, with textual data analyzed for themes related to factors that contributed to drinking during pregnancy. All but one woman reported her pregnancy as unplanned. The majority sustained or increased drinking after pregnancy recognition, with patterns typically including multiple days of binge drinking per week. Analysis of the textual data revealed five primary factors that contributed to drinking during pregnancy: 1) women used alcohol as a strategy to cope with stressors and negative emotions, including those associated with pregnancy; 2) women drank as a way to retain social connection, often during a difficult period of life transition; 3) social norms in women's peer groups supported drinking during pregnancy; 4) women lacked attachment to the pregnancy or were resistant to motherhood; and 5) women were driven physiologically by alcohol addiction. Our data suggest that alcohol-serving settings are important sites to identify and target women at risk of drinking during pregnancy. Intervention approaches to reduce alcohol use during pregnancy should include counseling and contraception to prevent unwanted pregnancies, mental health and coping interventions targeting pregnant women, peer-based interventions to change norms around perinatal drinking, and treatment for alcohol dependence during pregnancy. Our findings suggest that innovative interventions that go beyond the boundaries of the health care system are urgently needed to address FASD in this region.
南非西开普省是全球胎儿酒精谱系障碍（FASD）发病率最高的地区之一。减少孕期饮酒是该地区紧迫的公共卫生优先事项，但目前缺乏对孕期饮酒女性经历的深入了解。研究采用在提供酒精饮料场所的便利抽样方法，确定了目前怀孕（n = 12）或近期产后（n = 12）且报告在孕期有饮酒行为的女性。于2013年4月至8月进行了深入的定性访谈。访谈探讨了饮酒经历，并对文本数据进行分析，以找出与孕期饮酒相关因素的主题。除一名女性外，所有女性均称其怀孕为意外怀孕。大多数女性在确认怀孕后仍持续或增加饮酒量，饮酒模式通常包括每周有多天狂饮。对文本数据的分析揭示了导致孕期饮酒的五个主要因素：1）女性将酒精作为应对压力源和负面情绪的策略，包括与怀孕相关的情绪；2）女性饮酒是为了保持社交联系，通常是在生活艰难的过渡时期；3）女性同龄群体中的社会规范支持孕期饮酒；4）女性对怀孕缺乏情感联结或抗拒成为母亲；5）女性因酒精成瘾而产生生理上的依赖。我们的数据表明，提供酒精饮料的场所是识别和定位孕期有饮酒风险女性的重要场所。减少孕期饮酒的干预措施应包括咨询和避孕以防止意外怀孕、针对孕妇的心理健康和应对干预、基于同伴的干预以改变围产期饮酒的规范，以及孕期酒精依赖治疗。我们的研究结果表明，迫切需要超越医疗保健系统界限的创新干预措施来解决该地区的胎儿酒精谱系障碍问题。
