Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
Analysis Group, Inc., Boston, MA.
Med Decis Making. 2022 Feb;42(2):217-227. doi: 10.1177/0272989X211023203. Epub 2021 Jun 24.
Public health efforts to prevent alcohol-exposed pregnancies (AEPs) primarily focus on promoting abstinence from alcohol among women if pregnant or seeking pregnancy and using effective contraception to prevent unintended pregnancies if consuming alcohol. Little is known about how programs to improve adherence to these recommendations would affect the prevalence of AEPs.
We developed an individual-based simulation model of US women of reproductive age to project the prevalence of AEPs under different public health strategies. The model varies each woman's risk of an AEP over time depending on fertility, contraceptive use, awareness of pregnancy, sexual activity, and drinking patterns. We used the 2013-2015 National Survey on Family Growth data set to parameterize the model.
We estimate that 54% (95% uncertainty interval: 48%-59%) of pregnancies that result in a live birth in the United States are exposed to alcohol, 12% (10%-15%) are ever exposed to ≥5 alcoholic drinks in a week, and 3.0% (1.3%-4.2%) to ≥9 drinks. Unintended pregnancies (either due to contraceptive failure or sex without contraceptives) account for 80% (75%-87%) of pregnancies unknowingly exposed to alcohol. We project that public health efforts that focus only on promoting alcohol abstinence among women who are aware of their pregnancy or seeking pregnancy could reduce the prevalence of AEPs by at most 42% (36%-48%). Augmenting this strategy with efforts to avert unintended pregnancies could yield an 80% (73%-86%) reduction in the prevalence of AEPs.
Promoting alcohol abstinence among women who are aware of their pregnancy or seeking pregnancy offers limited potential to reduce the prevalence of AEPs. Programs to avert unintended pregnancies are essential to achieve more substantial reductions in AEPs in the United States.
公共卫生努力旨在预防酒精暴露的妊娠（AEPs），主要集中在促进怀孕或寻求怀孕的妇女戒酒，并使用有效的避孕措施来防止意外怀孕，如果饮酒。对于改善这些建议的依从性的项目如何影响 AEP 的流行率知之甚少。
我们开发了一个基于个人的美国育龄妇女的模拟模型，以预测不同公共卫生策略下 AEP 的流行率。该模型根据生育、避孕措施的使用、对怀孕的认识、性行为和饮酒模式，随时间推移而改变每个妇女 AEP 的风险。我们使用了 2013-2015 年全国家庭增长调查数据集来参数化模型。
我们估计，在美国，54%（95%的不确定性区间：48%-59%）的活产妊娠暴露于酒精，12%（10%-15%）曾在一周内暴露于≥5 个酒精饮料，3.0%（1.3%-4.2%）暴露于≥9 个饮料。意外怀孕（由于避孕失败或无避孕措施的性行为）占未察觉暴露于酒精的妊娠的 80%（75%-87%）。我们预测，仅关注促进怀孕或寻求怀孕的妇女戒酒的公共卫生努力最多可将 AEP 的流行率降低 42%（36%-48%）。通过努力避免意外怀孕来增强这一策略，可以使 AEP 的流行率降低 80%（73%-86%）。
促进怀孕或寻求怀孕的妇女戒酒对于降低 AEP 的流行率潜力有限。避免意外怀孕的方案是在美国实现 AEP 更大幅度降低的关键。
